The DOI matches its Crossref record; 277 of the 293 references it cites were found in a registry or an index; 79 of the 228 sources its claims cite were checked for support.
Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults
Open accessAbstract
EDITORIAL NOTE: This editorial note has been published by the editors of Cochrane to alert readers that the following study included in this systematic review has an associated retraction. Associated studies with retractions of one or more study reports: Hollon SD, DeRubeis RJ, Fawcett J, Amsterdam JD, Shelton RC, Zajecka J, et al. Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomised clinical trial. JAMA Psychiatry. 2014;71(10):1157–64. An assessment into the impact of removing this study on the review’s findings and conclusions is currently underway. Further editorial updates will be provided once this assessment is complete. BACKGROUND: Depression and anxiety are the most frequent indication for which antidepressants are prescribed. Long-term antidepressant use is driving much of the internationally observed rise in antidepressant consumption. Surveys of antidepressant users suggest that 30% to 50% of long-term antidepressant prescriptions had no evidence-based indication. Unnecessary use of antidepressants puts people at risk of adverse events. However, high-certainty evidence is lacking regarding the effectiveness and safety of approaches to discontinuing long-term antidepressants. OBJECTIVES: To assess the effectiveness and safety of approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults. SEARCH METHODS: We searched all databases for randomised controlled trials (RCTs) until January 2020. SELECTION CRITERIA: We included RCTs comparing approaches to discontinuation with continuation of antidepressants (or usual care) for people with depression or anxiety who are prescribed antidepressants for at least six months. Interventions included discontinuation alone (abrupt or taper), discontinuation with psychological therapy support, and discontinuation with minimal intervention. Primary outcomes were successful discontinuation rate, relapse (as defined by authors of the original study), withdrawal symptoms, and adverse events. Secondary outcomes were depressive symptoms, anxiety symptoms, quality of life, social and occupational functioning, and severity of illness. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by Cochrane. MAIN RESULTS: We included 33 studies involving 4995 participants. Nearly all studies were conducted in a specialist mental healthcare service and included participants with recurrent depression (i.e. two or more episodes of depression prior to discontinuation). All included trials were at high risk of bias. The main limitation of the review is bias due to confounding withdrawal symptoms with symptoms of relapse of depression. Withdrawal symptoms (such as low mood, dizziness) may have an effect on almost every outcome including adverse events, quality of life, social functioning, and severity of illness. Abrupt discontinuation Thirteen studies reported abrupt discontinuation of antidepressant. Very low-certainty evidence suggests that abrupt discontinuation without psychological support may increase risk of relapse (hazard ratio (HR) 2.09, 95% confidence interval (CI) 1.59 to 2.74; 1373 participants, 10 studies) and there is insufficient evidence of its effect on adverse events (odds ratio (OR) 1.11, 95% CI 0.62 to 1.99; 1012 participants, 7 studies; I² = 37%) compared to continuation of antidepressants, without specific assessment of withdrawal symptoms. Evidence about the effects of abrupt discontinuation on withdrawal symptoms (1 study) is very uncertain. None of these studies included successful discontinuation rate as a primary endpoint. Discontinuation by "taper" Eighteen studies examined discontinuation by "tapering" (one week or longer). Most tapering regimens lasted four weeks or less. Very low-certainty evidence suggests that "tapered" discontinuation may lead to higher risk of relapse (HR 2.97, 95% CI 2.24 to 3.93; 1546 participants, 13 studies) with no or little difference in adverse events (OR 1.06, 95% CI 0.82 to 1.38; 1479 participants, 7 studies; I² = 0%) compared to continuation of antidepressants, without specific assessment of withdrawal symptoms. Evidence about the effects of discontinuation on withdrawal symptoms (1 study) is very uncertain. Discontinuation with psychological support Four studies reported discontinuation with psychological support. Very low-certainty evidence suggests that initiation of preventive cognitive therapy (PCT), or MBCT, combined with "tapering" may result in successful discontinuation rates of 40% to 75% in the discontinuation group (690 participants, 3 studies). Data from control groups in these studies were requested but are not yet available. Low-certainty evidence suggests that discontinuation combined with psychological intervention may result in no or little effect on relapse (HR 0.89, 95% CI 0.66 to 1.19; 690 participants, 3 s
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
79 of 228 cited sources checked · 33 supported · 2 flagged · accuracy not yet measured
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“16 of 85 (split 8/43) (19%) were able to reduce the dose by a minimum of 50%.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 3.1 Successful discontinuation rate
What the sources say
- Disputedcites Bockting 2018 sourceExperimental — accuracy not yet measured
In the Results baseline table (page unavailable), 16/85 (19%) refers to participants receiving current psychological or psychotherapeutic treatment, not to antidepressant dose reduction. The Statistical analysis section defines a 50% dose reduction for a per-protocol analysis, but does not report 8/43 or 16/85 as achieving it. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Disputed
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“randomised studies with a tapering period up to 14 days showed either no or minimal reduction in withdrawal symptom severity compared with abrupt discontinuation (Baldwin 2006;Bogetto 2002;Montgomery 2004a).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Disputedcites Baldwin 2006 sourceExperimental — accuracy not yet measured
The Tolerability assessments section describes a randomized comparison of stopping treatment immediately versus continuing the same dose for one more week before stopping—not tapering versus abrupt discontinuation. The DESS results section says the dose-reduction group had no randomized withdrawal comparison and omits its results from the figure. This paper therefore does not show that tapering reduced withdrawal symptoms minimally or not at all compared with abrupt discontinuation. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
- Not checked — no full text of the sourcecites Bogetto 2002 source
- Not matchedcites Montgomery 2004a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Disputed
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“although none of the trials on which this conclusion was based measured withdrawal effects (Cohen 2019;Hengartner 2020;Recalt 2019)”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Continuation and maintenance treatment
What the sources say
- Not checked — no full text of the sourcecites Cohen 2019 source
- Partly supportedcites Hengartner 2020 sourceExperimental — accuracy not yet measured
The ‘Withdrawal confounding in relapse prevention trials’ section says that symptom scales used to assess relapse cannot distinguish withdrawal symptoms from depression relapse. The ‘Summary and conclusion’ likewise says withdrawal confounding makes the trials difficult to interpret. Neither passage establishes the stronger claim that none of the trials measured withdrawal effects. (LLM, conf=0.82)
- Not checked — no full text of the sourcecites Recalt 2019 source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesEvery source the paper cites for this claim was checked and supports it.
In the paper
“Antidepressant treatment duration of up to one year results in lower relapse rates among responders compared with treatment discontinuation in anxiety disorders, irrespective of the type of anxiety disorder (Batelaan 2017).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Anxiety disorders
What the sources say
- Supportedcites Batelaan 2017 source
The Discussion’s ‘What this study adds’ section reports a clear benefit of continuing antidepressants for up to one year in patients with remitted anxiety disorders and says relapse risk was not significantly influenced by anxiety disorder type. The abstract likewise reports higher relapse rates among responders who discontinued treatment than among those who continued it during up to one year of follow-up. (LLM, conf=0.93)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“For stable remitters (all HAM-D scores ≥ 7 during remission), there were no differences in relapse of absence of withdrawal symptoms measured a er antidepressants were tapered (relapse rates: 50% discontinuation group, 59% antidepressant group; HR not reported; P = 0.49).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.2.1.2 Studies that could not be pooled
What the sources say
- Partly supportedcites Segal 2010 sourceExperimental — accuracy not yet measured
The Relapse section reports 50% relapse with placebo after antidepressant taper versus 59% with maintenance antidepressants among stable remitters, with P=.49 for that comparison. However, the Study Phases section defines stable remission as HRSD scores ≤7, not ≥7 as the citing sentence states. The cited passages also do not establish the sentence’s suggestion about withdrawal symptoms. (LLM, conf=0.90)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Wilson 2003 (n = 113) reported that 2 of 57 (3.5%) participants in remission of a first depression in the discontinuation group experienced adverse events that necessitated discontinuation compared to 2 of 56 (3.6%) participants treated with antidepressants.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.4.2 Studies with other outcome measures
What the sources say
- Partly supportedcites Wilson 2003 sourceExperimental — accuracy not yet measured
The Study sample section reports 56 participants assigned to sertraline and 57 to placebo, matching the claim’s group sizes. However, the passages in our copy do not report two adverse-event-related discontinuations in either group; searches for adverse events and reasons for withdrawal did not establish those counts. (LLM, conf=0.78)
Strength:plain· not yet calibratedn = 113Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Among unstable remitters (one or more with HAM-D score ≥ 7 during remission), participants in the discontinuation group showed higher risk of relapse compared with those in the continuation group (relapse rates: discontinuation group 71%, 27% antidepressant; HR 4.16, 95% CI 1.12 to 14.3; P = 0.03).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.2.1.2 Studies that could not be pooled
What the sources say
- Partly supportedcites Segal 2010 sourceExperimental — accuracy not yet measured
The Relapse section reports adjusted relapse rates of 71% for placebo (antidepressant discontinuation) and 27% for maintenance antidepressants among unstable remitters, with P=.03. Its hazard ratio is expressed in the opposite direction: 0.24 (95% CI 0.07–0.89) for maintenance antidepressants versus placebo, approximately 4.16 (1.12–14.3) when inverted. The Study Phases section defines unstable remission by occasional elevated HRSD scores of 8–14, not by a score of ≥7, as the citing sentence states. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Bockting 2018 reported that 34 of 85 (split to allow multiple-arm comparisons: 17/43) (40%) participants in the discontinuation with PCT group followed the discontinuation advice and discontinued their antidepressant a er six months”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 3.1 Successful discontinuation rate
What the sources say
- Partly supportedcites Bockting 2018 sourceExperimental — accuracy not yet measured
The Results (page unavailable) identify 85 participants assigned to PCT while tapering antidepressants, supporting the group size. They report that 30 of 50 participants still in the study after six months adhered to the antidepressant protocol, but do not report that 34 of 85 discontinued antidepressants or establish the citing paper’s split figure of 17/43. (LLM, conf=0.82)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Huijbers 2016 reported no differences between groups on six scales (World Health Organization (WHO) Quality of Life overall perception, Q1 and Q2, and WHO Quality of Life emotional, physical, psychological, and environmental domains) a er 15 months of follow-up (see Table 2).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.7.2 Quality of life measured by other scales
What the sources say
- Partly supportedcites Huijbers 2016 sourceExperimental — accuracy not yet measured
The Results (Secondary outcomes; page unavailable) report no between-group differences in quality of life at 15 months, supporting the main finding. Our copy does not identify the six named scales or report their results separately, so that level of specificity is not verified. (LLM, conf=0.82)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In all, 162 of 212 (76%) participants in the continuation group remained on the therapeutic dose and 50 (24%) did not remain on the therapeutic dose.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 3.1 Successful discontinuation rate
What the sources say
- Supportedcites Kuyken 2015 source
The Results (Table 2, adherence to treatment) report that 162 (76%) participants in the maintenance antidepressant group remained on a therapeutic dose and 50 (24%) did not. The Results also state that 212 participants were allocated to that group. (LLM, conf=0.95)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Supported
- It may state two separate claims as one. 166
- Probably not a substantial claim. 239
- The quote only partly states this claim. 16
Every source the paper cites for this claim was checked and supports it.
In the paper
“Antidepressant withdrawal reactions are widespread.A recent review suggests incidence rates from 27% to 86%, with an average incidence of 56%, and with up to half of those experiencing withdrawal symptoms having severe reactions (Davies 2019).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Long-term antidepressant use
What the sources say
- Supportedcites Davies 2019 source
The Incidence section reports rates of 27%–86% across 14 studies and a weighted average of 55.7%, which rounds to 56%. The Severity section reports that 43%–51% of people experiencing withdrawal selected the most extreme severity level in four surveys, supporting the description that up to half had severe reactions. (LLM, conf=0.94)
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Evidence is lacking regarding strategies for discontinuation of antidepressants, and the optimal method of stopping antidepressants is currently unknown; however slow enough tapering can make withdrawal symptoms tolerable (Horowitz 2019).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Description of the intervention
What the sources say
- Partly supportedcites Horowitz 2019 sourceExperimental — accuracy not yet measured
The Future directions for research section says robust evidence to guide tapering is lacking and that the proposed approach needs confirmation in randomized trials. The paper also says slow tapering can limit withdrawal symptoms to tolerable severity. Its analysis and proposed method focus on SSRIs, however, so the claim extends its conclusions to antidepressants generally. (LLM, conf=0.82)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“We assessed two studies as having high of bias; in one study, authors reported possible bias due to absence of independent raters (Kocsis 1996); in the other study, authors reported that it was impossible to keep research assistants at different sites masked to intervention group because they were involved in the practical organisation of the trial (Huijbers 2016).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Detection bias (blinding of outcome assessment)
What the sources say
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Antidepressants have been associated with withdrawal symptoms since 1960 for TCAs and MAOs (Nilsen 2012), and since the 1990s for SSRIs and SNRIs (Fava 2015; Fava 2018b).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Selective reporting
What the sources say
- Not matchedcites Nilsen 2012
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Partly supportedcites Fava 2015 sourceExperimental — accuracy not yet measured
The Introduction says case reports began documenting SSRI withdrawal reactions in the 1990s. The Multiple Drug Comparisons section also reports withdrawal symptoms with venlafaxine XR, an SNRI, but does not establish that SNRI withdrawal was documented in the 1990s. The TCA/MAOI portion is attributed to a different citation and is not assessed here; page numbers were not supplied for these passages. (LLM, conf=0.86)
- Supportedcites Fava 2018b source
The 2018 citation is offered alongside a separate SSRI review, so its relevant part is the claim about SNRIs. The Results (p. 5) identify venlafaxine withdrawal case reports, and the paper’s reference list (p. 9) dates reports of venlafaxine withdrawal to 1996, supporting an association since the 1990s. (LLM, conf=0.90)
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Study authors reported a significant difference in discontinuation, favouring the discontinuation group (Van Leeuwen 2020c [pers comm]): 17 of 128 (13%) in the discontinuation group reduced the dose of antidepressant and 17 of 121 (14%) in the antidepressant group.Study authors reported no difference in adherence to the allocated intervention (chi = 3.30; P = 0.07).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.1.1 All studies
What the sources say
- Partly supportedcites Huijbers 2016 sourceExperimental — accuracy not yet measured
The Results section ('Patient characteristics, flow and adherence'; page unavailable) reports no statistically significant difference in adherence to the medication regimens (χ² = 3.30, P = 0.07), as claimed. It does not support a significant difference in discontinuation favouring the discontinuation group: 53% adhered to discontinuation versus 64% to continuation, and the cited 17-of-128 and 17-of-121 figures are not reported in the passages found. (LLM, conf=0.90)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In the discontinuation group (n = 128), 68 of 128 (53%) discontinued antidepressant within six months a er baseline and 2 of 128 (2%) additional participants discontinued a er six months compared to 14 of 121 (12%) in the continuation group who discontinued antidepressant during the 15-month follow-up.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.1.1 All studies
What the sources say
- Partly supportedcites Huijbers 2016 sourceExperimental — accuracy not yet measured
The Results section (‘Patient characteristics, flow and adherence’; page unavailable) reports that 68/128 (53%) adhered to the discontinuation regimen and identifies the continuation group as n=121. It does not report that the 68 discontinued within six months, that another 2/128 discontinued later, or that 14/121 discontinued during the 15-month follow-up. (LLM, conf=0.86)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Partly supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“This study reported that 17 of 42 (40%) participants in the discontinuation group discontinued the antidepressant a er six months and 8 of 42 participants (19%) were able to reduce the dose by a minimum of 50%.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.1.1 All studies
What the sources say
- Could not verifycites Bockting 2018 sourceExperimental — accuracy not yet measured
The Results report six-month protocol adherence as 30 of 50 participants in the PCT-with-tapering group, not the claimed discontinuation and dose-reduction figures. The Statistical analysis section uses a 50% dose reduction within six months as a per-protocol criterion, but our copy does not report 17/42 discontinuing or 8/42 reducing their dose; searches for both fractions and percentages found no matching passage. No page numbers were available in the indexed passages. (LLM, conf=0.75)
Strength:plain· not yet calibratedn = 42Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Could not verify
Every source the paper cites for this claim was checked and supports it.
In the paper
“Bockting 2018 (n = 146) recorded serious adverse events and reported one suicide attempt in the tapering group; one participant in the continuation with PCT group died.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.4.3 Studies that could not be pooled
What the sources say
- Supportedcites Bockting 2018 source
The Results report one suicide attempt in the PCT-with-tapering group and one death in the PCT-and-antidepressants group during 24 months of follow-up. The paper also reports a second suicide attempt in the antidepressants-alone group, which does not conflict with the claim. (LLM, conf=0.94)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Kuyken 2015 reported that 124 of 212 (59%) discontinued the antidepressant”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 3.1 Successful discontinuation rate
What the sources say
- Partly supportedcites Kuyken 2015 sourceExperimental — accuracy not yet measured
Table 2 (Results; page not available in our copy) reports that 124 participants discontinued antidepressants, but its denominator is the 176 MBCT-TS participants who attended at least four sessions: 124/176 (71%). The trial allocated 212 participants to MBCT-TS, making 124/212 approximately 59%, but the paper does not report that as its discontinuation rate or specify that the 124 discontinued at 24 months. (LLM, conf=0.86)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe quote only partly states this claim.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“They reported two suicide attempts (one in the PCT with tapering of antidepressants group, and one in the antidepressants only group).Study authors reported no indication that these were Cochrane Database of Systematic Reviews related to the interventions.They reported no deaths in both groups.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 3.4 Adverse events
What the sources say
- Partly supportedcites Bockting 2018 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Strength:plain· not yet calibratedn = 185Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Kuyken 2015 (n = 424) reported three non-fatal and two fatal serious adverse events (deaths) in each treatment group; these were considered probably not related to the intervention or the trial.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 3.4 Adverse events
What the sources say
- Supportedcites Kuyken 2015 source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Strength:plain· not yet calibratedn = 424Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Neither of these studies measured withdrawal symptoms nor made adjustments for withdrawal symptoms.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > See Analysis 3.2.
What the sources say
Strength:plain· not yet calibratedTests✗ Asserted: fails✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The authors may not put it forward as true. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Neither of these studies measured withdrawal symptoms nor made adjustments for withdrawal symptoms.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > See Analysis 3.2.
