Managing antidepressant discontinuation: a systematic review
Open accessAbstract
PURPOSE: We aimed to determine the effectiveness of interventions to manage antidepressant discontinuation, and the outcomes for patients. METHODS: We conducted a systematic review with narrative synthesis and meta-analysis of studies published to March 2017. Studies were eligible for inclusion if they were randomized controlled trials, quasi-experimental studies, or observational studies assessing interventions to facilitate discontinuation of antidepressants for depression in adults. Our primary outcomes were antidepressant discontinuation and discontinuation symptoms. Secondary outcomes were relapse/recurrence; quality of life; antidepressant reduction; and sexual, social, and occupational function. RESULTS: Of 15 included studies, 12 studies (8 randomized controlled trials, 2 single-arm trials, 2 retrospective cohort studies) were included in the synthesis. None were rated as having high risk for selection or detection bias. Two studies prompting primary care clinician discontinuation with antidepressant tapering guidance found 6% and 7% of patients discontinued, vs 8% for usual care. Six studies of psychological or psychiatric treatment plus tapering reported cessation rates of 40% to 95%. Two studies reported a higher risk of discontinuation symptoms with abrupt termination. At 2 years, risk of relapse/recurrence was lower with cognitive behavioral therapy plus taper vs clinical management plus taper (15% to 25% vs 35% to 80%: risk ratio = 0.34; 95% CI, 0.18-0.67; 2 studies). Relapse/recurrence rates were similar for mindfulness-based cognitive therapy with tapering and maintenance antidepressants (44% to 48% vs 47% to 60%; 2 studies). CONCLUSIONS: Cognitive behavioral therapy or mindfulness-based cognitive therapy can help patients discontinue antidepressants without increasing the risk of relapse/recurrence, but are resource intensive. More scalable interventions incorporating psychological support are needed.
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Maund 2019 found no difference in recurrence or quality of life between MBCT plus tapering and maintenance antidepressants across two studies.
“They found no difference in recurrence or quality of life between MBCT and tapering versus maintenance antidepressants treatment (2 studies).”
From Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (2021) · cites this paper as Maund 2019
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)
Experimental — accuracy not yet measuredMaund 2019 included observational studies and excluded placebo-controlled trials.
“Maund 2019 included observational studies and excluded placebocontrolled trials.”
From Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (2021) · cites this paper as Maund 2019
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)
Experimental — accuracy not yet measuredMaund 2019 concluded that prompting general practitioners to review long-term antidepressant users was not effective for discontinuation, based on one RCT and one uncontrolled trial.
“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).”
From Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (2021) · cites this paper as Maund 2019
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)
Experimental — accuracy not yet measuredMaund 2019 found higher risk of withdrawal symptoms with abrupt discontinuation compared with tapering in two studies.
“Maund 2019 found higher risk of withdrawal symptoms with abrupt discontinuation compared with tapering in two studies (one RCT and one retrospective cohort study)”
From Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (2021) · cites this paper as Maund 2019
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)
Experimental — accuracy not yet measuredThis review could not confirm Maund 2019's finding of higher withdrawal symptom risk with abrupt discontinuation versus tapering.
“but we could not confirm this finding”
From Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (2021) · cites this paper as Maund 2019
Experimental — accuracy not yet measured
The finding from Maund 2019 that prompting general practitioners to review long-term antidepressant users was not effective for discontinuation agrees with this review's findings.
“This finding is consistent with the findings of our review.”
From Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (2021) · cites this paper as Maund 2019
Experimental — accuracy not yet measuredIn Maund 2019, discontinuation rates in intervention groups varied from 6% to 95% across eight studies.
“The discontinuation rate in the discontinuation intervention group was reported in eight studies and varied widely, from 6% to 95%.”
From Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (2021) · cites this paper as Maund 2019
There is a paucity of evidence for specific tapering regimens.
“Given the paucity of evidence for specific tapering regimens [13, 14]”
From The relationship between dose and serotonin transporter occupancy of antidepressants—a systematic review (2022) · cites this paper as [13]
Prior academic literature has paid scant attention to antidepressant tapering, focusing primarily on starting medication.
“Overall, there has been scant attention paid to the issue of antidepressant tapering previously in the academic literature,48,53–56 which has been focused primarily on starting medication.57”
The focus on targeted psychological support during withdrawal is consistent with a recent systematic review on managing withdrawal from antidepressants.
“The focus on targeted psychological support during withdrawal is consistent with a recent systematic review on managing withdrawal from antidepressants’.37”
From A survey of UK general practitioners about depression, antidepressants and withdrawal: implementing the 2019 Public Health England report (2020) · cites this paper as [37]
The evidence base for recommendations of short periods of tapering or no tapering is unclear.
“but the evidence base for such recommendations is unclear.”
From Clinical practice guideline recommendations on tapering and discontinuing antidepressants for depression: a systematic review (2022) · cites this paper as [19]
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- Authors
- Maund, E., Stuart, B., Moore, M., Dowrick, C., Geraghty, A. W. A., Dawson, S., & Kendrick, T.
- Affiliations
- University of Southampton (GB)
- University of Liverpool (GB)
- University of Bristol (GB)
- ORCID
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2019-01
- Volume
- 17
- Issue
- 1
- Pages
- 52-60
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC6342590
- OpenAlex
- W2911553263
- Semantic Scholar
- 1284ecba42695a4e6dee667ecf65498ceb796397
- Cited by
- 82
- References
- 64
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 11 · 2023: 15 · 2022: 11 · 2021: 17 · 2020: 13 · 2019: 3
- FWCI
- 1.41
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion, other-oa)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Bristol Research (University of Bristol) (submittedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (RP-PG-1214-20004)
- University College London
- Programme Grants for Applied Research (RP-PG-1214-20004)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- antidepressant discontinuation, depression, antidepressant tapering, discontinuation symptoms, relapse and recurrence, cognitive behavioral therapy, mindfulness-based cognitive therapy, primary care, quality of life
- MeSH terms
- Antidepressive Agents, Depression, Humans, Recurrence, Withholding Treatment
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