The best way for people with depression to stop taking antidepressants once their condition improves is to slowly taper off the medication while also receiving psychological support, new research suggested Thursday.
More than 5% of the global population is estimated to suffer from depression, according to the World Health Organization (WHO), and a range of drugs to treat the condition have been widely prescribed for decades.
But how exactly to stop taking these drugs has proved a difficult problem.
"As soon as an antidepressant is changed or reduced, it is a source of anxiety for the person," Christine Villelongue, co-head of the France Depression association, told Agence France-Presse (AFP).
However, "there are no guidelines: very often, when medication is stopped, there is no follow-up," she added.
In recent years, a process called "deprescribing," which gradually reduces the dose, has gained traction with psychiatrists concerned about overprescription, long-term side effects, withdrawal symptoms or the risk of a relapse.
Now, a large-scale study has been published in The Lancet Psychiatry journal evaluating the available evidence across 76 different randomized controlled trials, which included 17,000 people.
It found that the most effective way for a patient to stop taking antidepressants was to gradually lower the dosage, alongside seeing a psychologist.
Compared to suddenly stopping or tapering off too quickly, this recommendation could prevent a relapse in one out of every five patients, the study said.
The worst option, in all cases, was abruptly stopping.
"Our findings suggest that while antidepressants are effective in preventing depressive relapses, they do not need to be a long-term treatment for everyone," study co-author Debora Zaccoletti from Italy's University of Verona said in a statement.
However, some specialists urged caution.
"Even with very slow tapering, discontinuation of antidepressant therapy continues to be associated with risk of relapse," Jonathan Henssler of Charite Berlin university hospital said in a linked comment.
The study, therefore, highlights the "benefit of psychotherapy," he added.
French psychiatrist Maeva Musso emphasised that getting off antidepressants was too often overlooked.
"Throughout my residency, which I only recently completed, this topic was never addressed," she told AFP.
When patients "express a desire to reduce their medication, it is still often interpreted by the medical community as a denial of their disorder," Musso added.
However, Villelongue pointed out that the psychological support called for by the research is not a realistic option for everyone.
The study's conclusions are based "on an ideal world, but the reality on the ground is quite different," she said.
"Sometimes the psychiatrist is unavailable – you go a month or two without seeing them," she said.
"In the meantime, if the person is tapering off medication and is struggling, they have no one to talk to."
