Adults who have recovered from depression may safely discontinue antidepressants through a slow, individualized taper paired with psychological support, according to the largest review to date of deprescribing strategies. The findings, published in The Lancet Psychiatry, suggest this approach is as effective as staying on medication to prevent relapse.
Researchers analyzed 76 randomized controlled trials and found that gradual tapering combined with structured therapy offered the best outcomes for people seeking to stop antidepressants. The authors stress, however, that the results do not mean antidepressants are unnecessary or that psychotherapy alone is sufficient. Instead, the study underscores the need for tailored plans that consider each patient’s history and preferences.
“Depression often recurs, and without treatment up to three-quarters of people with recurrent depression relapse,” said lead author Professor Giovanni Ostuzzi of the University of Verona. “Guidelines advise continuing antidepressants for a period after remission before considering discontinuation, yet in practice treatment often extends beyond recommendations. Many people want to stop long-term medication or struggle with side effects, but we have lacked solid evidence on the safest and most effective ways to do that.”
Ostuzzi said the review expands the evidence base by including a wider range of tapering strategies and direct comparisons between them. “This could reshape how antidepressant discontinuation is managed worldwide,” he added. He urged patients to discuss tapering plans with their doctors to identify the most appropriate approach.
Concerns About Long-Term Use
Guidelines for moderate-to-severe depression and anxiety typically recommend antidepressants for six to nine months after a first episode, and up to two years for people with recurrent illness or high relapse risk. But rising concern about overprescribing, long-term dependence, and withdrawal symptoms has increased pressure for evidence-based deprescribing strategies.
What the New Analysis Found
The review examined data from more than 17,000 adults with remitted or partially remitted depression or anxiety who had been treated primarily with SSRIs or SNRIs. Participants were monitored for roughly 10 to 11 months.
The analysis compared five strategies:
- Abrupt discontinuation
- Fast tapering (four weeks or less)
- Slow tapering (more than four weeks)
- Dose reduction (50% or less of the minimally effective dose)
- Continuing medication
Slow tapering paired with psychological support was one of the two most effective strategies for preventing relapse—offering protection similar to staying on a full-dose antidepressant. The researchers estimated that this approach could prevent one relapse for every five people compared with abrupt stopping or rapid tapering, the least effective methods.
Dose reduction also outperformed sudden stopping and fast tapering, although the supporting evidence was weaker. Psychological support enhanced outcomes across all tapering strategies, but the evidence quality for this finding varied.
Side effects and dropout rates were similar across all methods. Data on withdrawal symptoms, quality of life, and social functioning were limited.
Implications for Anxiety and Clinical Practice
Evidence related specifically to anxiety disorders was less robust, and researchers said dedicated trials are needed.
“Antidepressants help prevent relapse, but they are not always required long-term,” said co-author Dr. Debora Zaccoletti. She noted that short-term psychological interventions—including cognitive behavioral and mindfulness-based therapies—can offer safe alternatives, though greater investment is needed to expand access to such treatments.
Zaccoletti said the findings support updating clinical guidelines to prioritize routine treatment reviews and individualized deprescribing plans that include gradual tapering and structured psychological support.
Expert Perspective
In an accompanying commentary, Dr. Jonathan Henssler of Charité–Universitätsmedizin Berlin said the clearest result from the review was the benefit of psychological support, regardless of the pharmacological strategy used. He also emphasized that the most favorable outcomes occurred when patients continued antidepressant therapy.
“This is a reminder of how severe and chronic depression can be,” Henssler wrote. While minimizing medication duration is ideal, he noted that both antidepressants and psychotherapy have limited ability to fully prevent relapse on their own.
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