Stopping antidepressants safely
African Journal of Primary Health Care & Family Medicine
| Field | Value | |
| Title | Stopping antidepressants safely | |
| Creator | Horowitz, Mark Perry, Thomas L. | |
| Description | Long-term antidepressant pharmacotherapy is frequently continued beyond guideline-recommended durations. This occurs particularly among women, despite limited evidence of ongoing benefit for many people treated for mild-to-moderate depression and an increasing burden of adverse effects over time. In randomised trials, average symptom improvement over placebo is small (approximately 2 points on the 52-point Hamilton Depression Rating Scale), with an estimated number needed to treat of about 7–10 for a clinically meaningful benefit, underscoring the importance of planning for discontinuation once treatment is initiated. Antidepressant withdrawal is common yet under-recognised: at least half of people experience withdrawal symptoms when stopping, with risk and severity increasing with higher doses, longer duration of use and prior withdrawal experiences. This Therapeutic Letter outlines a practical, patient-centred approach to deprescribing that tailors tapering to individual risk, uses clinical response to guide the pace of reduction and emphasises careful differentiation of withdrawal symptoms from relapse. To minimise harms, abrupt discontinuation should be avoided; higher-risk patients may require very gradual tapering over months or years, often using hyperbolic dose reductions enabled by liquid formulations or dissolving tablets, with close follow-up every 2–4 weeks and the option to pause or reverse tapering if symptoms emerge. The guidance also highlights strategies for challenging presentations, including withdrawal-associated akathisia and protracted withdrawal, alongside patient education, shared decision-making and informed consent to support safer discontinuation and improved outcomes. | |
| Publisher | AOSIS | |
| Date | 2026-03-31 | |
| Identifier | 10.4102/phcfm.v18i1.5431 | |
| Source | African Journal of Primary Health Care & Family Medicine; Vol 18, No 1 (2026); 6 pages 2071-2936 2071-2928 | |
| Language | eng | |
| Relation |
The following web links (URLs) may trigger a file download or direct you to an alternative webpage to gain access to a publication file format of the published article:
https://phcfm.org/index.php/phcfm/article/view/5431/9131
https://phcfm.org/index.php/phcfm/article/view/5431/9132
https://phcfm.org/index.php/phcfm/article/view/5431/9133
https://phcfm.org/index.php/phcfm/article/view/5431/9137
https://phcfm.org/index.php/phcfm/article/view/5431/9134
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