Understanding Antidepressant Medications—Part 2: How and When to Safely Stop Them

Author: Dr. David Gardner, Professor & Community Psychiatry Research Director, Department of Psychiatry, Dalhousie University

Bibliography

  1. National Institute for Health and Care Excellence (NICE). Depression in adults: treatment and management. 2022 June 22 [cited 2024 Oct 22]. Available from: https://www.nice.org.uk/guidance/ng222.

  2. Lam RW, Kennedy SH, Adams C, Bahji A, Beaulieu S, Bhat V, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on clinical guidelines for management of major depressive disorder in adults. Can J Psychiatry. 2024 Sep;69(9):641-687. PMCID: PMC11351064.

  3. Batelaan NM, Bosman RC, Muntingh A, Scholten WD, Huijbregts KM, van Balkom AJLM. Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials. BMJ. 2017 Sep 13 [cited 2024 Oct 22];358:j3927. doi: 10.1136/bmj.j3927.

  4. McGuire P, Castelli G, Stevermer JJ. PURLs: Antidepressant Tx for anxiety disorders: How long? J Fam Pract. 2019 Sep;68(7):409-410.

  5. Royal College of Psychiatrists, UK. Stopping Antidepressants [Internet]. 2024 Mar [cited 2024 Oct 22]. Available from: https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/stopping-antidepressants.

  6. Horowitz MA, Taylor D. Tapering of SSRI treatment to mitigate withdrawal symptoms. Lancet Psychiatry. 2019 Jun [cited 2024 Oct 22];6(6):538-546. doi: 10.1016/S2215-0366(19)30032-X.

  7. Geddes JR, Carney SM, Davies C, Furukawa TA, Kupfer DJ, Frank E, Goodwin GM. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet. 2003 Feb 22 [cited 2024 Oct 22];361(9358):653-61. doi: 10.1016/S0140-6736(03)12599-8.

  8. Van Leeuwen E, van Driel ML, Horowitz MA, Kendrick T, Donald M, De Sutter AI, Robertson L, Christiaens T. Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults. Cochrane Database Syst Rev. 2021 Apr 15;4(4):CD013495. doi: 10.1002/14651858.CD013495.pub2.

  9. Lewis G, Marston L, Duffy L, Freemantle N, Gilbody S, Hunter R, et al. Maintenance or discontinuation of antidepressants in primary care. N Engl J Med. 2021 Sep 30 [cited 2024 Oct 22];385(14):1257-1267. doi: 10.1056/NEJMoa2106356.

  10. Breedvelt JJF, Warren FC, Segal Z, Kuyken W, Bockting CL. Continuation of antidepressants vs sequential psychological interventions to prevent relapse in depression: an individual participant data meta-analysis. JAMA Psychiatry. 2021 Aug 1 [cited 2024 Nov 8];78(8):868-875. doi: 10.1001/jamapsychiatry.2021.0823.

  11. This Way Up. Mindfulness-enhanced CBT program [Internet]. Darlinghurst: St. Vincent’s Hospital. c2012 [cited 2024 Oct 22]. Available from: https://thiswayup.org.au/programs/mindfulness-enhanced-cbt-program/.

  12. Kendrick T. Strategies to reduce use of antidepressants. Br J Clin Pharmacol. 2021 Jan;87(1):23-33. doi: 10.1111/bcp.14475.

  13. van Os J, Groot PC. Outcomes of hyperbolic tapering of antidepressants. Ther Adv Psychopharmacol. 2023 May 9;13:20451253231171518. doi: 10.1177/20451253231171518.