What the sources say
- Not checked — no full text of the sourcecites Kuyken 2008 source
- Supportedcites Kuyken 2015 source
The Outcomes section lists the measures collected at follow-up, including GRID-HAMD depressive-symptom scores, but does not list a withdrawal-symptom measure. The Table 4 note says the analyses were adjusted for baseline depression severity and centre, not withdrawal symptoms. These passages support the statement for the PREVENT trial; this source cannot establish what the other study measured. (LLM, conf=0.86)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Bockting 2018 (n = 185; split 143) reported two suicide attempts (one in the discontinuation with PCT group, and one in the continuation group) during the 104-week follow-up.Study authors reported that these events were not related to the interventions.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 3.10 Suicide, suicide attempt, or suicidal ideation
What the sources say
- Partly supportedcites Bockting 2018 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Davies 2019 found withdrawal symptoms are o en severe and may last from a few weeks to several months or even longer.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
What the sources say
- Supportedcites Davies 2019 sourceExperimental — accuracy not yet measured
The Severity section reports that nearly half of people who experienced withdrawal effects selected the most severe response option in four large studies. The Duration section reports symptoms lasting beyond several weeks in a substantial proportion of people, with some reports extending beyond a year. The claim reflects both findings. (LLM, conf=0.92)
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Recently, it has been recognised that very low doses of antidepressants have significant effects on target receptors, suggesting that pharmacologically informed rational tapering of antidepressants requires reduction to very low doses before stopping (perhaps 1/40th of regular therapeutic doses) (Horowitz 2019).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
What the sources say
- Supportedcites Horowitz 2019 source
The Pharmacological principles section explains that low SSRI doses still affect serotonin transporter occupancy and recommends hyperbolic tapering to very small final doses. The paper also describes tapering strips reaching 0.5 mg for paroxetine and citalopram—about 1/40 of a 20 mg dose. Its specific pharmacological analysis concerns SSRIs rather than every antidepressant class. (LLM, conf=0.90)
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A recent review suggested incidence rates between 27% and 86%, with an average incidence of 56%, reduced to 50.7% when restricted to RCTs (6 studies), and excluding observational studies and online surveys (Davies 2019).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
What the sources say
- Supportedcites Davies 2019 source
Section 3.2 (Incidence) reports rates of 27%–86% across 14 studies and a combined weighted average of 55.7%, reasonably rounded to 56%. It separately reports 50.7% for the six RCTs, excluding the surveys and naturalistic studies from that subgroup calculation. (LLM, conf=0.94)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Overall, the prognosis of a first episode of depression is positive, with 50% to 60% achieving stable recovery, 35% to 40% experiencing at least one recurrence in the next 15 years, and 15% developing chronic depression (Eaton 2008;Mattisson 2007;Moffit 2010).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
What the sources say
- Partly supportedcites Eaton 2008 sourceExperimental — accuracy not yet measured
The Conclusions report that about half of first-onset cases recover without further episodes, 35% recur, and 15% remain unremitting. The 15-year qualifier is not supported for the stated 35%–40% recurrence rate: the Results give about 38% after 10 years and describe about half of the first-onset group as having recurred after 15 years. No page numbers are available in our copy. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites Mattisson 2007 source
- Not matchedcites Moffit 2010
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Information is lost when continuous data are transformed to dichotomous data and the data can be influenced by data distribution and the cut-off point selected (Jakobsen 2017).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
What the sources say
- Supportedcites Jakobsen 2017 source
The Discussion states that transforming continuous data into dichotomous data loses information and that results can be greatly influenced by the data distribution and the choice of cut-point. This directly supports the cited sentence. (LLM, conf=0.95)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“however, discontinuation of long-term antidepressants could be considered in other contexts, for example, prescribing in the context of medicalising”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
What the sources say
- Partly supportedcites Johnson 2017 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
- Not matchedcites Pilgrim 1999
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites Ulfarson 2003
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one. The quote only partly states this claim.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In contrast, the mean duration of antidepressant treatment is longer than two years in the UK (Johnson 2012: Petty 2006), four years in Australia (Kjosavik 2016), and longer than five years in the United States (Mojtabi 2014; Pratt 2011).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
What the sources say
- Partly supportedcites Johnson 2012 sourceExperimental — accuracy not yet measured
The Results (p. 1) report that 47.1% of antidepressant users in the Scottish study were classified as long-term users, defined in Patients (p. 2) as taking the same antidepressant for at least two years. The paper does not report a mean treatment duration or establish that the UK mean exceeds two years. The Australia and US figures are attached to other citations, not Johnson 2012. (LLM, conf=0.82)
- Not checked — no full text of the sourcecites Petty 2006 source
- Not matchedcites Kjosavik 2016
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Dichotomisation is a potential concern and has been criticised by several authors (Altman 2006: Jakobsen 2017: Kirsch 2007: Munkholm 2019).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
What the sources say
- Not checked — no full text of the sourcecites Altman 2006 source
- Supportedcites Jakobsen 2017 source
The Discussion warns that transforming continuous data into dichotomous data loses information and that results can depend greatly on an arbitrary cut-point. This directly supports describing dichotomisation as a potential concern; the paper also cites other authors on the issue. No page number is available in our copy. (LLM, conf=0.93)
- Not checked — no full text of the sourcecites Kirsch 2007 source
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“They found no difference in recurrence or quality of life between MBCT and tapering versus maintenance antidepressants treatment (2 studies).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Partly supportedcites Maund 2019 sourceExperimental — accuracy not yet measured
The “Recurrence After More Than 6 Months” section reports no difference in recurrence between MBCT with tapering support and maintenance antidepressants in a meta-analysis of two studies. The “Quality of Life” section reports no significant difference at 12 months or later, but a significant difference favoring MBCT with tapering support in psychological and social quality-of-life domains after one month. The claim omits that short-term exception. (LLM, conf=0.89)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“One review author (TK) was involved in two ongoing trials (Duffy 2019; ISRCTN12417565).None of the other review authors was involved in any of the included trials.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
What the sources say
- Supportedcites Duffy 2019 source
The citation to Duffy 2019 identifies one of the two ongoing trials, not both trials or the review authors’ involvement in included trials. Tony Kendrick (TK) is an author of this protocol; the Contribution section says all authors contributed to the trial’s design, management and conduct, and Trial status says recruitment was ongoing at the time of writing. (LLM, conf=0.91)
- Not matchedcites ISRCTN12417565
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“we did identify two RCTs that assessed discontinuation of antidepressants among older people in nursing homes without a documented history of depression or anxiety”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Partly supportedcites Bergh 2012 sourceExperimental — accuracy not yet measured
The Patients section describes a randomised trial of antidepressant discontinuation in Norwegian nursing-home residents and says people with a documented depressive disorder were excluded. It does not say that a history of anxiety was checked or excluded, so the claim about residents without a documented history of anxiety is not established by this paper. The citing authors’ count of two RCTs is their review finding, not a claim this individual trial needs to establish. (LLM, conf=0.84)
- Not matchedcites Ulfarson 2003
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“the STAR-D trial raises questions about the long-term effects of antidepressants and suggests overestimation of their effects (Pigott 2015).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Supportedcites Pigott 2015 source
In the Methods section (page not provided), Pigott questions the durability of antidepressant treatment gains during STAR*D’s 12-month follow-up, reporting high relapse and dropout rates. The paper also argues that the trial’s widely cited remission rates relied on unrealistic assumptions and overstated the observed outcomes. (LLM, conf=0.92)
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Based on one RCT -Eveleigh 2018 -and one uncontrolled trial -Johnson 2012, they concluded that prompting GPs to review participants on long-term antidepressants was not an effective intervention to discontinue antidepressants (Maund 2019).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Not matchedcites Eveleigh 2018
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Supportedcites Johnson 2012 source
Johnson 2012 is the study identified as the uncontrolled evaluation: its Aim and Method (p. 1) describe GP reviews of long-term antidepressant users with pre- and post-review measurements, rather than a randomized comparison. The conclusion that prompting GPs was not effective is attributed to Maund 2019 in the citing sentence, not to Johnson 2012. (LLM, conf=0.89)
- Partly supportedcites Maund 2019 sourceExperimental — accuracy not yet measured
The Discontinuation of Antidepressants section reports no significant difference between clinician letters with tapering advice (6% discontinuation) and usual care (8%); its table also reports 7% discontinuation in Johnson’s single-arm trial. The Summary of Main Findings describes these as low rates for prompted primary-care review and guided tapering. However, the table identifies the Eveleigh RCT as 2015, not 2018. (LLM, conf=0.86)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
- Not matched
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Maund 2019 included observational studies and excluded placebocontrolled trials.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Partly supportedcites Maund 2019 sourceExperimental — accuracy not yet measured
The Results section reports that the review included two retrospective cohort studies, supporting the observational-studies portion. The Study Inclusion and Exclusion section excludes placebo-controlled trials aimed only at testing maintenance antidepressants to prevent relapse or recurrence; it does not state a blanket exclusion of all placebo-controlled trials. (LLM, conf=0.86)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A previous review that did not specifically focus on long-term use found that continuation of antidepressant treatment for anxiety disorders resulted in lower relapse rates among responders compared with treatment discontinuation (28 studies) (Batelaan 2017).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Supportedcites Batelaan 2017 source
The Discussion reports that this meta-analysis of 28 studies found a clear benefit of continuing antidepressants rather than discontinuing them among patients with anxiety disorders who had responded to treatment. The Abstract specifies that relapse rates were lower with continuation during follow-up of up to one year, consistent with the citing sentence’s distinction from long-term use. (LLM, conf=0.94)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Systematic reviews have reported that barriers to and facilitators of discontinuing antidepressants are numerous and complex (Maund 2018: Scholten 2020).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Implications for research
What the sources say
- Not matchedcites Maund 2018
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Partly supportedcites Scholten 2020 sourceExperimental — accuracy not yet measured
The Abstract and Conclusion describe multiple barriers to discontinuation, and the clinical recommendations discuss ways to facilitate it. But the Abstract explicitly calls Scholten 2020 a narrative review, not a systematic review, so the claim mischaracterizes the type of review. (LLM, conf=0.88)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
Every source the paper cites for this claim was checked and supports it.
In the paper
“However, as is the case for our review, withdrawal confounding bias could have resulted in overestimation of the effectiveness of antidepressants.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Supportedcites Batelaan 2017 source
The Discussion states that falsely interpreting withdrawal symptoms as relapse would overestimate the protective effect of continuing antidepressants. It also describes reasons the authors believed this bias was limited in their review; the citing sentence’s ‘could have’ appropriately expresses a possibility, not an established overestimate. No page number is available in our copy. (LLM, conf=0.92)
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The discontinuation rate in the discontinuation intervention group was reported in eight studies and varied widely, from 6% to 95%.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Supportedcites Maund 2019 source
The Discontinuation of Antidepressants section states that eight studies reported discontinuation, with cessation rates ranging from 6% to 95%. Table 1 identifies those rates in the intervention arms. (LLM, conf=0.95)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Given that withdrawal symptoms are common, participants may be aware if randomised to the discontinuation group, thereby compromising blinding and introducing bias (Moncrieff 2004).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
What the sources say
- Partly supportedcites Moncrieff 2004 sourceExperimental — accuracy not yet measured
The Background (page unavailable) says that differing experiences of an antidepressant and placebo may reveal treatment allocation and introduce bias. It does not say that withdrawal symptoms are common or address participants identifying assignment to a discontinuation group; the review concerns antidepressant-versus-placebo trials. (LLM, conf=0.88)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A recent non-systematic review showed that short tapers of between two and four weeks have minimal benefit over abrupt discontinuation, and that short tapering regimens such as these o en are not tolerated by patients (Horowitz 2019).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Supportedcites Horowitz 2019 source
The paper’s Abstract states that recommended two-to-four-week tapers show minimal benefit over abrupt discontinuation and are often not tolerated by patients. The tapering discussion also reports that a four-week regimen was not feasible for many patients. (LLM, conf=0.95)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“71% of the 895 participants (97% of whom had experienced some withdrawal previously) discontinued their medication over a median of 56 days, with 68% still off their antidepressant a er one to five years (Groot 2018Groot 2020).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Not checked — no full text of the sourcecites Groot 2018 source
- Partly supportedcites Groot 2020 sourceExperimental — accuracy not yet measured
The Introduction reports a previously observed 71% short-term discontinuation rate and a median of two 28-day taperingstrips, but does not give the claimed 895 participants. The Results report that, among 408 antidepressant users assessed after 1–5 years, 66% remained off medication; the 68% success rate also includes 2% who reduced their dose but remained on medication. The sentence therefore combines results from different assessments and incorrectly describes the 68% as still off antidepressants. (LLM, conf=0.92)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Maund 2019 found higher risk of withdrawal symptoms with abrupt discontinuation compared with tapering in two studies (one RCT and one retrospective cohort study)”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Partly supportedcites Maund 2019 sourceExperimental — accuracy not yet measured
The Abstract says two studies reported a higher risk of discontinuation symptoms with abrupt termination. But the Discontinuation Symptoms section and Table 2 distinguish their outcomes: the retrospective cohort found significantly more discontinuation syndrome after abrupt withdrawal, while the RCT found more discontinuation-emergent adverse events but no statistically significant difference in discontinuation syndrome. (LLM, conf=0.88)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“review authors recommended hyperbolic antidepressant tapering regimens based on the relationship between SSRI dose and the serotonin transporter occupancy and on findings that hyperbolically reducing doses of SSRI reduces their effect on the transporter in a linear manner (Horowitz 2019).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Supportedcites Horowitz 2019 source
The Abstract says the authors used PET data on SSRI dose and serotonin transporter occupancy to show that hyperbolic dose reductions produce a linear reduction in transporter inhibition, and recommends slow hyperbolic tapering. The Pharmacological principles section explains the dose–occupancy relationship and the proposed tapering regimen. (LLM, conf=0.94)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“These results are consistent with the findings of a previous review reporting consensus about tapering antidepressants slowly over a period of weeks or months to avoid withdrawal symptoms (Wilson 2015).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Supportedcites Wilson 2015 source
The Discussion reports a general consensus to taper antidepressants slowly to avoid discontinuation symptoms. It also describes a recommended minimum four-week taper after long-term treatment, preferably extending over months, while noting uncertainty about the optimal schedule. (LLM, conf=0.94)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The intervention of this study met the definition of 'minimal intervention (Voshaar 2006) and therefore we added a new type of intervention.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
What the sources say
- Supportedcites Voshaar 2006 source
The Selection procedure, data extraction and quality assessment section (p. 1) defines minimal interventions as simple measures applicable to large groups, such as an advisory letter or meeting advising long-term benzodiazepine users to stop. The citation supports that definition; whether Eveleigh 2018 meets it and the decision to add a category are the citing authors’ own judgments. (LLM, conf=0.91)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In 13 studies, the antidepressant was stopped abruptly; in 18 studies, the antidepressant was stopped gradually over several weeks (”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Study characteristics
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Withdrawal symptoms None of the studies reported withdrawal”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Study characteristics
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Bockting 2018 (n= 185; split 143) reported only suicide data.There were 2 suicide attempts (1 in the PCT with tapering group and 1 in the continuation group)”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Study characteristics
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Adverse events Not measured”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Study characteristics
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most people in these studies had recurrent depression (two or more episodes of depression before stopping antidepressants), and most were recruited from specialist mental healthcare services.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Study characteristics
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Kuyken 2015 (n = 424) reported 3 non-fatal and 2 fatal serious adverse events (deaths) in each treatment group, and these were considered probably not related to the intervention or the trial.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Study characteristics
Strength:hedged· not yet calibratedn = 424Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most tapering schemes lasted four weeks or less.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Study characteristics
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“One study measured withdrawal symptoms but did not analyse or report data”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Study characteristics
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our search up until January 2020 found 33 studies, which included 4995 adult participants.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Study characteristics
Strength:plain· not yet calibratedn = 4,995Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Adverse events 3 studies reported no differences in adverse events 690 (3 RCTs) ⊕⊝⊝ ⊝ VERY LOW d”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Study characteristics
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Kuyken 2008 (n = 123) reported that no serious adverse events were recorded through the oversight of the Trial Steering Committee.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Study characteristics
Strength:plain· not yet calibratedn = 123Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All studies included more female than male participants, except one study that included only males”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Sample size
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Eleven studies were published in 2000 or earlier.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Design
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Study authors described 21 studies as multi-centre studies”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Setting
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Four studies included only participants 65 years of age and older”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Sample size
Strength:plain· not yet calibratedn = 4Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The antidepressant is discontinued by”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation by "tapering" without psychological support (or psychological support as co-intervention)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Randomised participants represent a small fraction of participants in the pre-randomisation phase.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Participants
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We identified one unpublished study for which data were obtained from clinicaltrials.govand a conference abstract (Streim 2012).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Design
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Three types of studies were included.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Aims of studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Sample size varied from 11 in Mavissakalian 2001 to 336 participants in Kocsis 2007 (average, 151).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Sample size
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The mean age of participants ranged from 36 years in Mavissakalian 1999 to 76 years in Wilson 2003.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Sample size
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Twenty-two studies included participants with the main diagnosis of recurrent major depressive disorder”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Participants
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Trials evaluated several regimens for antidepressant discontinuation including abrupt discontinuation, discontinuation by tapering, discontinuation by tapering combined with highintensity psychological treatment, and discontinuation by tapering combined with a minimum intervention.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“All studies compared discontinuation with continuation of antidepressants, except one study that compared discontinuation with usual care (Eveleigh 2018).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Design
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“13 studies discontinued during”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Design
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Five of the 33 studies included participants in partial remission.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Severity of depressive disorder/anxiety disorder at the moment of randomisation
Strength:plain· not yet calibratedn = 33Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Twenty-six studies included a placebo arm”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Design
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“four studies used a two-phase method (Kane 1982; Khan 2014; Mavissakalian 1999; Rickels 2010), 21 employed a three-phase method (Derubeis 2019;Gelenberg 2003;Gilaberte 2001;Keller 1998;Klysner 2002;Kocsis 1996;Kocsis 2007;Kornstein 2006;Kupfer 1992;Mavissakalian 2001;Montgomery 1988;Montgomery 2004;Perahia 2009;Peterson 2010;Rapaport 2001;Rickels 2010;Rouillon 2000;Segal 2010;Stewart 1997;Terra 1”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Design
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies investigating the effectiveness of an intervention designed to facilitate discontinuation of long-term antidepressants (five studies)”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Aims of studies
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies with a psychological co-intervention (six studies)”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Aims of studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the 33 included studies, 25 were conducted in a psychiatric outpatient setting.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Setting
