Effective Strategies for Tapering Off Antidepressants Revealed

Antidepressants don't have to be taken forever, according to a new analysis published in The Lancet Psychiatry journal. Researchers in France and Italy conducted a rigorous review of 76 randomized trials involving over 17,000 participants.

They found that gradually reducing medication while continuing psychological support is as effective as remaining on antidepressants for preventing symptoms from returning in the short term. Giovanni Ostuzzi, the review's lead author and a professor at the University of Verona in Italy, emphasized that for many patients, tapering off antidepressants is feasible but should be discussed with a specialist.

The study defined slow tapering as reducing medication over a period longer than four weeks, with very slow tapering as anything over 12 weeks. The analysis indicated that this method, combined with psychological support such as therapy, could prevent one in five patients from relapsing compared to going cold turkey or tapering in under four weeks.

Co-author Debora Zaccoletti mentioned that safe alternative treatments like cognitive behavioural and mindfulness-based therapies could be promising even in the short-term. However, the authors cautioned that their findings do not imply antidepressants are unnecessary or that psychotherapy alone is sufficient.

They highlighted the need to tailor each strategy to the individual patient, focusing on developing cost-effective and scalable psychotherapy approaches. The study does have limitations, particularly regarding insufficient evidence on psychotherapy, as only about 20 percent of the trials explored anxiety, in contrast to 80 percent that focused on depression.

Experts not involved in the study advised caution, noting the proven effectiveness of antidepressants and the risk of relapse for individuals with a history of depressive episodes. Sameer Jauhar, a clinical associate professor in affective disorders and psychosis at Imperial College London, stated that long-term cohort data indicate that approximately 60 to 70 percent of individuals who experience a first episode of depression may have another episode over time.

He also pointed out that maintenance antidepressants can significantly reduce that risk. Therefore, while tapering with psychological support may work for some, many individuals may still require ongoing pharmacological treatment.