SLOWLY tapering off antidepressants, combined with psychological support, could help prevent depression relapse to a similar extent as remaining on antidepressants, according to a large review published in Lancet Psychiatry.
The authors emphasised that these findings do not suggest that antidepressants are unnecessary, or that psychotherapy alone is adequate, but highlight the importance of tailoring deprescribing to each individual.
The team analysed 76 randomised controlled trials representing over 17,000 adults and found slow tapering antidepressants (reducing the dosage over more than four weeks) combined with psychological support is more effective than quickly tapering off (over less than four weeks) or suddenly stopping the medication.
While more research is needed, the team added this slow tapering method with support could prevent one relapse in every five people when compared with the other methods.
Evidence-based guidelines for moderate-to-severe depression typically recommend that antidepressants be taken for six to 12 months after a first episode, or for up to two years in people who have experienced multiple recurring episodes or have specific risk factors for relapse.
However, overprescribing, long-term use, and withdrawal symptoms after discontinuation, are common issues, as a recent analysis of Australian PBS data demonstrated (PD 04 Dec).
"Depression is often a recurring condition and without ongoing treatment as many as three out of four people with recurrent depression relapse at some point," said lead author Professor Giovanni Ostuzzi from the University of Verona in Italy.
"Yet in everyday practice, treatment is often prolonged far beyond what guidelines suggest.
"Our new review clarifies the scientific evidence about the most effective way to come off antidepressants for individuals successfully treated for depression and could change how coming off antidepressants is managed globally," he concluded.
Read the paper HERE. KB
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