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“None of these studies used an active placebo tablet.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Design
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“16 studies discontinued at the start of or during maintenance treatment”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Design
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In eight studies, participants discontinued (or tapered) the antidepressant and the antidepressant was not replaced by placebo (Bockting 2018;Derubeis 2019;Eveleigh 2018;Huijbers 2016;Kuyken 2008;Kuyken 2015;Segal 2010;Streim 2012).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Design
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Four studies included participants with anxiety disorder: three included participants with panic disorder with agoraphobia (Mavissakalian 1999; Mavissakalian 2001), or with or without agoraphobia (Rapaport 2001), and one included participants with generalised anxiety disorder (Rickels 2010).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Anxiety (4 studies)
Strength:plain· not yet calibratedn = 4Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Indication for antidepressant Depression (28 studies)”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Participants
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In four studies, duration of treatment a er stabilisation was not specified”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Design
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Fourteen studies investigated antidepressant discontinuation by”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation by "tapering" without psychological support (or psychological support as co-intervention)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Four studies were conducted in general practice/primary care settings”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Setting
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most studies included adults between 18 and 65 years of age.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Sample size
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Most studies required that participants were in remission to enter the discontinuation trial and reported remission criteria.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Severity of depressive disorder/anxiety disorder at the moment of randomisation
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Twenty-six studies included multiple treatment phases before randomisation to antidepressants or to placebo (”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Design
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Thirty-two studies were RCTs, and one was a cluster-RCT (Eveleigh 2018).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Design
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“None of the studies included discontinuation with changed pharmacological form (e.g.fluoxetine or paroxetine liquid) or a low-intensity psychological intervention.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Most studies excluded participants at high risk for suicide.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Social and occupational functioning
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This included 31 studies.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“In one study, editorial and medical writing support was provided by a medical writer funded by the sponsor of the trial (Khan 2014); therefore we judged this study to be at high risk of other bias.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Other potential sources of bias
What the sources say
- Not checked — no full text of the sourcecites Khan 2014 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We judged 12 studies with only non-commercial sponsorship to be at low risk for industry sponsorship (Bockting 2018;Eveleigh 2018;Huijbers 2016;Kane 1982;Kupfer 1992;Kuyken 2008;Kuyken 2015;Mavissakalian 1999;Mavissakalian 2001;Segal 2010;Stewart 1997;Streim 2012).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Other potential sources of bias
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Included studies compared abrupt discontinuation with continuation of antidepressant treatment: eight studies used SSRI (Gilaberte 2001;Klysner 2002;Kornstein 2006;Montgomery 1988;Peterson 2010;Rapaport 2001;Terra 1998;Wilson 2003), one study TCA (Kane 1982), one study an atypical antidepressive (Gelenberg 2003), two studies SNRI (Khan 2014;Rouillon 2000), and one study a non-specified type of ant”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Effects of interventions
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“One study investigated tapering with a recommendation to review the antidepressant to GP versus usual care”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation in combination with a minimal intervention
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In these eight studies, participants and/or clinicians were not blinded and were aware of the treatment, and the discontinued antidepressant was not replaced by a placebo.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Performance bias (blinding of participants and personnel)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Six studies used only DSM or research diagnostic criteria (RDC) for diagnosis of major depression: DSM-IV criteria were assessed with a structured clinical interview for DSM-IV Axis I Disorders (SCID-I), including retrospective parts and information from monthly ratings on the Inventory of Depressive Symptomatology-Self-Report (IDS-SR) (Bockting 2018).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Two studies used only clinical judgement: appearance of a depressive episode as decided upon by the patient and by the blinded research clinician (Bialos 1982), as well as investigator's clinical assessment that change in pharmacological treatment was indicated (Cook 1986).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We judged 12 studies to be at low risk of bias for this domain.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Sequence generation
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Eight studies used nine different scales: HAM-A (Keller 2007; Kocsis 2007; Rapaport 2001; Rickels 2010); anxiety/somatisation subscale of the HAM-D scale (Perahia 2009); IDS-SR anxiety (Keller 2007; Kocsis 2007); BAI and SQ anxiety scores (Peterson 2010); Covi Anxiety Scale (Terra 1998); Panic and Agoraphobia Scale (PAS) (Eveleigh 2018); Hospital Anxiety and Depression Scale (HADS), anxiety factor”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“A total of 21 studies measured adverse events of antidepressants, but this outcome may be biased because it may include withdrawal symptoms as these studies did not distinguish withdrawal symptoms from adverse events of antidepressants.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Selective reporting
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“We judged one study as having unclear risk as the authors used last observation carried forward (LOCF) as the imputation method for missing data for secondary outcomes, and we considered this to be an inappropriate method in this context (see discussion) (Kuyken 2008).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Incomplete outcome data
What the sources say
- Not checked — no full text of the sourcecites Kuyken 2008 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All studies except two addressed relapse”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All studies except two reported relapse using hazard ratios”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We deemed 12 studies to be at low risk of detection bias as they provided a clear description of the method of blinding of outcome assessors (Bialos 1982;Bockting 2018;Cook 1986;Derubeis 2019;Eveleigh 2018;Gelenberg 2003;Kupfer 1992;Kuyken 2008;Kuyken 2015;Segal 2010;Stewart 1997;Wilson 2003).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Detection bias (blinding of outcome assessment)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We judged four studies to be at unclear risk as they did not report the reasons for dropout but dropout numbers were similar between groups or the number of dropouts was not clear from the text (Kane 1982;Montgomery 1988;Stewart 1997;Terra 1998).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Incomplete outcome data
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Seven studies used a combination of DSM or RDC for major depression and scale measurements: HAM-D score ≥ 16 plus major depression (diagnosed on two consecutive visits via DSM-IV) (Gelenberg 2003); meeting DSM-III criteria for major depression with HAM-D score ≥ 18 and CGI-S score ≥ 4, or both of these, for at least two weeks (Gilaberte 2001);”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We judged 11 studies as having low risk of performance bias.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Performance bias (blinding of participants and personnel)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“All studies addressed at least one of our primary outcomes.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Outcome measures
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Study duration varied widely from 4 weeks to 156 weeks.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Study duration
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Five studies used five different scales: Social Adjustment Scale Self-Report (SAR-SR) (Bialos 1982;Keller 1998;Keller 2007;Kocsis 2007), LIFE subject assessment, interviewer assessment, and satisfaction assessment (Keller 1998), and Sheehan Disability Scale (SDS) (Perahia 2009).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Social and occupational functioning
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Nine studies used 18 different scales: Short Form (SF)-36 subscales of social functioning, role limitations due to emotional problems and to physical health problems (Keller 1998; Keller 2007; Kocsis 2007); SF-36 mental and physical component summary scores (Keller 2007; Kocsis 2007; Perahia 2009);”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Eleven studies contributed data for this outcome (Gelenberg 2003;Gilaberte 2001;Kane 1982;Klysner 2002;Kornstein 2006;Montgomery 1988;Peterson 2010;Rapaport 2001;Rouillon 2000;Terra 1998;Wilson 2003).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.2 Relapse (as defined by study authors)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Six studies used a combination of scale measurements and clinical judgement: HAM-D score > 12 and GAS score < 60 on three successive ratings over a period of four weeks, or at least one rating meeting these criteria, and urgent need for alternative treatment for a depressive syndrome (Kocsis 1996);”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Twelve studies included antidepressants for depressive disorder, and one study included antidepressants for panic disorder with or without agoraphobia (Rapaport 2001).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Effects of interventions
What the sources say
- Not checked — no full text of the sourcecites Rapaport 2001 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Five other studies measured depressive symptoms by using the HAM-D scale but did not report data for each treatment group (Gelenberg 2003;Mavissakalian 1999;Mavissakalian 2001;Segal 2010;Stewart 1997).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“The most common reason for exclusion was that participants had received antidepressant treatment for less than six months (e.g.Dobson 2008, Walker 2000).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Excluded studies
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The source of funding was not described in four studies (Cook 1986;Montgomery 1988;Peterson 2010;Terra 1998).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Funding
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The primary outcomes successful discontinuation rate, relapse, and adverse events were not reported in 31 (94%), 2 (6%), and 12 (36%) trials.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Selective reporting
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Twelve studies reported only non-commercial sponsorship (Bockting 2018;Eveleigh 2018;Huijbers 2016;Kane 1982;Kupfer 1992;Kuyken 2008;Kuyken 2015;Mavissakalian 1999;Mavissakalian 2001;Segal 2010;Stewart 1997;Streim 2012).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Funding
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Seventeen studies were supported by a grant from the pharmaceutical industry (Bialos 1982;Derubeis 2019;Gelenberg 2003;Gilaberte 2001;Keller 1998;Keller 2007;Khan 2014;Klysner 2002;Kocsis 1996;Kocsis 2007;Kornstein 2006;Montgomery 2004;Perahia 2009;Rapaport 2001;Rickels 2010;Rouillon 2000;Wilson 2003).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Funding
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Five studies used only scale measurements: LIFE Rating Scale score of 5 or 6 for two consecutive weeks at any time a er the first eight weeks and for three consecutive weeks during the first eight weeks (Derubeis 2019), MADRS score ≥ 22 confirmed a er three to seven days (Klysner 2002), HAM-D score > 18 (Montgomery 1988), CGI-S score ≥ 4 (Montgomery 2004), and two consecutive weeks of a CGI rating”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The most common high-risk domain was reporting bias, followed by attrition bias.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Risk of bias in included studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“We judged no studies to be at risk for baseline imbalance.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Other potential sources of bias
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“One study reported adjusted mean DESS total score over the first two weeks a er discontinuation and the proportion of participants with withdrawal syndrome based on DESS (Khan 2014).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
What the sources say
- Not checked — no full text of the sourcecites Khan 2014 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A total of 17 studies used 10 different scales to measure depressive symptoms: HAM-D (Bialos 1982; Cook 1986; Gilaberte 2001; Keller 1998; Keller 2007; Kocsis 2007; Kornstein 2006; Kuyken 2008; Kuyken 2015; Montgomery 2004; Peterson 2010; Perahia 2009; Stewart 1997) and/or HAM-D subscale depressed mood item 1 score (Montgomery 2004; Perahia 2009), MADRS (Cook 1986; Keller 1998; Kornstein 2006;”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We assessed 19 studies as being at unclear risk; study authors did not specify whether outcome assessors were blinded or how they were blinded (Gilaberte 2001;Kane 1982;Keller 1998;Keller 2007;Khan 2014;Klysner 2002;Kocsis 2007;Kornstein 2006;Mavissakalian 1999;Mavissakalian 2001;Montgomery 1988;Montgomery 2004;Perahia 2009;Peterson 2010;Rapaport 2001;Rickels 2010;Rouillon 2000;Streim 2012;Terra 1”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Detection bias (blinding of outcome assessment)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“This was measured in three studies, but only one reported data on withdrawal symptoms (Khan 2014).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
What the sources say
- Not checked — no full text of the sourcecites Khan 2014 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A total of 21 studies reported serious adverse events and/or adverse events: Cook 1986; Bockting 2018; Derubeis 2019; Gelenberg 2003; Gilaberte 2001; Keller 1998; Keller 2007; Khan 2014; Klysner 2002; Kornstein 2006; Kocsis 2007; Kuyken 2008; Kuyken 2015; Montgomery 2004; Perahia 2009; Rapaport 2001; Rickels 2010; Rouillon 2000; Streim 2012; Terra 1998; Wilson 2003.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“We judged 20 studies receiving support from the pharmaceutical industry or reporting an unclear source of funding to be at unclear risk for industry sponsorship bias (Catalogue of Bias 2019) (Bialos 1982;Cook 1986;Derubeis 2019;Gelenberg 2003;Gilaberte 2001;Keller 1998;Keller 2007;Klysner 2002;Kocsis 1996;Kocsis 2007;Kornstein 2006;Montgomery 1988;Montgomery 2004;Perahia 2009;Peterson 2010;Rap”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Other potential sources of bias
What the sources say
- Not matchedcites Catalogue of Bias 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
In the paper
“Bialos 1982 did not report the number of (serious) adverse events but reported only the insomnia factor and the autonomic anticholinergic factor of the Treatment-Emergent Symptoms Scale in the tapering group but not in the continuation group.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Relapse (as defined by study authors)
What the sources say
- Not checked — no full text of the sourcecites Bialos 1982 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We excluded 78 studies from the review (see Characteristics of excluded studies).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Excluded studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The secondary outcomes depressive symptoms, anxiety symptoms, quality of life, social functioning, and severity of illness were not clearly reported in 16 (48%), 25 (76%), 24 (73%), 28 (85%), and 22 (67%) trials.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Selective reporting
Load-bearingStrength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We assessed 20 studies to be at high risk as a large proportion of data were missing and/or there was an imbalance in the number of missing participants across treatment groups (Bialos 1982;Derubeis 2019;Eveleigh 2018;Gelenberg 2003;Gilaberte 2001;Huijbers 2016;Keller 1998;Keller 2007;Klysner 2002;Kocsis 2007;Kornstein 2006;Mavissakalian 1999;Mavissakalian 2001;Montgomery 2004;Perahia 2009;Rap”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Incomplete outcome data
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“The most commonly reported DESS symptoms on the DESS scale (by 10% or more participants) in the discontinuation group were irritability, trouble sleeping and/or insomnia, nervousness, anxiety, sudden worsening of mood, sudden outbursts of anger, bouts of crying or tearfulness, agitation, feeling unreal or detached, confusion or trouble concentrating, forgetfulness or problems with memory, mood”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.3.1 Types of withdrawal symptoms
What the sources say
- Not checked — no full text of the sourcecites Khan 2014 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Seventeen studies reported relapse rate as an outcome (Bialos 1982;Bockting 2018;Cook 1986;Derubeis 2019;Huijbers 2016;Keller 1998;Keller 2007;Kocsis 1996;Kocsis 2007;Kupfer 1992;Mavissakalian 1999;Mavissakalian 2001;Montgomery 2004;Perahia 2009;Rickels 2010;Segal 2010;Stewart 1997).All but one -Cook 1986 -reported time to relapse by using hazard ratios.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.2 Relapse rate (as defined by study authors)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Khan 2014 (n = 184) reported that one participant (1/148; number in control group split) in the abrupt discontinuation group reported suicidal ideation on the Columbia Suicide Severity Rating Scale during the discontinuation phase.The trial reported no suicidal behaviours.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.10 Suicide, suicide attempt, or suicidal ideation
What the sources say
- Not checked — no full text of the sourcecites Khan 2014 source
Strength:plain· not yet calibratedSingle caseTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Kornstein 2006 (n = 139) reported one suicide attempt one month a er the last reported dose of blinded placebo in a participant with a history of suicide attempt in the discontinuation group (n = 66), and this was assessed by the investigator as 'possibly related' to study medication.However,”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.10 Suicide, suicide attempt, or suicidal ideation
What the sources say
- Not checked — no full text of the sourcecites Kornstein 2006 source
Strength:plain· not yet calibratedSingle caseTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
In the paper
“Study authors reported that most DESS symptoms were rated as mild or moderate in severity.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.3.1 Types of withdrawal symptoms
What the sources say
- Not checked — no full text of the sourcecites Khan 2014 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Khan 2014 reported mean (self-rated) Quick Inventory of Depressive Symptomatology Self-Report 16 total scores (QIDS-SR16) at the end of the trial: 6.5 (SD 4.7) in the abrupt discontinuation group (n = 146) and 6.7 (SD 4.8) in the continuation group (n = 36) (LCOF analysis).Study authors concluded that there were no clinically significant changes in QIDS-SR16 scores.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.5.3 Depressive symptoms measured with other scales
What the sources say
- Not checked — no full text of the sourcecites Khan 2014 source
Strength:plain· not yet calibratedn = 146Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Study authors reported that most DESS symptoms were rated mild or moderate in severity.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.3.1 Types of withdrawal symptoms
What the sources say
- Not checked — no full text of the sourcecites Khan 2014 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“None of these studies measured separately symptoms of withdrawal nor attempted to make adjustments for them.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.2 Relapse (as defined by study authors)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“The DESS items most commonly reported to be severe were trouble sleeping/insomnia (4.1% of participants in the discontinuation group, and 4.2% in the antidepressant group) and nervousness/anxiety (4.1% in the discontinuation group, and 1.4% in the antidepressant group).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.3.1 Types of withdrawal symptoms
What the sources say
- Not checked — no full text of the sourcecites Khan 2014 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Removing them from the analyses reduced statistical heterogeneity to 0%.This did not change the direction of the effect but reduced its magnitude (MD 0.44, 95% CI 0.30 to 0.57).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.9.1 Pooled studies
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“The most commonly reported symptoms on the DESS scale (by ≥ 10% of participants) in the discontinuation group were irritability, trouble sleeping and/or insomnia, nervousness, anxiety, sudden worsening of mood, sudden outbursts of anger, bouts of crying or tearfulness, agitation, feeling unreal or detached, confusion or trouble concentrating, forgetfulness or problems with memory, mood swings,”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.3.1 Types of withdrawal symptoms
What the sources say
- Not checked — no full text of the sourcecites Khan 2014 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
In the paper
“Mean MADRS score was 12.5 (standard deviation (SD) 11.5) in the discontinuation group (n = 94) and 7.8 (SD 9.7) in the continuation group (n = 109).Study authors concluded that fluvoxamine continuation was more effective than discontinuation (P < 0.001).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.5.3 Depressive symptoms measured with other scales
What the sources say
- Not checked — no full text of the sourcecites Terra 1998 source
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“In one study (n = 160), 4 of 84 (4.8%) participants in the discontinuation group (with or without CBT) and 4 of 76 (5.3%) participants in the continuation group (with or without CBASP) experienced adverse events serious enough to discontinue the trial, but data on differences between groups were not reported (Gelenberg 2003).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.4.2 Studies with other outcome measures
What the sources say
- Not checked — no full text of the sourcecites Gelenberg 2003 source
Strength:plain· not yet calibratedn = 160Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Mean GDS score at endpoint was 5.03 (SD 1.15) in the discontinuation group (n = 13) and 5.11 (SD 0.86) in the continuation group (n = 23).Study authors concluded that there were no differences in GDS score.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.5.3 Depressive symptoms measured with other scales
What the sources say
- Not matchedcites Streim 2012
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedn = 13Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
In the paper
“All studies measured relapse of depression except one, which reported relapse of panic disorder in participants with panic disorder (Rapaport 2001).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.2 Relapse (as defined by study authors)
What the sources say
- Not checked — no full text of the sourcecites Rapaport 2001 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Streim 2012 assessed also the numbers of participants experiencing one or more serious adverse events in the discontinuation group (4/13; 30.7%) and in the continuation group (8/23; 34.8%) but provided no data on differences between groups.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.4.1 Pooled studies
What the sources say
- Not matchedcites Streim 2012
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Removing these two studies from the analyses reduced statistical heterogeneity to 0%.This did not change the direction of effect but slightly increased the effect size (MD 0.64, 95% CI -0.27 to 1.54), favouring continuation of long-term antidepressant.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.5.1 Pooled studies
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Mean change from baseline to 28 weeks on the HAM-A Scale for participants with panic disorder was 3.95 (SD 7.35) in the discontinuation group (n = 89) and 1.65 (SD 7.01) in the antidepressant group (n = 92).Study authors reported no differences between groups (P = 0.154; P value obtained from (ANCOVA) model, with treatment, site, and baseline values as effects).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 1.6 Anxiety symptoms
What the sources say
- Not checked — no full text of the sourcecites Rapaport 2001 source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The most common adverse events (≥ 10%) in the discontinuation group included headache, insomnia, dizziness, fatigue, dyspepsia, pain, asthenia, diarrhoea, upper respiratory infection, nausea, dizziness, vasodilatation, dry mouth, insomnia, sweating, nausea, nervousness, and paraesthesia.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.4.2 Types of adverse events
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe quote only partly states this claim.
