Slowly reducing the dosage of antidepressants while continuing psychotherapy, can help prevent symptoms from returning, a comprehensive new study found.
Antidepressants don’t have to be taken forever, a new analysis suggests.
Every year, a growing number of people across Europe take antidepressants to help treat symptoms related to depression and anxiety. While current guidelines recommend they stay on these medications for six to nine months after their initial symptoms disappear, treatment is often prolonged far beyond that.
Additionally, the fear of relapsing keeps many patients on these drugs – even if they experience troublesome long-term side effects, such as sexual dysfunction or emotional blunting, the inability to fully experience both positive and negative emotions.
To help patients and psychologists make informed decisions about stopping antidepressants, a group of researchers in France and Italy put together what they say is the most rigorous review of the issue yet, which they published this week in The Lancet Psychiatry journal.
After looking at 76 randomised trials – representing over 17,000 participants – they found that gradually reducing medication while continuing psychological support “appears to be as effective as remaining on antidepressants” for preventing symptoms from returning in the short term.
The researchers said the findings could change how people come off antidepressants across the globe.
“For probably the majority of patients, coming off antidepressants is feasible, but this should be discussed with a specialist and the best possible strategies should be tailored to the individual characteristics of each person,” Giovanni Ostuzzi, the review’s lead author and a professor at the University of Verona in Italy, said during a press briefing.
Two major factors for success
The analysis focused on what it took to prevent relapse in the first year after a patient stopped antidepressants. Deciding factors included how long it took to reduce the dosage and whether patients received psychological support during the process, the review found.
The authors defined slow tapering as coming off medication over a period longer than four weeks, with “very slow tapering” as anything over 12 weeks.
They estimated that slow tapering of antidepressants plus psychological support such as therapy could prevent one in five patients from relapsing, compared with going cold turkey, or tapering the dosage in under four weeks.
These findings offer a window of hope for patients who feel they’ve recovered from their depression and would like to try living without medication, researchers said.
“Safe alternative treatments like psychological support, including cognitive behavioural and mindfulness-based therapies, can be a promising tool – even in the short-term,” co-author Debora Zaccoletti from the University of Verona said in a statement.
However, the authors emphasised that the findings do not suggest that antidepressants are unnecessary or that psychotherapy alone is enough.
Instead, they underlined the importance of tailoring each strategy to the individual patient, and developing psychotherapy approaches that are both cost-effective and scalable.
Limitations and warnings from experts
The study has some limitations, namely due to insufficient evidence on psychotherapy, which the authors said requires further study.
They also stressed that the evidence for anxiety was less robust than depression – only around 20 per cent of the included trials explored anxiety, compared to around 80 per cent which focused on depression.
Experts who were not involved in the study urged caution when interpreting the results, highlighting the proven effectiveness of antidepressants – and the real risk of relapse for people who have already had depressive episodes.
“We know from long-term cohort data that roughly 60 to 70 per cent of people who have a first episode of depression will have a further episode over time, and good continuation trials suggest that maintenance antidepressants roughly halve that risk,” said Sameer Jauhar, a clinical associate professor in affective disorders and psychosis at Imperial College London.
“Those data therefore do not show that psychological support can replace maintenance medication; they show that carefully supported tapering works for some, while many still need ongoing pharmacological treatment,” he added.