In the paper
“Rickels 2010 reported no differences in measurement of adverse events between antidepressant and discontinuation groups.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.4.3 Studies that could not be pooled
What the sources say
- Not checked — no full text of the sourcecites Rickels 2010 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Mean endpoint scores at four weeks were 6.2 (SD 4.5) in the taper group (n = 139) and 6.7 (SD 4.8) in the continuation group (n = 36), with no differences between groups.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.5.3 Depressive symptoms measured on other scales
What the sources say
- Not checked — no full text of the sourcecites Khan 2014 source
Strength:plain· not yet calibratedn = 139Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“In the further six-month follow-up period, rates of antidepressant usage between the two groups continued to be highly significantly different (P < 0.0001), although no data on antidepressant use in both groups were provided.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 3.1 Successful discontinuation rate
What the sources say
- Not checked — no full text of the sourcecites Kuyken 2008 source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Cook 1986 (n = 18) reported no differences in adverse events between discontinuation and antidepressant groups.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.4.3 Studies that could not be pooled
What the sources say
- Not checked — no full text of the sourcecites Cook 1986 source
Strength:plain· not yet calibratedn = 18Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Adverse events were not measured.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 4.4 Adverse events
What the sources say
- Not matchedcites Eveleigh 2018
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
In the paper
“Social and occupational functioning was not measured.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 4.9 Social and occupational functioning
What the sources say
- Not matchedcites Eveleigh 2018
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For the outcome relapse, the test for subgroup differences for age was not statistically significant (age; P = 0.69; I = 0%).This suggests that there is no difference between participants based on age (younger than 65 years versus 65 years and older).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation abrupt versus continuation of long-term antidepressants
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Severity of illness was not measured.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 4.10 Severity of illness
What the sources say
- Not matchedcites Eveleigh 2018
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
In the paper
“This study did not provide data on suicidality.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 4.11 Suicide, suicide attempt, or suicidal ideation
What the sources say
- Not matchedcites Eveleigh 2018
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“None of the included studies compared discontinuation with changed pharmacological form versus continuation of antidepressants.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Comparison 5. Discontinuation with psychosocial interventions versus continuation of long-term antidepressants versus continuation of long-term antidepressants
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The remaining tests were not statistically significant (type of antidepressant (TCA versus SNRI): P = 0.48 (no SSRI subgroup due to only 1 study), I = 0%; duration of antidepressant (shorter than 52 weeks versus 52 weeks or longer: P = 0.36; I = 0%).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > See Analysis 5.1 Analysis 6.1 and Analysis 7.1.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Time to relapse was not measured.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 4.7 Time to relapse
What the sources say
- Not matchedcites Eveleigh 2018
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“No studies measured this outcome.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 3.6 Anxiety symptoms
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“None of the studies compared discontinuation with low-intensity psychological interventions or a changed pharmacological form to continuation of antidepressants.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > D I S C U S S I O N Summary of main results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of our four primary outcomes of interest, 2 studies addressed successful discontinuation rate, 31 addressed relapse, 1 withdrawal symptoms, and 21 adverse events.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > D I S C U S S I O N Summary of main results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The discontinuation rate was low, with 6% of participants discontinuing compared to 8% in the usual care group.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation with minimal intervention to usual care
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Withdrawal symptoms were measured a er tapering of antidepressants but were not analysed.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation with minimal intervention to usual care
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Thirteen studies (1780 participants) compared abrupt discontinuation to continuation of long-term antidepressants.Two of these studies included a psychological co-intervention (cognitive-behavioural therapy (CBT) and cognitive-behavioural analysis system of psychotherapy (CBASP)) in both treatment groups.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Abrupt discontinuation versus continuation of long-term antidepressants
Strength:plain· not yet calibratedn = 1,780Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Subgroup analyses based on age and setting was not possible.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation by "tapering" versus continuation of longterm antidepressants
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Sensitivity analyses excluding six studies (with funding from industry or an unknown source of funding) made confidence intervals substantially wider but did not change the direction of the effect (OR 1.14, 95% CI 0.09 to 13.97).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation abrupt versus continuation of long-term antidepressants
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Very low-certainty evidence suggests that discontinuation by”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation by "tapering" versus continuation of longterm antidepressants
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“None of the eligible studies in this comparison reported the antidepressant discontinuation rate or either of the patient-centred outcomes quality of life and social and occupational functioning.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Abrupt discontinuation versus continuation of long-term antidepressants
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Discontinuation by”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation by "tapering" versus continuation of longterm antidepressants
Strength:plain· not yet calibratedTests✗ Asserted: fails✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The authors may not put it forward as true. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The study did not report adverse events, social and occupational functioning, or severity of illness.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation with minimal intervention to usual care
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Very low-certainty evidence suggests that”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation by "tapering" versus continuation of longterm antidepressants
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✗ Asserted: fails✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The authors may not put it forward as true. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. The quote only partly states this claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“very low-certainty evidence suggests that”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation by "tapering" versus continuation of longterm antidepressants
Strength:hedged· not yet calibratedTests✗ Asserted: fails✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The authors may not put it forward as true. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Sensitivity analyses excluding these nine studies reduced substantially the magnitude of the treatment effect, and the confidence interval included the null effect (HR 1.20, 95% CI 0.84 to 1.71).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation abrupt versus continuation of long-term antidepressants
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Pooling data on anxiety symptoms was not possible due to heterogeneity in measures (3 studies; very low-certainty evidence).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Abrupt discontinuation versus continuation of long-term antidepressants
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There is insufficient evidence of its effect on adverse events (7 studies; very low certainty evidence) and depressive symptoms (3 studies).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Abrupt discontinuation versus continuation of long-term antidepressants
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Sensitivity analyses excluding these 9 studies did not change the direction of the effect but increased the magnitude of the treatment effect and made the confidence interval wider (HR 3.36, 95% CI 1.58 to 7.16).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation by "tapering" versus continuation of long-term antidepressants
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Additionally no studies have systematically reported other medication use (e.g.chronic psychoactive medication) and psychotherapy at baseline or at trial initiation, and few have examined other psychiatric disorders or non-psychiatric disorders (if not excluded).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies in people aged 65 years and older are sparse (3 studies), indicating a gap in the evidence.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“One study included a tapering schedule determined by clinician and patient together but poorly described the discontinuation and tapering process.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As all studies captured in our review used commercially available formulations of antidepressants, no study included a slow tapering regimen with very low doses over some months or a changed pharmacological form such as liquid or tapering strips (to allow low doses of antidepressants).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“As described in the Background section of this review, there are other methods to support discontinuation that were not captured here.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Additionally, a minority of the studies assessed patients' preferences for outcomes (Eiring 2015): nine studies quality of life, and five of the 33 studies social and occupational functioning (e.g.daily activities, social activities, return to work).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
What the sources say
- Not matchedcites Eiring 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Overall, the dropout rate in these studies was high.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most tapering regimens in the included studies were limited to four weeks or less, which makes them very similar to rapid discontinuation regimens.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > A U T H O R S ' C O N C L U S I O N S Implications for practice
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Moreover, few studies reported data on suicide, and none of the study authors assessed suicide, suicide attempt, or suicidal ideation related to the medication.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most (60%) individuals tapered antidepressants with their doctors over 6 months”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Munkholm 2019
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“1.3.1 HAM-D total score endpoint 1 140 Mean Difference (IV, Random, 95% CI) 3.40 [0.42, 6.38]”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe quote only partly states this claim.
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“The duration of continuation treatment recommended in depression guidelines varies from four months to 12 months a er remission (APA 2010;CANMAT 2016;Declercq 2017;NHG 2012;NICE 2009;WHO 2017).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Continuation and maintenance treatment
What the sources say
- Not matchedcites APA 2010
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites CANMAT 2016
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites Declercq 2017
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
In the paper
“Evidence for treatment durations longer than nine months is relatively limited, with lack of long-term trials in which participants were randomised six months a er remission to determine the effects of treatment a er this time (Kaymaz 2008).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Continuation and maintenance treatment
What the sources say
- Not matchedcites Kaymaz 2008
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“Continuation treatment should be continued for at least two years a er remission for those at high risk of relapse (APA 2010;CANMAT 2016;Declercq 2017;NHG 2012;NICE 2009;WHO 2017), which is defined as having two or more episodes, residual symptoms, or severe previous episodes (Geddes 2003).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Continuation and maintenance treatment
What the sources say
- Not matchedcites APA 2010
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites CANMAT 2016
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites Geddes 2003 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
In the paper
“and almost all trials were conducted in secondary care and probably are not representative of primary care patients (Aroll 2017).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Continuation and maintenance treatment
What the sources say
- Not matchedcites Aroll 2017
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Discontinuation of antidepressants may decrease risk of adverse events and risk of drug-drug interactions and may minimise the number of medicines, whilst making no difference in depressive and anxiety symptoms.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > How the intervention might work
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We contacted trial authors and subject experts for information on unpublished or ongoing trials, or to request additional trial data.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Correspondence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We calculated the proportion lost to follow-up for each group and reported this.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Dealing with missing data
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We performed an additional sensitivity analysis to test the impact of a long tapering scheme as current guidelines recommend tapering over 4 weeks and more.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Sensitivity analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Two review authors (EVL, LR) independently extracted trial characteristics and outcome data from included trials.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Data extraction and management
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We performed additional sensitivity analyses to test the impact of industry sponsorship by excluding trials with industry sponsorship or with an unclear source of funding because drug companies whose primary interest may not be in discontinuation.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Sensitivity analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, discontinuation might cause withdrawal symptoms and recurrence or worsening of the original depressive or anxiety symptoms, which contributes to unsuccessful discontinuation.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > How the intervention might work
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We searched international trials registries via the World Health Organization trials portal (ICTRP) and ClinicalTrials.gov to identify unpublished or ongoing trials.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Timing of outcome assessment
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We checked the reference lists of all included trials and relevant systematic reviews to identify additional trials missed during the original electronic searches (e.g.unpublished citations, in-press citations).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Reference lists
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We used a data collection form that we had piloted on at least one trial in the review, to extract trial characteristics and outcome data.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Data extraction and management
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“When considering treatment effects, we took into account the risk of bias for trials that contributed to that outcome.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Data extraction and management
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We assessed evidence as high, moderate, low, or very low certainty, depending on the seriousness of concern about risk of bias, imprecision, inconsistency, indirectness, and publication bias.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Summary of findings and assessment of the certainty of the evidence
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Three review authors (EVL, MVD, TC) used the GRADE approach independently to assess evidence certainty for all outcomes.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Summary of findings and assessment of the certainty of the evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We investigated potential publication bias by using a funnel plot when at least 10 trials met the inclusion criteria of the review.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Assessment of reporting biases
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“When possible, we carried out an intention-to-treat (ITT) analysis for all outcomes.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Dealing with missing data
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We carried out sensitivity analysis to assess the impact on the effect estimate of trials with high risk of bias.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Sensitivity analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We extracted the intraclass correlation coefficient (ICC) for each trial.We adjusted for the clustering effect by dividing the clusters by a 'design effect'.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Cluster-randomised trials
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We resolved disagreements by reaching consensus or by involving a third review author (MVD).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Data extraction and management
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We assessed each potential source of bias as high, low, or unclear and provided a supporting quote from the trial report together with a justification for our judgement in the 'Risk of bias' table.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Data extraction and management
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We resolved any disagreements through discussion, or, if required, we consulted a third review author (MVD).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Selection of studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We retrieved full-text trial reports and publications, and two review authors (EVL, MD) independently screened the full text, identified trials for inclusion, and identified and recorded reasons for exclusion of ineligible trials.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Selection of studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Low-intensity psychological or psychosocial interventions have the potential to reach more people.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Description of the intervention
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We conducted a complete-case analysis and included in the analysis only participants with a recorded outcome.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Dealing with missing data
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“It is important to note that the majority of relapse prevention discontinuation trials did not distinguish relapse from symptoms of withdrawal a er discontinuation; this is a confounder that makes study findings difficult to interpret.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Long-term antidepressant use
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We identified and excluded duplicate records, and we collated multiple reports that relate to the same trial, so that each trial rather than each report was the unit of interest in the review.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Selection of studies
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We did not make any assumptions about loss to follow-up for dichotomous or continuous data.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Dealing with missing data
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We summarised risk of bias judgements across different trials for each of the domains listed.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Data extraction and management
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“If ICCs were not reported, we requested them from trial authors.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Cluster-randomised trials
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“To minimise risk of publication bias, we performed a comprehensive search of multiple databases, including searching for unpublished trials.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Assessment of reporting biases
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Reviews suggest that 30% to 50% of long-term antidepressant prescriptions had no evidence-based indication supporting their use, and that users could try to stop treatment (Ambresin 2015;Cruickshank 2008;Piek 2010).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Why it is important to do this review
What the sources say
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Two review authors (EVL, MD) independently screened titles and abstracts for inclusion of all potential trials identified as a result of the search and coded them as 'retrieve' (eligible or potentially eligible/unclear) or 'do not retrieve'.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Selection of studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We double-checked that data had been entered correctly by comparing data presented in the systematic review with data provided in trial reports.A second review author (LR) spot-checked trial characteristics for accuracy against the trial report.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Data extraction and management
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“We recorded the selection process in sufficient detail to complete a PRISMA flow diagram (Moher 2009), along with Characteristics of included studies and Characteristics of excluded studies tables.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Selection of studies
What the sources say
- Not checked — no full text of the sourcecites Moher 2009 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We searched the grey literature for dissertations and theses.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Grey literature
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We performed meta-analysis only when trials were sufficiently homogeneous in terms of participants, interventions, and outcomes.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Assessment of heterogeneity
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We investigated heterogeneity by conducting pre-specified subgroup analyses, and we compared subgroups using the formal test for subgroup differences for primary outcomes.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Subgroup analysis and investigation of heterogeneity
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We justified all decisions to downgrade the certainty of evidence in the footnotes of the 'Summary of findings' table.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Summary of findings and assessment of the certainty of the evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We did not apply any restrictions on date, language, or publication status to the searches.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Timing of outcome assessment
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All studies had to meet the main inclusion criterion that participants received long-term antidepressants (for at least 24 weeks) for depressive or anxiety disorder.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Participants
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“Two review authors (EVL, LR) independently assessed each of the 33 included studies for risk of bias across the six domains, using the Cochrane 'Risk of bias' assessment tool (Higgins 2017), as described in the Methods (Assessment of risk of bias in included studies).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Risk of bias in included studies
What the sources say
- Not matchedcites Higgins 2017
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“It is important to note that adverse events may include withdrawal symptoms, as these studies did not distinguish between adverse events and withdrawal symptoms.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > See Analysis 1.2.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We did not downgrade for attrition bias, as censoring for survival data is unlikely to introduce bias.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.2.1.1 Pooled studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We did not downgrade for attrition bias, as censoring for survival data is unlikely to introduce bias.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.2.1.1 Pooled studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We did not downgrade for attrition bias, as censoring for survival data is unlikely to introduce bias.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.2.1.1 Pooled studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Neither of the studies assessed withdrawal symptoms; therefore withdrawal symptoms could be misclassified, and this may result in a restart of antidepressants due to intolerable withdrawal symptoms.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 2.1.1 All studies
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“None of these studies distinguished symptoms of relapse from symptoms of withdrawal nor made adjustments for withdrawal symptoms.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 3.2 Relapse rate (as defined by study authors)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Three studies reported on discontinuation rate in the discontinuation group.None of these studies assessed withdrawal symptoms.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 3.1 Successful discontinuation rate
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We were unable to perform subgroup analysis for the outcome withdrawal symptoms and for adverse events due to lack of pooling.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Discontinuation abrupt versus continuation of long-term antidepressants
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The study did not make adjustments for withdrawal symptoms.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Comparison 4. Discontinuation with a minimal intervention versus usual care
What the sources say
- Not matchedcites Eveleigh 2018
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We assessed the certainty of evidence for this outcome as low, downgraded by one level due to risk of bias (withdrawal confounding bias, attrition bias) and by one level due to imprecision (a single study).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 4.5 Depressive symptoms
Strength:plain· not yet calibratedTests✗ Asserted: fails✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The authors may not put it forward as true. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
- Rests on an assumption: Withdrawal symptoms may be misclassified as relapse and this may lead to restart of the antidepressant.
In the paper
“There was a high dropout rate in returning all three monthly self-report questionnaires: 32 of 70 (45%) participants in the discontinuation group and 33 of 76 (43%) did not have complete data.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 4.8 Quality of life
What the sources say
- Not matchedcites Eveleigh 2018
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
- Not matched
In the paper
“Eveleigh 2018 measured the prevalence and severity of antidepressant withdrawal symptoms using the Discontinuation-Emergent Signs and Symptoms (DESS) Scale as the outcome; however this was not analysed”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 4.3 Withdrawal symptoms
What the sources say
- Not matchedcites Eveleigh 2018
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“None of these studies distinguished between adverse events and withdrawal symptoms nor made adjustments for withdrawal symptoms.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > 3.4 Adverse events
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Evidence for discontinuation of long-term antidepressant use lacks completeness and has low applicability.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For example, low mood and other withdrawal symptoms may register on the Hamilton Rating Scale for Depression (HAM-D) -the prioritised measure for depressive symptoms -and may result in people falsely allocated to having”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Furthermore, physical and emotional symptoms of withdrawal may impair work, socialising, and emotional wellbeing, thereby affecting scores on quality of life and functioning scales.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We did not perform subgroup analysis for the other comparisons (discontinuation with high-intensity psychological intervention or minimal intervention) due to the small number of included studies.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > See Analysis 5.1 Analysis 6.1 and Analysis 7.1.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We did not perform sensitivity analyses for studies with a co-intervention, for studies with a high-intensity psychological intervention, or for studies with minimal intervention due to the small number of studies.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Sensitivity analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, we could not perform sensitivity analyses excluding studies at high risk of bias.All included studies had high risk for at least one risk of bias domain.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Sensitivity analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We could not perform subgroup analyses based on setting, disorder, type of antidepressant, or duration of antidepressant use prior to randomisation.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Abrupt discontinuation versus continuation of long-term antidepressants
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“The recommended duration of tapering has been revised to four weeks or longer, particularly for drugs with a shorter half-life (such as paroxetine and venlafaxine) (NICE 2009).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
What the sources say
- Not matchedcites NICE 2009
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Very low-certainty evidence suggests that abrupt discontinuation of long-term antidepressants may increase relapse (10 studies) compared to continuation of antidepressant, but none of the studies distinguished between relapse and symptoms of withdrawal.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Abrupt discontinuation versus continuation of long-term antidepressants
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: Withdrawal symptoms may be misclassified as relapse and this may lead to restart of the antidepressant.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We were unable to analyse subgroups on the basis of age and setting.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > See Analysis 5.1 Analysis 6.1 and Analysis 7.1.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Also, the UK Royal College of Psychiatrists guidelines now recommend 'months of tapering' (UK Royal College of Psychiatrists 2020).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
What the sources say
- Not matchedcites UK Royal College of Psychiatrists 2020
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
In the paper
“Recently, the National Institute for Health and Care Excellence (NICE) has updated antidepressant guidelines to reflect severity and length of withdrawal symptoms related to”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
What the sources say
- Not checked — no full text of the sourcecites Iacobucci 2019 source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This occurs when relapse criteria rely on clinical scale scores that include domains for depressed mood, insomnia, agitation, gastrointestinal somatic symptoms, anxiety, general somatic symptoms, and/or sexual dysfunction -all potential symptoms of withdrawal.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“however these psychological interventions are resource-intensive, and access is o en limited.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Discontinuation may be more appropriate and effective in such a population.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“As study endpoints differed, we pooled studies with different follow-up durations.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All things considered, this is a major limitation of our review and may be a source of potential bias; therefore, our findings for relapse should be interpreted with caution.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Because pooling was not possible for some outcomes, the potential benefit of a meta-analysis to produce a more precise effect estimate could not be realised; therefore we reduced the evidence by one level for imprecision.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Imprecision
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The effect of this is that abrupt changes in effect on target receptors occur when the dose is reduced to zero, meaning that many of the regimens in the tapering studies are very similar to abrupt cessation, perhaps explaining the lack of success in discontinuation and the apparent 'relapse' rate.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It is important to note that adverse events may include withdrawal symptoms, as the studies did not distinguish between adverse events and withdrawal symptoms.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We may have missed other relevant studies, especially those with a negative result.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Definitions of remission and relapse differed widely between studies, and this could introduce bias.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Five studies that are ongoing or awaiting classification have not been included and may be a source of potential bias.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We used a comprehensive search strategy in multiple databases with no restrictions on language.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We assessed 20 studies to be at unclear risk and one study at high risk for sponsorship bias.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Cochrane Database of Systematic Reviews
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This is a specific subpopulation of patients taking long-term antidepressants in the community; therefore the generalisability of our results is limited to those with multiple episodes of depression.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Indirectness of evidence
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“A third review author acted as arbiter to minimise risk of bias in the review process.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We conducted a comprehensive search for published and unpublished studies, thereby reducing the risk of publication bias.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Publication bias
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“It is unclear if this difference in study duration impacted the conclusions (however, all except one study had a follow-up period of six months or longer).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Therefore, we have provided little detail on whether studies assessed systematically beneficial and harmful effects of withdrawal.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, for some outcomes, the effect estimate of the pooled studies had a wide 95% confidence interval, which included the null effect (i.e.no difference between treatments).Therefore, we downgraded the evidence by one level.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Imprecision
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We have not downgraded the evidence for any comparison for inconsistency.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Inconsistency of results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“A clear distinction between depression and anxiety is o en difficult in clinical practice (MaGPIe Research Group 2003).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Overall completeness and applicability of evidence
What the sources say
- Not matchedcites MaGPIe Research Group 2003
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“we could not perform subgroup analyses based on duration for the other comparisons”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > A U T H O R S ' C O N C L U S I O N S Implications for practice
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“The conclusion that suicide was”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
What the sources say
- Not checked — no full text of the sourcecites Valuck 2009 source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Consequently, the effect of these on outcomes is unknown.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“A previous Cochrane Review reported that sponsorship of drug studies by the manufacturing company leads to more favourable efficacy results and conclusions than sponsorship by other sources (Lundh 2017).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
What the sources say
- Not matchedcites Lundh 2017
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
In the paper
“In the STAR-D trial, the largest naturalistic study of antidepressants so far conducted, the remission rate at one year for all participants taking antidepressants was 2.7% (108/4000), and 92.9% relapsed or dropped out (Pigott 2010).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Not checked — no full text of the sourcecites Pigott 2010 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Two studies showed a very high discontinuation rate (87%) for CBT plus tapering compared to clinical management plus tapering (95%) (Fava 1994;Fava 1998a), and with no difference in relapse rates between groups a er 20 weeks.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Not checked — no full text of the sourcecites Fava 1994 source
- Not matchedcites Fava 1998a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Long-term psychoactive drug use and psychotherapy, other psychiatric disorders (if not excluded), and baseline antidepressant type or dose were not systematically reported and may be a source of potential bias.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“a slow tapering regimen with very low doses over months or discontinuation with a changed pharmaceutical form (such as liquids or tapering strips) to allow low doses was not included in our review.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > A U T H O R S ' C O N C L U S I O N S Implications for practice
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our review did not evaluate different discontinuation support strategies”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Implications for research
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“However, these recommendations are based on consensus and were introduced into guidelines without evidence.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > A U T H O R S ' C O N C L U S I O N S Implications for practice
What the sources say
- Not checked — no full text of the sourcecites Geddes 2003 source
- Not matchedcites Kaymaz 2008
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We pooled studies with and without co-intervention separately for the primary outcomes successful discontinuation rate and relapse because psychological support may increase the risk on discontinuation and reduce the risk of relapse.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“These time points were based on the findings of the Geddes 2003 review, in spite of the fact that there was no association between relapse rate and duration of treatment in this review.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Not checked — no full text of the sourcecites Geddes 2003 source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our review included only four studies of participants with anxiety and therefore is unable to provide a clear conclusion on discontinuation in anxiety disorders.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Despite the growing de-prescribing movement (Reeve 2017), only a few studies focused on de-prescribing long-term antidepressants have been undertaken.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Implications for research
What the sources say
- Not checked — no full text of the sourcecites Reeve 2017 source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We did not use this criterion to assess performance and detection bias, and this could introduce bias.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Many studies did not systematically assess the harmful effects of antidepressants separately or did not report a safety composite endpoint, and this may be a source of potential bias (Warren 2020).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Potential biases in the review process
What the sources say
- Not checked — no full text of the sourcecites Warren 2020 source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Another systematic review found no evidence for treatment of a single episode for six to nine months, or for more than two episodes for longer than two years (Kaymaz 2008).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Not matchedcites Kaymaz 2008
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Withdrawal symptoms are an indication to taper more slowly and do not imply that the underlying disorder has re-emerged.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > A U T H O R S ' C O N C L U S I O N S Implications for practice
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Random sequence generation (selection bias) Low risk Comment: a random component is used”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The antidepressant discontinuation rate was low: 37% of participants discontinued their antidepressant over 16 months with no difference between groups, and only 28% discontinued their antidepressant without recurrence (Scholten 2018).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Not checked — no full text of the sourcecites Scholten 2018 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Incomplete outcome data (attrition bias) All outcomes High risk Comment: 2 participants (10.5%) withdrew before completion of study.Not clear what group they were randomised to.Analysis was done on 17 completing study rather than on 19 randomised”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Munkholm 2019
Strength:plain· not yet calibratedn = 2Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Selective reporting (reporting bias) High risk Comment: study protocol is available; predefined outcomes were not reported (types of serious adverse events).Other adverse events and withdrawal symptoms were not an outcome”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“low participation rate: 15% of participants deemed eligible by the GP; consented to participate”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Cochrane Database of Systematic Reviews
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Comment: study protocol not available; adverse events reported; no withdrawal symptoms measured”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“patient characteristics were well balanced at randomisation; any differences were not statistically significant”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Cochrane Database of Systematic Reviews
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Withdrawal symptoms were measured but were not reported.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Cochrane Database of Systematic Reviews
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Comment: study protocol not available; adverse events reported but incompletely (not all adverse events for each treatment group reported); no information on withdrawal symptoms reported”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Comment: large numbers of dropouts in placebo group and antidepressant group (55/61 (90%) in placebo group and 37/60 (62%) in antidepressant group); only 6/61 placebo patients completed the trial compared to 23/60 citalopram patients”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
Strength:plain· not yet calibratedn = 61Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Blinding of outcome assessment (detection bias) All outcomes Low risk Comments: study is described as single-blind and it is unlikely that blinding could have been broken”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“ITT analysis on 160/165 patients entered into the RCT with at least 1 post-baseline assessment”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Cochrane Database of Systematic Reviews
Strength:plain· not yet calibratedn = 165Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Selective reporting (reporting bias) High risk Comment: study protocol not available, although given the age of this study, protocols might not have been standard practice at that time.Study authors report that they assessed participants on the Treatment-Emergent Symptoms Scale, yet adverse events were reported incompletely.Withdrawal symptoms were not an outcome”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Allocation concealment (selection bias) Low risk Comment: an independent research assistant was responsible for allocation (central allocation)”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Blinding of outcome assessment (detection bias) All outcomes Low risk Comment: blinding of outcome assessment ensured; likely that blinding was successful”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Other bias Unclear risk Comment: funding not described”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Munkholm 2019
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Incomplete outcome data (attrition bias) All outcomes High risk Comment: dropout rates different across groups (28.5% discontinuation group, 35.5% antidepressant group); reasons for dropout not accounted for”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Blinding of outcome assessment (detection bias) All outcomes Low risk Comment: study is described as double-blinded, and blinding appeared to be maintained”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Munkholm 2019
Strength:hedged· not yet calibratedTests✗ Asserted: fails✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The authors may not put it forward as true. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Comment: no protocol available; withdrawal symptoms not an outcome; incomplete information on adverse events reported”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Blinding of participants and personnel (performance bias) All outcomes Low risk Comment: study is described as double-blinded, and blinding appeared to be maintained”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Munkholm 2019
Strength:hedged· not yet calibratedTests✗ Asserted: fails✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The authors may not put it forward as true. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“random assignment was ensured by picking a sealed envelope with intervention or control group”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Cochrane Database of Systematic Reviews
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Blinding of participants and personnel (performance bias) All outcomes High risk Comments: study is described as single-blind; participants and physicians were not blinded, and the outcome is likely to be influenced by lack of blinding”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“no blinding or incomplete blinding; outcome is likely to be influenced by lack of blinding”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Cochrane Database of Systematic Reviews
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Study authors concluded that the absolute benefit of SSRIs in preventing depression recurrence is much smaller than was previously estimated, with a number needed to treat for an additional beneficial outcome (NNTB) of 8 (18 months).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Not matchedcites Mangin 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Other bias Low risk Comment: none”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Other bias Unclear risk Source of funding not reported”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Blinding of participants and personnel (performance bias) All outcomes High risk Comment: medication withdrawn was not accompanied by the use of placebo.Due to the nature of the trial (monotherapy vs combination therapy), blinding would not be possible for patients and providers”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The retrospective cohort study found that withdrawal syndrome occurred significantly less frequently in patients who discontinued gradually compared with patients who discontinued abruptly, and most patients could discontinue paroxetine with a taper of 5 mg every two or four weeks (Himei 2006).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Not checked — no full text of the sourcecites Himei 2006 source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Comment: no protocol available; relevant outcomes measured; adverse events reported; no withdrawal symptoms”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Random sequence generation (selection bias) Unclear risk Comment: not enough information provided.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Munkholm 2019
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“random assignment was ensured by picking a sealed envelope with intervention or control group”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Cochrane Database of Systematic Reviews
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“because our trial is cluster randomised, calculations to determine the minimum number of general practices is stricter than in a non-clustered trial.To account for this, we used an ICC of 0.05”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Cochrane Database of Systematic Reviews
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Blinding of outcome assessment (detection bias) All outcomes Low risk Comment: blinding of outcome assessment ensured; unlikely that blinding could have been broken”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“indicating that a time frame of 4 weeks was not considered feasible for many individuals”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Munkholm 2019
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. The quote only partly states this claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Comment: study report fails to include results for adverse events and withdrawal symptoms that would be expected to have been reported for such a study.None of our secondary outcomes were reported”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Allocation concealment (selection bias) Unclear risk Comment: insufficient information to permit judgement”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Comment: adverse events were reported incompletely (not separated for each treatment group; no numbers for increased sweating); withdrawal symptoms were not measured”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Allocation concealment (selection bias) Unclear risk Comment: not described”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Comment: protocol is not available; reports include all expected outcomes.Adverse events were reported.Withdrawal symptoms were not an outcome.None of our secondary outcomes were reported”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Blinding of participants and personnel (performance bias) All outcomes Low risk Comment: blinding of participants and key study personnel ensured; unlikely that blinding could have been broken”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Selective reporting (reporting bias) High risk Comment: protocol not available.Hamilton and Raskin scores reported only for total (N = 17) participants and placebo (N = 10) participants.Not reported for active (N = 7) participants.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Munkholm 2019
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Random sequence generation (selection bias) Low risk Comment: randomisation was performed by using a computer random number generator”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Random sequence generation (selection bias) Unclear risk Comment: insufficient information to judge”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“An unpublished primary care placebo-controlled discontinuation trial of maintenance SSRI treatment in New Zealand -one of our ongoing studies -found a recurrence rate of 23% in the taper arm over 18 months and 10% in the continuation arm, and 6% had to restart because of intolerable withdrawal symptoms despite tapering (Mangin 2015).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Agreements and disagreements with other studies or reviews
What the sources say
- Not matchedcites Mangin 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Allocation concealment (selection bias) Unclear risk Comment: not enough information provided”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Munkholm 2019
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“blinding of outcome assessment ensured; unlikely that blinding could have been broken”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Cochrane Database of Systematic Reviews
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Selective reporting (reporting bias) High risk Comment: the study protocol is available, and all of the study's pre-specified (primary and secondary) outcomes have been reported in the pre-specified way.Suspected serious adverse events were recorded and were reported to the ethics committee, although they were not mentioned in the report.Withdrawal symptoms were not an outcome”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Adherence to PCT (i.e.completing ≥ 5 sessions): 90%”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Munkholm 2019
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. The quote only partly states this claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“blinding of outcome assessment ensured; unlikely that blinding could have been broken”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Cochrane Database of Systematic Reviews
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Other bias Unclear risk Comment: grant from pharmaceutical industry”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Incomplete outcome data (attrition bias) All outcomes Low risk Comment: 3/18 withdrew before randomisation but reasons clearly stated”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Intervention 2: continuation of antidepressant treatment
Strength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We performed an additional sensitivity analysis to test the impact of a long tapering scheme as current guidelines recommend tapering over 4 weeks and more.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: Guidelines currently advise tapering for at least four weeks.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The analysis for our primary outcome, discontinuation rate, is reported as ITT.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, in the comparison 'discontinuation with other intervention versus usual care', only one cluster-randomised trial provided data (Eveleigh 2018); therefore, we did not adjust the data with the intra-cluster correlation coefficient (ICC).”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Due to the small number of included studies, not all defined subgroup and sensitivity analyses could be performed.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We did not carry out an ITT analysis for all outcomes as planned in the protocol.Most studies reported outcomes for all participants, but if data were not available for all participants, we included only participants with a recorded outcome.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We conducted an additional post-hoc sensitivity analysis for industry sponsorship bias because drug companies whose primary interest may not be in discontinuation.”
§ Cochrane Database of Systematic Reviews Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review) > Additional information
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: Pharmaceutical companies may not have discontinuation as their main interest.
The paper relies on this without support.
The DESS scale validly measures antidepressant withdrawal syndrome.
“a withdrawal syndrome based on DESS Scale”
“withdrawal syndrome based on DESS scores”
The authors state this as an assumption.
The included studies would be too dissimilar and would display substantial clinical and methodological heterogeneity.
“We used a random-effects model because we assumed that the included studies would not be sufficiently similar and would show considerable clinical and methodological heterogeneity (Deeks 2017).”
The paper relies on this without support.
Psychological support may lead to higher risk of successful antidepressant discontinuation and lower risk of relapse.
“because psychological support may lead to higher risk of successful antidepressant discontinuation and lower risk of relapse.”
The paper relies on this without support.
Withdrawal symptoms are a fundamental outcome in drug discontinuation trials.
“although this is a fundamental outcome in drug discontinuation trials.”
The paper relies on this without support.
Clinical scale scores include domains that are symptoms of withdrawal.
“all of which are symptoms of withdrawal.”
The paper relies on this without support.
The HAM-D scale contains domains that are symptoms of withdrawal.
“The HAM-D scale contains domains for depressed mood, insomnia, agitation, gastrointestinal somatic symptoms, anxiety, general somatic symptoms, and sexual dysfunction, all of which are symptoms of withdrawal.”
The paper relies on this without support.
The HAM-A scale contains domain symptoms of psychic anxiety and somatic anxiety that are symptoms of withdrawal.
“It is important to note that HAM-A contains domain symptoms of psychic anxiety and somatic anxiety, all of which are symptoms of withdrawal.”
The paper relies on this without support.
Withdrawal symptoms including psychological symptoms may impair severity of illness.
“Withdrawal symptoms including psychological symptoms may impair the severity of illness.”
The paper relies on this without support.
The COVI Anxiety Scale may register anxiety and other symptoms of withdrawal.
“A weakness of the COVI Anxiety Scale is that anxiety and other symptoms of withdrawal may register on the COVI Anxiety Scale.”
The paper relies on this without support.
Low mood is a common withdrawal symptom.
“Low mood is a common withdrawal symptom, but none of these studies measured withdrawal symptoms nor made adjustments for withdrawal symptoms.”
The paper relies on this without support.
HAM-A scales contain symptoms from domains of psychic anxiety and somatic anxiety, all of which are symptoms of withdrawal.
“HAM-A scales contain symptoms from domains of psychic anxiety and somatic anxiety, all of which are symptoms of withdrawal.”
The paper relies on this without support.
Withdrawal symptoms may impair work, socialising, and emotional well-being (social functioning and emotional role functioning).
“Withdrawal symptoms may impair work, socialising, and emotional well-being (social functioning and emotional role functioning) because of disturbing physical and emotional symptoms.”
The paper relies on this without support.
Withdrawal symptoms may influence social and occupational functioning.
“Withdrawal symptoms may influence social and occupational functioning due to disturbing physical and emotional symptoms.”
The paper relies on this without support.
Withdrawal symptoms including psychological symptoms may impair the severity of illness.
“Withdrawal symptoms including psychological symptoms may impair the severity of illness.”
The paper relies on this without support.
Withdrawal symptoms may be misdiagnosed as adverse events.
“confounding withdrawal bias; withdrawal symptoms may be misdiagnosed as adverse events”
The paper relies on this without support.
Low mood as a withdrawal symptom may be misdiagnosed as depressive symptoms.
“low mood as withdrawal symptom may be misdiagnosed as depressive symptoms with scores from the HAM-D scale or other clinical scales”
The paper relies on this without support.
Withdrawal symptoms may impair quality of life measures.
“withdrawal symptoms may impair QoL measures”
The paper relies on this without support.
Withdrawal symptoms may be misclassified as relapse and this may lead to restart of the antidepressant.
“withdrawal confounding bias; withdrawal symptoms may be misclassified as relapse and this may lead to restart of the antidepressant”
The paper relies on this without support.
Adverse events may include withdrawal symptoms.
“withdrawal confounding bias; adverse events may include withdrawal symptoms”
The paper relies on this without support.
Pharmaceutical companies may not have discontinuation as their main interest.
“because drug companies whose primary interest may not be in discontinuation.”
The paper relies on this without support.
Guidelines currently advise tapering for at least four weeks.
“as current guidelines recommend tapering over 4 weeks and more.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
The six-study severity analysis names a different scale for one study
MinorThe analysis says all six studies measured severity with CGI-S, but its description of Rickels 2010 says that study reported PGI-S scores.
“The six studies reported severity of illness by measurements of Clinical Global Impressions-Severity (CGI-S), as rated by clinicians (Keller 1998;Keller 2007;Kocsis 2007;Montgomery 2004;Perahia 2009;Rickels 2010).”
“One study reported PGI-S mean scores for repeated continuous measures over the time of the trial (Rickels 2010).”
Low-intensity intervention is both absent and assigned to a study
MinorThe intervention summary says no included study used low-intensity support for discontinuation, whereas the fourth comparison describes its included study as using a low-intensity intervention.
“No studies used low-intensity psychological intervention or psychosocial support to support discontinuation.”
“One study compared discontinuation (taper) of antidepressant with low-intensity intervention to usual care (Eveleigh 2018).”
Severity-of-illness study count changes within the same analysis
MinorThe text identifies five studies and reports a five-study pooled result, but calls them six studies between those statements.
“The six studies were considered suitable for pooling.”
“favouring antidepressant continuation (714 participants, 5 studies; I = 65%; random-effects model).”
Removing studies is said to reduce an increased effect
MinorThe reported mean difference rises from 0.31 to 0.44 after the two studies are removed, contrary to the statement that its magnitude decreased.
“This did not change the direction of the effect but reduced its magnitude (MD 0.44, 95% CI 0.30 to 0.57).”
“Participants in the discontinuation group had higher severity score rated on the CGI-S compared to those in the continuation group (MD 0.31, 95% CI 0.13 to 0.49)”
Tapering withdrawal comparison gives two control-group sizes
MinorThe same Khan 2014 tapering comparison gives the continuation group as 37 participants and then uses 36 as its denominator.
“Khan 2014 compared venlafaxine tapering (n = 139) over one week to venlafaxine continuation (n = 37; control group split to allow comparison of multiple arms) over four weeks.”
“between the discontinuation group (30/139; 21.6%) and the continuation group (4/36; 11.1%)”
Short Form scale labels are reversed in the abbreviations
MinorThe outcome-measures section identifies SF-36 as Short Form 36 and SF-12 as Short Form 12. The abbreviations list assigns the 36-item name to SF-12 and the 12-item name to SF-36.
“SF-12 Short Form 36-Item Health Survey SF-36 Short Form 12-item Health Survey”
“measured by Short Form 36 (SF-36; Ware 1992), Short Form 12 (SF-12;Gandek 1998)”
Count of older-adult-only studies differs
MinorThe sample-size section names four studies that included only participants aged 65 or older, while the applicability discussion says there were three.
“Four studies included only participants 65 years of age and older (Cook 1986;Klysner 2002;Streim 2012;Wilson 2003)”
“Studies in people aged 65 years and older are sparse (3 studies), indicating a gap in the evidence.”
Four-week follow-up is classified inconsistently
MinorThe methods define four weeks or less as short-term follow-up, but the results place a four-week study in the medium-term category.
“We analysed effects of discontinuation over the short term (trials with follow-up of four weeks or less)”
“One study with medium-term follow-up (4 weeks to 24 weeks): four weeks (Khan 2014).”
Abrupt-discontinuation relapse result names the wrong comparator
MinorThe relapse estimate is described as comparing abrupt discontinuation with discontinuation. The comparison and its two groups are instead discontinuation versus continuation.
“Abrupt discontinuation increased the risk of relapse (as defined by study authors) (HR 1.97, 95% confidence interval (CI) 1.56 to 2.50; 1555 participants, 11 studies) compared to discontinuation”
“A total of 775 (49.8%) participants were included in the pooled discontinuation group, and 780 (50.2%) in the pooled continuation group.”
Cited works that were retracted
Works this paper cites that were later retracted, from the retraction notices publishers deposit. Major when the notice came out before this paper was published.
Cites a retracted work: 10.1001/jamapsychiatry.2014.1054
InfoThe cited work was retracted; the date of the notice is not on record.
Cited work 10.1001/jamapsychiatry.2014.1054 · retraction date not known · this paper published 2021-04-22
“Hollon, 2014, Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomised clinical trial, JAMA Psychiatry, 71, 1157, 10.1001/jamapsychiatry.2014.1054”
Citations
Cites
1 retracted
Hollon, S. D., DeRubeis, R. J., Fawcett, J., Amsterdam, J. D., Shelton, R. C., Zajecka, J., Young, P. R., & Gallop, R. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.1054 · Cited by 179
RetractedDiagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859
An inventory for measuring depression
BECK, A. T. (1961) · Archives of General Psychiatry · doi:10.1001/archpsyc.1961.01710120031004 · Cited by 38,032
(1992) · PubMed · Cited by 33,716
Hamilton, M. (1960) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.23.1.56 · Cited by 32,817
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765
The MOS 36-ltem Short-Form Health Survey (SF-36): I. Conceptual Framework and Item Selection
Ware, J. E., & Sherbourne, C. D. (1992) · Medical Care · doi:10.1097/00005650-199206000-00002 · Cited by 30,033
Wang, G., Ma, R., Qiao, G., Wada, K., Aizawa, Y., & Satoh, T. (2015) · Integrative Medicine International · doi:10.1159/000368408 · Cited by 18,762
A new depression scale designed to be sensitive to change
Montgomery, S. A., & Åsberg, M. (1979) · British Journal of Psychiatry · doi:10.1192/bjp.134.4.382 · Cited by 13,962
The assessment of anxiety states by rating
HAMILTON, M. (1959) · British Journal of Medical Psychology · doi:10.1111/j.2044-8341.1959.tb00467.x · Cited by 11,455
Spitzer, R. L. (1999) · JAMA · doi:10.1001/jama.282.18.1737 · Cited by 9,802
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
Hu, R. J. (2003) · Elsevier eBooks · doi:10.1016/b0-12-226870-9/01070-4 · Cited by 9,168
Selective Cortical Undercutting As a Means of Modifying and Studying Frontal Lobe Function in Man
Scoville, W. B. (1949) · Journal of neurosurgery · doi:10.3171/jns.1949.6.1.0065 · Cited by 7,374
Practical methods for incorporating summary time-to-event data into meta-analysis.
Tierney, J. F., Stewart, L. A., Ghersi, D., Burdett, S., & Sydes, M. R. (2007) · Trials · doi:10.1186/1745-6215-8-16 · Cited by 6,208
(2008) · Cited by 3,790
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., Leucht, S., Ruhe, H. G., Turner, E. H., Higgins, J. P. T., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(17)32802-7 · Cited by 3,541
Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy.
Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.4.615 · Cited by 3,236
Cross-Validation of Item Selection and Scoring for the SF-12 Health Survey in Nine Countries
Gandek, B., Ware, J. E., Aaronson, N. K., Apolone, G., Bjorner, J. B., Brazier, J. E., Bullinger, M., Kaasa, S., Leplege, A., Prieto, L., et al. (1998) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(98)00109-7 · Cited by 2,907
The cost of dichotomising continuous variables
Altman, D. G., & Royston, P. (2006) · BMJ · doi:10.1136/bmj.332.7549.1080 · Cited by 2,688
The clinical global impressions scale: applying a research tool in clinical practice.
Busner, J., & Targum, S. D. (2007) · PubMed Central · Cited by 1,963
Frank, E. (1991) · Archives of General Psychiatry · doi:10.1001/archpsyc.1991.01810330075011 · Cited by 1,959
Industry sponsorship and research outcome
Lundh, A., Lexchin, J., Mintzes, B., Schroll, J. B., & Bero, L. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.mr000033.pub3 · Cited by 1,697
New approaches to antidepressant drug discovery: beyond monoamines
Berton, O., & Nestler, E. J. (2006) · Nature Reviews Neuroscience · doi:10.1038/nrn1846 · Cited by 1,589
Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse
Hodo, D. W. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.7.1257 · Cited by 1,405
Keller, M. B., McCullough, J. P., Klein, D. N., Arnow, B., Dunner, D. L., Gelenberg, A. J., Markowitz, J. C., Nemeroff, C. B., Russell, J. M., Thase, M. E., et al. (2000) · New England Journal of Medicine · doi:10.1056/nejm200005183422001 · Cited by 1,331
Three-Year Outcomes for Maintenance Therapies in Recurrent Depression
Frank, E. (1990) · Archives of General Psychiatry · doi:10.1001/archpsyc.1990.01810240013002 · Cited by 1,294
Kennedy, S. H., Lam, R. W., McIntyre, R. S., Tourjman, S. V., Bhat, V., Blier, P., Hasnain, M., Jollant, F., Levitt, A. J., MacQueen, G. M., et al. (2016) · The Canadian Journal of Psychiatry · doi:10.1177/0706743716659417 · Cited by 1,181
Maier, W., Buller, R., Philipp, M., & Heuser, I. (1988) · Journal of Affective Disorders · doi:10.1016/0165-0327(88)90072-9 · Cited by 1,044
Cohen, L. S. (2006) · JAMA · doi:10.1001/jama.295.5.499 · Cited by 1,031
Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review
Geddes, J. R., Carney, S. M., Davies, C., Furukawa, T. A., Kupfer, D. J., Frank, E., & Goodwin, G. M. (2003) · The Lancet · doi:10.1016/s0140-6736(03)12599-8 · Cited by 945
Moffitt, T. E., Caspi, A., Taylor, A., Kokaua, J., Milne, B. J., Polanczyk, G., & Poulton, R. (2010) · Psychological Medicine · doi:10.1017/s0033291709991036 · Cited by 938
Management of Depression in Older Adults: A Review
Kok, R. M., & Reynolds, C. F. (2017) · JAMA · doi:10.1001/jama.2017.5706 · Cited by 890
Kuyken, W., Warren, F. C., Taylor, R. S., Whalley, B., Crane, C., Bondolfi, G., Hayes, R., Huijbers, M., Ma, H., Schweizer, S., et al. (2016) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2016.0076 · Cited by 821
Piet, J., & Hougaard, E. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2011.05.002 · Cited by 807
Mindfulness-based cognitive therapy to prevent relapse in recurrent depression.
Kuyken, W., Byford, S., Taylor, R. S., Watkins, E., Holden, E., White, K., Barrett, B., Byng, R., Evans, A., Mullan, E., et al. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0013786 · Cited by 770
Prevention of Relapse following cognitive therapy vs medications in moderate to severe depression.
Hollon, S. D., DeRubeis, R. J., Shelton, R. C., Amsterdam, J. D., Salomon, R. M., O’Reardon, J. P., Lovett, M. L., Young, P. R., Haman, K. L., Freeman, B. B., et al. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.4.417 · Cited by 735
Sackeim, H. A., Haskett, R. F., Mulsant, B. H., Thase, M. E., Mann, J. J., Pettinati, H. M., Greenberg, R. M., Crowe, R. R., Cooper, T. B., & Prudic, J. (2001) · JAMA · doi:10.1001/jama.285.10.1299 · Cited by 686
Baldwin, D. S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den Boer, J. A., Christmas, D. M., Davies, S., Fineberg, N., Lidbetter, N., et al. (2014) · Journal of Psychopharmacology · doi:10.1177/0269881114525674 · Cited by 676
Reynolds III, C. F., Frank, E., Perel, J. M., Imber, S. D., Cornes, C., Miller, M. D., Mazumdar, S., Houck, P. R., Dew, M. A., Stack, J. A., et al. (1999) · JAMA · doi:10.1001/jama.281.1.39 · Cited by 659
Wilson, S., Nutt, D., Alford, C., Argyropoulos, S., Baldwin, D., Bateson, A., Britton, T., Crowe, C., Dijk, D.-J., Espie, C., et al. (2010) · Journal of Psychopharmacology · doi:10.1177/0269881110379307 · Cited by 634
How do antidepressants work? New perspectives for refining future treatment approaches
Harmer, C. J., Duman, R. S., & Cowen, P. J. (2017) · The Lancet Psychiatry · doi:10.1016/s2215-0366(17)30015-9 · Cited by 616
Population-based study of first onset and chronicity in major depressive disorder
Eaton, W. W., Shao, H., Nestadt, G., Lee, B. H., Bienvenu, O. J., & Zandi, P. (2008) · Archives of General Psychiatry · doi:10.1001/archpsyc.65.5.513 · Cited by 612
Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial
Rosenbaum, J. F., Fava, M., Hoog, S. L., Ascroft, R. C., & Krebs, W. B. (1998) · Biological Psychiatry · doi:10.1016/s0006-3223(98)00126-7 · Cited by 574
Dobson, K. S., Hollon, S. D., Dimidjian, S., Schmaling, K. B., Kohlenberg, R. J., Gallop, R. J., Rizvi, S. L., Gollan, J. K., Dunner, D. L., & Jacobson, N. S. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.76.3.468 · Cited by 560
Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T., Kessler, D., Lewis, G., Watkins, E., Brejcha, C., Cardy, J., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(14)62222-4 · Cited by 527
Treatment of Depression by Drugs and Psychotherapy
Klerman, G. L., DiMascio, A., Weissman, M. M., Prusoff, B. A., & Paykel, E. S. (1974) · American Journal of Psychiatry · doi:10.1176/ajp.131.2.186 · Cited by 502
Prevention of Recurrent Depression With Cognitive Behavioral Therapy: Preliminary Findings
Fava, G. A., Rafanelli, C., Grandi, S., Conti, S., & Belluardo, P. (1998) · Archives of General Psychiatry · doi:10.1001/archpsyc.55.9.816 · Cited by 491
Executive Dysfunction and Long-term Outcomes of Geriatric Depression
Alexopoulos, G. S., Meyers, B. S., Young, R. C., Kalayam, B., Kakuma, T., Gabrielle, M., Sirey, J. A., & Hull, J. (2000) · Archives of General Psychiatry · doi:10.1001/archpsyc.57.3.285 · Cited by 486
Fava, G. A., Gatti, A., Belaise, C., Guidi, J., & Offidani, E. (2015) · Psychotherapy and Psychosomatics · doi:10.1159/000370338 · Cited by 436
Segal, Z. V., Bieling, P., Young, T., MacQueen, G., Cooke, R., Martin, L., Bloch, R., & Levitan, R. D. (2010) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2010.168 · Cited by 429
Rush, A. J., Carmody, T., & Reimitz, P. (2000) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.79 · Cited by 427
Influences on antidepressant prescribing trends in the UK: 1995–2011
Mars, B., Heron, J., Kessler, D., Davies, N. M., Martin, R. M., Thomas, K. H., & Gunnell, D. (2017) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-016-1306-4 · Cited by 419
Antidepressant use in persons aged 12 and over: United States, 2005-2008.
Pratt, L. A., Brody, D. J., & Gu, Q. (2011) · PubMed · Cited by 389
Davies, J., & Read, J. (2019) · Addictive Behaviors · doi:10.1016/j.addbeh.2018.08.027 · Cited by 387
Five-Year Outcome for Maintenance Therapies in Recurrent Depression
Kupfer, D. J. (1992) · Archives of General Psychiatry · doi:10.1001/archpsyc.1992.01820100013002 · Cited by 370
Jakobsen, J. C., Katakam, K. K., Schou, A., Hellmuth, S. G., Stallknecht, S. E., Leth-Møller, K., Iversen, M., Banke, M. B., Petersen, I. J., Klingenberg, S. L., et al. (2017) · BMC Psychiatry · doi:10.1186/s12888-016-1173-2 · Cited by 366
Antidepressants versus placebo for depression in primary care
Arroll, B., Elley, C. R., Fishman, T., Goodyear‐Smith, F., Kenealy, T. W., Blashki, G. A., Kerse, N. M., & MacGillivray, S. A. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007954 · Cited by 353
Efficacy and effectiveness of antidepressants: current status of research
Pigott, H. E., Leventhal, A. M., Alter, G. S., & Boren, J. J. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000318293 · Cited by 347
Active placebos versus antidepressants for depression
Moncrieff, J., Wessely, S., & Hardy, R. (2004) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003012.pub2 · Cited by 342
Goodwin, G. M., Emsley, R., Rembry, S., Rouillon, F., & the Agomelatine Study Group (2009) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.08m04548 · Cited by 340
Reeve, E., Thompson, W., & Farrell, B. (2017) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2016.12.021 · Cited by 331
Bandelow, B. (1995) · International Clinical Psychopharmacology · doi:10.1097/00004850-199506000-00003 · Cited by 314
Six-Year Outcome for Cognitive Behavioral Treatment of Residual Symptoms in Major Depression
Fava, G. A., Rafanelli, C., Grandi, S., Canestrari, R., & Morphy, M. A. (1998) · American Journal of Psychiatry · doi:10.1176/ajp.155.10.1443 · Cited by 299
Godfrin, K. A., & van Heeringen, C. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.04.006 · Cited by 296
Antidepressant discontinuation reactions: Are preventable and simple to treat
Haddad, P., Lejoyeux, M., & Young, A. (1998) · BMJ · doi:10.1136/bmj.316.7138.1105 · Cited by 286
Tapering of SSRI treatment to mitigate withdrawal symptoms
Horowitz, M. A., & Taylor, D. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30032-x · Cited by 280
Self-citationAntidepressant Use Among Persons Aged 12 and Over:United States,2011-2014.
Pratt, L. A., Brody, D. J., & Gu, Q. (2017) · PubMed · Cited by 270
Cognitive behavioral treatment of residual symptoms in primary major depressive disorder
(1994) · American Journal of Psychiatry · doi:10.1176/ajp.151.9.1295 · Cited by 266
Kerr, I. B. (2005) · Psychiatry · doi:10.1383/psyt.4.5.28.65105 · Cited by 257
Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline.
(2018) · Europe PMC (PubMed Central) · Cited by 250
Bockting, C. L. H., DELTA Study Group, Schene, A. H., Spinhoven, P., Koeter, M. W. J., Wouters, L. F., Huyser, J., & Kamphuis, J. H. (2005) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.73.4.647 · Cited by 249
Mojtabai, R., & Olfson, M. (2014) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.13m08443 · Cited by 247
Sertraline in the Prevention of Depression
Doogan, D. P., & Caillard, V. (1992) · The British Journal of Psychiatry · doi:10.1192/bjp.160.2.217 · Cited by 246
Long-term antidepressant use: patient perspectives of benefits and adverse effects
Cartwright, C., Gibson, K., Read, J., Cowan, O., & Dehar, T. (2016) · Patient Preference and Adherence · doi:10.2147/ppa.s110632 · Cited by 242
Side effects of antidepressants during long-term use in a naturalistic setting
Bet, P. M., Hugtenburg, J. G., Penninx, B. W. J. H., & Hoogendijk, W. J. G. (2013) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2013.05.001 · Cited by 239
The medicalisation of misery: A critical realist analysis of the concept of depression
Bentall, R. P. (1999) · Journal of Mental Health · doi:10.1080/09638239917427 · Cited by 239
Davidson, J. R. T., Pearlstein, T. B., Londborg, P. D., Brady, K. T., Rothbaum, B. O., Bell, J., Maddock, R. J., Hegel, M. T., & Farfel, G. M. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.12.1974 · Cited by 236
The Prophylactic Efficacy of Fluoxetine in Unipolar Depression
Montgomery, S. A., Dufour, H., Brion, S., Gailledreau, J., Laqueille, X., Ferrey, G., Morón, P., PARANT-LUCENA, N., Singer, L., Danion, J., et al. (1988) · The British Journal of Psychiatry · doi:10.1192/s0007125000297328 · Cited by 231
Wong, J., Motulsky, A., Abrahamowicz, M., Eguale, T., Buckeridge, D. L., & Tamblyn, R. (2017) · BMJ · doi:10.1136/bmj.j603 · Cited by 221
Kane, J. M. (1982) · Archives of General Psychiatry · doi:10.1001/archpsyc.1982.04290090053011 · Cited by 212
Fava, G. A., Benasi, G., Lucente, M., Offidani, E., Cosci, F., & Guidi, J. (2018) · Psychotherapy and Psychosomatics · doi:10.1159/000491524 · Cited by 209
[Solitary median maxillary central incisor syndrome:a case of report].
Kang, L.-Y., & Liu, X. (2014) · PubMed · Cited by 208
Strategies for discontinuing long-term benzodiazepine use: Meta-analysis
Voshaar, R. C. O., Couvée, J. E., Van Balkom, A. J. L. M., Mulder, P. G. H., & Zitman, F. G. (2006) · British Journal of Psychiatry · doi:10.1192/bjp.189.3.213 · Cited by 205
Placebo effect in the treatment of depression and anxiety
Kirsch, I. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00407 · Cited by 205
Reimherr, F. W., Amsterdam, J. D., Quitkin, F. M., Rosenbaum, J. F., Fava, M., Zajecka, J., Beasley, Jr., Michelson, D., Roback, P., & Sundell, K. (1998) · American Journal of Psychiatry · doi:10.1176/ajp.155.9.1247 · Cited by 204
Sertraline for Prevention of Depression Recurrence in Diabetes Mellitus
Lustman, P. J., Clouse, R. E., Nix, B. D., Freedland, K. E., Rubin, E. H., McGill, J. B., Williams, M. M., Gelenberg, A. J., Ciechanowski, P. S., & Hirsch, I. B. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.5.521 · Cited by 202
Recovery From Major Depression: A 10-Year Prospective Follow-up Across Multiple Episodes
Solomon, D. A. (1997) · Archives of General Psychiatry · doi:10.1001/archpsyc.1997.01830230033005 · Cited by 199
Montgomery, S. A., Kennedy, S. H., Burrows, G. D., Lejoyeux, M., & Hindmarch, I. (2004) · International Clinical Psychopharmacology · doi:10.1097/01.yic.0000137184.64610.c8 · Cited by 196
Paroxetine is better than placebo in relapse prevention and the prophylaxis of recurrent depression
Montgomery, S. A., & Dunbar, G. (1993) · International Clinical Psychopharmacology · doi:10.1097/00004850-199300830-00009 · Cited by 190
Maintenance Phase Efficacy of Sertraline for Chronic Depression A Randomized Controlled Trial
Keller, M. B. (1998) · JAMA · doi:10.1001/jama.280.19.1665 · Cited by 184
Biesheuvel-Leliefeld, K. E. M., Kok, G. D., Bockting, C. L. H., Cuijpers, P., Hollon, S. D., van Marwijk, H. W. J., & Smit, F. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.12.016 · Cited by 175
Guidi, J., Tomba, E., & Fava, G. A. (2016) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2015.15040476 · Cited by 167
Relapse and recurrence prevention in depression: Current research and future prospects
Beshai, S., Dobson, K. S., Bockting, C. L. H., & Quigley, L. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2011.09.003 · Cited by 165
Montgomery, S., Rasmussen, J., & Tanghøj, P. (1993) · International Clinical Psychopharmacology · doi:10.1097/00004850-199300830-00008 · Cited by 163
Treatment Indications for Antidepressants Prescribed in Primary Care in Quebec, Canada, 2006-2015
Wong, J., Motulsky, A., Eguale, T., Buckeridge, D. L., Abrahamowicz, M., & Tamblyn, R. M. (2016) · JAMA · doi:10.1001/jama.2016.3445 · Cited by 163
Reynolds, C. F., Frank, E., Perel, J. M., Imber, S. D., Cornes, C. L., Morycz, R. K., Mazumdar, S., Miller, M. D., Pollock, B. G., & Rifai, A. H. (1992) · American Journal of Psychiatry · doi:10.1176/ajp.149.12.1687 · Cited by 160
Wetherell, J. L., Petkus, A. J., White, K. S., Nguyen, H., Kornblith, S. J., Andreescu, C., Zisook, S., & Lenze, E. J. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.12081104 · Cited by 159
Georgotas, A., McCue, R. E., & Cooper, T. B. (1989) · Archives of General Psychiatry · doi:10.1001/archpsyc.1989.01810090025004 · Cited by 157
How Long Should the Elderly Take Antidepressants?
Old Age Depression Interest Group, Jacoby, R. J., Lunn, A. D., Ardern, M., Bergmann, K., Conway, J., Cooling, N. J., Davies, G., Fisk, J., Gehlhaar, E., et al. (1993) · The British Journal of Psychiatry · doi:10.1192/bjp.162.2.175 · Cited by 155
Batelaan, N. M., Bosman, R. C., Muntingh, A., Scholten, W. D., Huijbregts, K. M., & van Balkom, A. J. L. M. (2017) · BMJ · doi:10.1136/bmj.j3927 · Cited by 153
Continuation and maintenance treatments for depression in older people
Wilkinson, P., & Izmeth, Z. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006727.pub3 · Cited by 151
Munkholm, K., Paludan-Müller, A. S., & Boesen, K. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-024886 · Cited by 151
Glen, A. I. M., Johnson, A. L., & Shepherd, M. A. (1984) · Psychological Medicine · doi:10.1017/s0033291700003068 · Cited by 141
Antidepressant Utilization and Suicide in Europe: An Ecological Multi-National Study
Gusmão, R., Quintão, S., McDaid, D., Arensman, E., Van Audenhove, C., Coffey, C., Värnik, A., Värnik, P., Coyne, J., & Hegerl, U. (2013) · PLoS ONE · doi:10.1371/journal.pone.0066455 · Cited by 136
Kaymaz, N., van Os, J., Loonen, A. J. M., & Nolan, W. A. (2008) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v69n0910 · Cited by 135
Paroxetine in the Treatment of Generalized Social Phobia
Stein, M. B., Chartier, M., Hazen, A. L., Kroft, C. D. L., Chale, R. A., Cote, D. D., & Walker, J. R. (1996) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-199606000-00005 · Cited by 133
Prevention of relapse in generalized anxiety disorder by escitalopram treatment
Allgulander, C., Florea, I., & Huusom, A. K. T. (2005) · The International Journal of Neuropsychopharmacology · doi:10.1017/s1461145705005973 · Cited by 130
A cognitive neuropsychological model of antidepressant drug action
Pringle, A., Browning, M., Cowen, P. J., & Harmer, C. J. (2011) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2010.07.022 · Cited by 130
Bockting, C. L. H., Klein, N. S., Elgersma, H. J., van Rijsbergen, G. D., Slofstra, C., Ormel, J., Buskens, E., Dekker, J., de Jong, P. J., Nolen, W. A., et al. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30100-7 · Cited by 130
Efficacy and Tolerability of Paroxetine for the Long-Term Treatment of Generalized Anxiety Disorder
Stocchi, F., Nordera, G., Jokinen, R., Lepola, U. M., Hewett, K., Bryson, H., Iyengar, M. K., & Paroxetine Generalized Anxiety Disorder Study Team (2003) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v64n0305 · Cited by 128
Boulenger, J.-P., Loft, H., & Florea, I. (2012) · Journal of Psychopharmacology · doi:10.1177/0269881112441866 · Cited by 127
Bergh, S., Selbaek, G., & Engedal, K. (2012) · BMJ · doi:10.1136/bmj.e1566 · Cited by 124
Continuation and Maintenance Use of Antidepressants in Recurrent Depression
Bockting, C. L. H., ten Doesschate, M. C., Spijker, J., Spinhoven, P., Koeter, M. W. J., & Schene, A. H. (2008) · Psychotherapy and Psychosomatics · doi:10.1159/000110056 · Cited by 121
Maintenance Therapy for Chronic Depression: A Controlled Clinical Trial of Desipramine
Kocsis, J. H. (1996) · Archives of General Psychiatry · doi:10.1001/archpsyc.1996.01830090013002 · Cited by 121
Sheard, L., Wright, N. M. J., Adams, C. E., Bound, N., Rushforth, B., Hart, R., & Tompkins, C. N. E. (2009) · Trials · doi:10.1186/1745-6215-10-53 · Cited by 117
Keller, M. B., Trivedi, M. H., Thase, M. E., Shelton, R. C., Kornstein, S. G., Nemeroff, C. B., Friedman, E. S., Gelenberg, A. J., Kocsis, J. H., Dunner, D. L., et al. (2007) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v68n0812 · Cited by 116
Montgomery, S. A., Nil, R., Dürr-Pal, N., Loft, H., & Boulenger, J.-P. (2005) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v66n1009 · Cited by 115
Baldwin, D. S., Huusom, A. K. T., & Mæhlum, E. (2006) · British Journal of Psychiatry · doi:10.1192/bjp.bp.105.012799 · Cited by 114
Bockting, C. L. H., Spinhoven, P., Wouters, L. F., Koeter, M. W. J., Schene, A. H., & DELTA Study Group (2009) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.08m04784blu · Cited by 113
Stewart, J. W., Quitkin, F. M., McGrath, P. J., Amsterdam, J., Fava, M., Fawcett, J., Reimherr, F., Rosenbaum, J., Beasley, C., & Roback, P. (1998) · Archives of General Psychiatry · doi:10.1001/archpsyc.55.4.334 · Cited by 113
Incidence and determinants of long-term use of antidepressants
Meijer, W. E. E., Heerdink, E. R., Leufkens, H. G. M., Herings, R. M. C., Egberts, T. C. G., & Nolen, W. A. (2004) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-004-0726-3 · Cited by 112
Predictors of Relapse in a Prospective Study of Fluoxetine Treatment of Major Depression
McGrath, P. J., Stewart, J. W., Quitkin, F. M., Chen, Y., Alpert, J. E., Nierenberg, A. A., Fava, M., Cheng, J., & Petkova, E. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.9.1542 · Cited by 111
Prevalence, duration and indications for prescribing of antidepressants in primary care
Petty, D. R., House, A., Knapp, P., Raynor, T., & Zermansky, A. (2006) · Age and Ageing · doi:10.1093/ageing/afl023 · Cited by 110
Psychotropic drug prescriptions in western European nursing homes
Janus, S. I. M., van Manen, J. G., IJzerman, M. J., & Zuidema, S. U. (2016) · International Psychogeriatrics · doi:10.1017/s1041610216001150 · Cited by 110
Recognising and managing antidepressant discontinuation symptoms
Haddad, P. M., & Anderson, I. M. (2007) · Advances in Psychiatric Treatment · doi:10.1192/apt.bp.105.001966 · Cited by 109
Klysner, R., Bent-Hansen, J., Hansen, H. L., Lunde, M., Pleidrup, E., Poulsen, D. L., Andersen, M., & Petersen, H. E. H. (2002) · The British Journal of Psychiatry · doi:10.1192/bjp.181.1.29 · Cited by 106
Valuck, R. J., Orton, H. D., & Libby, A. M. (2009) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.08m04943 · Cited by 106
Reviewing long-term antidepressants can reduce drug burden: a prospective observational cohort study
Johnson, C. F., Macdonald, H. J., Atkinson, P., Buchanan, A. I., Downes, N., & Dougall, N. (2012) · British Journal of General Practice · doi:10.3399/bjgp12x658304 · Cited by 105
Nielsen, M., Hansen, E. H., & Gøtzsche, P. C. (2012) · Addiction · doi:10.1111/j.1360-0443.2011.03686.x · Cited by 103
Continuation Therapy with Amitriptyline in Depression
Coppen, A. J., Ghose, K., Montgomery, S., Rao, V. A. R., Bailey, J., & Jørgensen, A. (1978) · The British Journal of Psychiatry · doi:10.1192/bjp.133.1.28 · Cited by 103
A review of the management of antidepressant discontinuation symptoms
Wilson, E., & Lader, M. (2015) · Therapeutic Advances in Psychopharmacology · doi:10.1177/2045125315612334 · Cited by 103
Meta-analysis of relapse prevention antidepressant trials in depressive disorders
Glue, P., Donovan, M. R., Kolluri, S., & Emir, B. (2010) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048671003705441 · Cited by 100
Gorgels, W. J. M. J., Oude Voshaar, R. C., Mol, A. J. J., van de Lisdonk, E. H., van Balkom, A. J. L. M., van den Hoogen, H. J. M., Mulder, J., Breteler, M. H. M., & Zitman, F. G. (2005) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2004.09.001 · Cited by 100
The long-term course of depressive disorders in the Lundby Study
MATTISSON, C., BOGREN, M., HORSTMANN, V., MUNK-JÖRGENSEN, P., & NETTELBLADT, P. (2007) · Psychological Medicine · doi:10.1017/s0033291707000074 · Cited by 95
Family psychoeducation for major depression: randomised controlled trial
Shimazu, K., Shimodera, S., Mino, Y., Nishida, A., Kamimura, N., Sawada, K., Fujita, H., Furukawa, T. A., & Inoue, S. (2011) · British Journal of Psychiatry · doi:10.1192/bjp.bp.110.078626 · Cited by 95
Stein, D. J., Ahokas, A., Albarran, C., Olivier, V., & Allgulander, C. (2012) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.11m07493 · Cited by 94
Pigott, H. E. (2015) · The Canadian Journal of Psychiatry · doi:10.1177/070674371506000104 · Cited by 93
Maund, E., Dewar-Haggart, R., Williams, S., Bowers, H., Geraghty, A. W. A., Leydon, G., May, C., Dawson, S., & Kendrick, T. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.10.107 · Cited by 90
Self-citationMethodologic issues in maintenance therapy clinical trials
Greenhouse, J. B. (1991) · Archives of General Psychiatry · doi:10.1001/archpsyc.1991.01810280029004 · Cited by 89
Escitalopram Prevents Relapse in Older Patients With Major Depressive Disorder
Gorwood, P. A. P. M., Weiller, E., Lemming, O. M., & Katona, C. (2007) · American Journal of Geriatric Psychiatry · doi:10.1097/01.jgp.0000240823.94522.4c · Cited by 89
Follow-up of depressed women after maintenance treatment
Weissman, M. M., Kasl, S. V., & Klerman, G. L. (1976) · American Journal of Psychiatry · doi:10.1176/ajp.133.7.757 · Cited by 88
Liebowitz, M. R., Lam, R. W. M., Lepola, U. M., Datto, C. J., Sweitzer, D. E., & Eriksson, H. (2010) · Depression and Anxiety · doi:10.1002/da.20740 · Cited by 87
'Doing the right thing': factors influencing GP prescribing of antidepressants and prescribed doses
Johnson, C. F., Williams, B., MacGillivray, S. A., Dougall, N. J., & Maxwell, M. (2017) · BMC Family Practice · doi:10.1186/s12875-017-0643-z · Cited by 86
Safety of Abrupt Discontinuation of Fluoxetine: A Randomized, Placebo-Controlled Study
Zajecka, J., Fawcett, J., Amsterdam, J., Quitkin, F., Reimherr, F., Rosenbaum, J., Michelson, D., & Beasley, C. (1998) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-199806000-00003 · Cited by 85
Prophylactic effect of citalopram in unipolar, recurrent depression
Hochstrasser, B., Pm, I., Koponen, H., Lauritzen, L., Mahnert, F. A., Rouillon, F., Wade, A. G., Andersen, M. Ø., Pedersen, S. F., Swart, J. C. G. D., et al. (2001) · The British Journal of Psychiatry · doi:10.1192/bjp.178.4.304 · Cited by 85
Efficacy of Mirtazapine for Prevention of Depressive Relapse
Thase, M. E., Nierenberg, A. A., Keller, M. B., & John Panagides for the Relapse Prevention Study Group (2001) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v62n1006 · Cited by 85
Walker, J. R., Van Ameringen, M. A., Swinson, R., Bowen, R. C., Chokka, P. R., Goldner, E., Johnston, D. C., Lavallie, Y.-J., Nandy, S., Pecknold, J. C., et al. (2000) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-200012000-00009 · Cited by 84
Lépine, J.-P., Caillard, V., Bisserbe, J.-C., Troy, S., Hotton, J.-M., Boyer, P., & For the PREVERS Investigators (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.5.836 · Cited by 83
Managing antidepressant discontinuation: a systematic review
Maund, E., Stuart, B., Moore, M., Dowrick, C., Geraghty, A. W. A., Dawson, S., & Kendrick, T. (2019) · The Annals of Family Medicine · doi:10.1370/afm.2336 · Cited by 82
Self-citationBogetto, F., Bellino, S., Revello, R. B., & Patria, L. (2002) · CNS Drugs · doi:10.2165/00023210-200216040-00006 · Cited by 80
Clinical trials and the response rate illusion
Kirsch, I., & Moncrieff, J. (2007) · Contemporary Clinical Trials · doi:10.1016/j.cct.2006.10.012 · Cited by 80
Croft, H. A., Houser, T. L., Jamerson, B. D., Leadbetter, R. A., Watson, C. B., Donahue, R. M. J., & Metz, A. L. (2002) · Clinical Therapeutics · doi:10.1016/s0149-2918(02)85141-4 · Cited by 79
Sertraline treatment of panic disorder: results of a long-term study
Rapaport, M. H., Wolkow, R., Rubin, A., Hackett, E., Pollack, M. H., & Ota, K. Y. (2001) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2001.00263.x · Cited by 79
Sertraline treatment of panic disorder: results of a long-term study
Rapaport, M. H., Wolkow, R., Rubin, A., Hackett, E., Pollack, M., & Ota, K. Y. (2001) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2001.00263.x · Cited by 79
Kocsis, J. H., Schatzberg, A. F., Rush, A. J., Klein, D. N., Howland, R. H., Gniwesch, L., Thomas, S., & Harrison, W. M. (2002) · Archives of General Psychiatry · doi:10.1001/archpsyc.59.8.723 · Cited by 77
Erratum to The MOS 36-item short form health survey (SF-36): I. Conceptual framework
Ware, J. E., & Sherbourne, C. D. (1992) · PharmacoEconomics · doi:10.1007/bf03260127 · Cited by 77
Gelenberg, A. J., Trivedi, M. H., Rush, A. J., Thase, M. E., Howland, R., Klein, D. N., Kornstein, S. G., Dunner, D. L., Markowitz, J. C., Hirschfeld, R. M. A., et al. (2003) · Biological Psychiatry · doi:10.1016/s0006-3223(02)01971-6 · Cited by 76
Stewart, J. W., TRICAMO, E., McGrath, P. J., & Quitkin, F. M. (1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.1.31 · Cited by 75
Wilson, K. C. M., Mottram, P. G., Ashworth, L., & Abou-Saleh, M. T. (2003) · British Journal of Psychiatry · doi:10.1192/bjp.182.6.492 · Cited by 74
Robinson, D. S., Sc, L., Bennett, B., Laux, D. E., Devereaux, E., Kayser, A., CORCELLA, J., & ALBRIGHT, D. (1991) · PubMed · Cited by 74
Bushnell, J., McLeod, D. L., Dowell, A., et al. (2003) · PubMed · Cited by 73
van Geffen, E. C. G., Hugtenburg, J. G., Heerdink, E. R., van Hulten, R. P., & Egberts, A. C. G. (2005) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-005-0921-x · Cited by 72
Brett, J., Karanges, E. A., Daniels, B. J., Buckley, N. A., Schneider, C. R., Nassir, A., Zoëga, H., McLachlan, A. J., & Pearson, S. (2017) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867417721018 · Cited by 72
Hengartner, M. P. (2020) · Therapeutic Advances in Psychopharmacology · doi:10.1177/2045125320921694 · Cited by 72
Davidson, J., Wittchen, H., Llorca, P., Erickson, J., Detke, M., Ball, S., & Russell, J. M. (2008) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2008.05.002 · Cited by 71
Karkare, S. U., Bhattacharjee, S., Kamble, P., & Aparasu, R. (2011) · The American Journal of Geriatric Pharmacotherapy · doi:10.1016/j.amjopharm.2011.03.001 · Cited by 70
Venlafaxine Versus Placebo in the Preventive Treatment of Recurrent Major Depression
Montgomery, S., Entsuah, R., Hackett, D., Kunz, N. R., Rudolph, R. L., & Venlafaxine 335 Study Group (2004) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v65n0307 · Cited by 69
Bockting, C. L. H., Spinhoven, P., Koeter, M. W. J., Wouters, L. F., Visser, I., & Schene, A. H. (2006) · Psychotherapy and Psychosomatics · doi:10.1159/000092893 · Cited by 68
Kocsis, J. H., Thase, M. E., Trivedi, M. H., Shelton, R. C., Kornstein, S. G., Nemeroff, C. B., Friedman, E. S., Gelenberg, A. J., Dunner, D. L., Hirschfeld, R. M. A., et al. (2007) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v68n0706 · Cited by 67
Machmutow, K., Meister, R., Jansen, A., Kriston, L., Watzke, B., Härter, M. C., & Liebherz, S. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012855.pub2 · Cited by 67
Rodgers, M., Asaria, M., Walker, S., McMillan, D., Lucock, M. P., Harden, M., Palmer, S., & Eastwood, A. J. (2012) · Health Technology Assessment · doi:10.3310/hta16280 · Cited by 66
Terra, J.-L., & Montgomery, S. (1998) · PubMed · Cited by 66
Phenelzine for chronic depression: a study of continuation treatment.
Harrison, W. M., Rabkin, J. G., Stewart, J. W., McGrath, P. J., TRICAMO, E., & Quitkin, F. M. (1986) · PubMed · Cited by 65
Rickels, K., Etemad, B., Khalid-Khan, S., Lohoff, F. W., Rynn, M. A., & Gallop, R. J. (2010) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2010.170 · Cited by 63
Recurrence of depression after discontinuation of long-term amitriptyline treatment
(1982) · American Journal of Psychiatry · doi:10.1176/ajp.139.3.325 · Cited by 62
Ambresin, G., Palmer, V., Densley, K., Dowrick, C., Gilchrist, G., & Gunn, J. M. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.01.055 · Cited by 61
Kornstein, S. G., Bose, A., Li, D., Saikali, K. G., & Gandhi, C. (2006) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v67n1115 · Cited by 60
Fluoxetine in the Prevention of Depressive Recurrences: A Double-Blind Study
Gilaberte, I., Montejo, A. L., de la Gándara, J., Pérez, V., Bernardo, M., Massana, J., Martín‐Santos, R., Santiso, A., Noguera, R., Casais, L., et al. (2001) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-200108000-00009 · Cited by 59
Huijbers, M. J., Spinhoven, P., Spijker, J., Ruhé, H. G., van Schaik, D. J. F., van Oppen, P., Nolen, W. A., Ormel, J., Kuyken, W., van der Wilt, G. J., et al. (2016) · British Journal of Psychiatry · doi:10.1192/bjp.bp.115.168971 · Cited by 58
Eiring, Ø., Landmark, B. F., Aas, E., Salkeld, G., Nylenna, M., & Nytrøen, K. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-007848 · Cited by 57
Himei, A., & Okamura, T. (2006) · CNS Drugs · doi:10.2165/00023210-200620080-00005 · Cited by 56
Antidepressant tapering strips to help people come off medication more safely
Groot, P. C., & van Os, J. (2018) · Psychosis · doi:10.1080/17522439.2018.1469163 · Cited by 55
Michelson, D., Pollack, M. H., Lydiard, R. B., Tamura, R., Tepner, R. G., Tollefson, G. D., & The Fluoxetine Panic Disorder Study Group (1999) · The British Journal of Psychiatry · doi:10.1192/bjp.174.3.213 · Cited by 54
Maintenance Therapy With Fluoxetine in Posttraumatic Stress Disorder
Davidson, J. R. T., Connor, K. M., Hertzberg, M. A., Weisler, R. H., Wilson, W. H., & Payne, V. (2005) · Journal of Clinical Psychopharmacology · doi:10.1097/01.jcp.0000155817.21467.6c · Cited by 54
Antidepressant discontinuation in the context of cognitive behavioral treatment for panic disorder
Schmidt, N. B., Woolaway-Bickel, K., Trakowski, J. H., Santiago, H. T., & Vasey, M. W. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00003-1 · Cited by 53
Hengartner, M. P. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00275 · Cited by 53
Woolley, S. B., Cardoni, A. A., & Goethe, J. W. (2009) · Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy · doi:10.1592/phco.29.12.1408 · Cited by 52
Withdrawal of unnecessary antidepressant medication: a randomised controlled trial in primary care
Eveleigh, R. M., Muskens, E., Lucassen, P. L., Verhaak, P. F. M., Spijker, J., van Weel, C., Voshaar, R. C. O., & Speckens, A. E. M. (2017) · BJGP Open · doi:10.3399/bjgpopen17x101265 · Cited by 52
Legacy drug prescribing patterns in primary care
Mangin, D., Lawson, J., Cuppage, J., Shaw, E., Ivanyi, K., Davis, A., & Risdon, C. (2018) · The Annals of Family Medicine · doi:10.1370/afm.2315 · Cited by 51
Terra, J. L., & Montgomery, S. A. (1998) · International Clinical Psychopharmacology · doi:10.1097/00004850-199803000-00001 · Cited by 51
Ferguson, J. M., Khan, A., Mangano, R. M., Entsuah, R., & Tzanis, E. L. (2007) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v68n0108 · Cited by 50
Correlation between patient and clinician assessments of depression severity in the PREVENT study
Dunlop, B. W., Li, T., Kornstein, S. G., Friedman, E. S., Rothschild, A. J., Pedersen, R., Ninan, P. T., & Keller, M. B. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2010.02.008 · Cited by 50
Long-term Maintenance and Discontinuation of Imipramine Therapy in Panic Disorder With Agoraphobia
MAVISSAKALIAN, M. R., & Perel, J. M. (1999) · Archives of General Psychiatry · doi:10.1001/archpsyc.56.9.821 · Cited by 48
Cruickshank, G., MacGillivray, S. A., Bruce, D. G., Mather, A., Matthews, K., & Williams, B. (2008) · Discovery Research Portal (University of Dundee) · Cited by 48
Antidepressant withdrawal – the tide is finally turning
Hengartner, M. P., Davies, J., & Read, J. (2020) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796019000465 · Cited by 48
DeRubeis, R. J., Zajecka, J., Shelton, R. C., Amsterdam, J. D., Fawcett, J., Xu, C., Young, P. R., Gallop, R., & Hollon, S. D. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.3900 · Cited by 48
Eveleigh, R., Speckens, A., van Weel, C., Oude Voshaar, R., & Lucassen, P. (2019) · Therapeutic Advances in Psychopharmacology · doi:10.1177/2045125319872344 · Cited by 48
Flagged first, then by citations
14 of the 293 references couldn’t be matched to a known paper.
Research works printed but not linked: 13
- Eveleigh, 2018, Withdrawal of unnecessary antidepressant medication: a randomised controlled trial in primary care, British Journal of General Practice Open, 1, bjgpopen17X1012
- Huijbers MJ Data supplement to Huijbers et al. Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: randomised controlled non-inferiority trial British Journal of Psychiatry 2016 doi: 10.1192/bjp.bp.115.168971 · DOI · Paper page
- Kornstein, 2014, Influence of sex and menopausal status on response, remission, and recurrence in patients with recurrent major depressive disorder treated with venlafaxine extended release or fluoxetine: analysis of data from the PREVENT study, Journal of Clinical Psychiatry, 75, 62, 10.4088/JCP.12m07841 · DOI
- Mavissakalian, 1998, Gauging the effectiveness of extended imipramine treatment for panic disorder with agoraphobia, Biological Psychiatry, 43, 848–54, 10.1016/S0006-3223(97)00376-4 · DOI
- Mavissakalian, 1999, Long-term maintenance and discontinuation of imipramine therapy in panic disorder with agoraphobia, Archives of General Psychiatry, 56, 821, 10.1001/archpsyc.56.9.821 · DOI
- Streim, 2012, Antidepressant discontinuation associated with cognitive decline in older adult residents of long-term care facilities, American Journal of Geriatric Psychiatry, 1), S147
- Mangin D Dowson C Mulder R Wells E Toop L Dowell T The effectiveness of maintenanceSSRI treatment in primary care depression to prevent recurrence: multicentre double blinded placebo controlled RCT Proceedings of the 2015 North American Primary Care Research Group (NAPCRG) 43rd Annual Meeting 2015
- American Psychiatric Association Practice guideline for the treatment of patients with major depressive disorder dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm04 · DOI
- Beck, 1993, Beck Anxiety Inventory Manual
- Deeks JJ Higgins JP on behalf of the Cochrane Statistical Methods Group Chapter 9. Analysing data and undertaking meta-analyses. In: Higgins JPT, Churchill R, Chandler J, Cumpston MS (editors), Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017), Cochrane, 2017 Available from www.training.cochrane.org/handbook
- Van Weel-Baumgarten, 2012, The NHG guideline depression (second revision of the NHG guideline depressive disorder), Huisarts en Wetenschap, 55, 252
- Review Manager 5 (RevMan 5) Nordic Cochrane Centre, The Cochrane Collaboration 2014
- Rosenbaum, 1988, Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial, Biological Psychiatry, 44, 77, 10.1016/S0006-3223(98)00126-7 · DOI · Paper page
Cited by
Sorted by citations
Lam, R. W. M., Kennedy, S. H., Adams, G. C., Bahji, A., Beaulieu, S., Bhat, V., Blier, P., Blumberger, D. M., Brietzke, E. M., Chakrabarty, T., et al. (2024) · The Canadian Journal of Psychiatry · doi:10.1177/07067437241245384 · Cited by 435
Management of Depression in Adults: A Review
Simon, G. E., Moise, N., & Mohr, D. C. (2024) · JAMA · doi:10.1001/jama.2024.5756 · Cited by 234
Adverse Effects of Antidepressant Medications and their Management in Children and Adolescents
Strawn, J. R., Mills, J. A., Poweleit, E. A., Ramsey, L. B., & Croarkin, P. E. (2023) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/phar.2767 · Cited by 211
Sørensen, A., Ruhé, H. G., & Munkholm, K. (2022) · Molecular Psychiatry · doi:10.1038/s41380-021-01285-w · Cited by 65
“The potential utility of the dose/occupancy relationship in guiding tapering to mitigate withdrawal symptoms has received recent interest by multiple groups [11, 12, 15], and was considered in a recent Cochrane review on approaches to antidepressant discontinuation [14] and in a recent iteration of a major guideline o…”
BackgroundGastaldon, C., Schoretsanitis, G., Arzenton, E., Raschi, E., Papola, D., Ostuzzi, G., Moretti, U., Seifritz, E., Kane, J. M., Trifirò, G., et al. (2022) · Drug Safety · doi:10.1007/s40264-022-01246-4 · Cited by 68
“Second, when discontinuing antidepressants, clinicians should acknowledge the potential occurrence of withdrawal syndrome and recognise the corresponding symptoms, informing patients about this possibility and about any potential management strategies, instead of mainly focusing on the relapse risk [12].”
BackgroundInfluential
Metadata
- Authors
- Van Leeuwen, E., van Driel, M. L., Horowitz, M. A., Kendrick, T., Donald, M., De Sutter, A. I., Robertson, L., & Christiaens, T.
- Affiliations
- Clinical Pharmacology Unit, Department of Basic and Applied Medical Sciences; Ghent University; Ghent Belgium
- Department of Public Health and Primary Care; Ghent University; Ghent Belgium
- University College London (GB)
- University of Southampton (GB)
- The University of Queensland (AU)
- University of York (GB)
- Ghent University (BE)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2021-04-22
- Volume
- 2026
- Issue
- 8
- Pages
- CD013495-CD013495
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC8092632
- OpenAlex
- W3154690009
- Cited by
- 90
- References
- 293
- Citations by year
- 2026: 5 · 2025: 15 · 2024: 21 · 2023: 12 · 2022: 21 · 2021: 16
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
- ePrints Soton (University of Southampton) (submittedVersion)
- Funders
- Bond University
- National Institute for Health and Care Research
- Department of Health and Social Care
- Radboud Universiteit
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- antidepressant discontinuation, long-term antidepressant use, depression, anxiety disorders, antidepressant withdrawal symptoms, relapse, tapering, minimal intervention, adverse events, quality of life, social and occupational functioning, recurrent depression, adults, children, adolescents
- MeSH terms
- Drug Tapering, Adult, Antidepressive Agents, Anxiety Disorders, Depression, Humans, Quality of Life, Recurrence, Time Factors, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Withholding Treatment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-09-28, under version 3 of the claim definition (prompt extract-v3).
A second model labelled each claim on 2026-09-28 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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