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Meta-Analysis
. 2019 Jan;17(1):52-60.
doi: 10.1370/afm.2336.

Managing Antidepressant Discontinuation: A Systematic Review

Emma Maund  1 , Beth Stuart  1 , Michael Moore  1 , Christopher Dowrick  2 , Adam W A Geraghty  1 , Sarah Dawson  3 , Tony Kendrick  4
Affiliations
Meta-Analysis

Managing Antidepressant Discontinuation: A Systematic Review

Emma Maund et al. Ann Fam Med. 2019 Jan.

Abstract

Purpose: We aimed to determine the effectiveness of interventions to manage antidepressant discontinuation, and the outcomes for patients.

Methods: We conducted a systematic review with narrative synthesis and meta-analysis of studies published to March 2017. Studies were eligible for inclusion if they were randomized controlled trials, quasi-experimental studies, or observational studies assessing interventions to facilitate discontinuation of antidepressants for depression in adults. Our primary outcomes were antidepressant discontinuation and discontinuation symptoms. Secondary outcomes were relapse/recurrence; quality of life; antidepressant reduction; and sexual, social, and occupational function.

Results: Of 15 included studies, 12 studies (8 randomized controlled trials, 2 single-arm trials, 2 retrospective cohort studies) were included in the synthesis. None were rated as having high risk for selection or detection bias. Two studies prompting primary care clinician discontinuation with antidepressant tapering guidance found 6% and 7% of patients discontinued, vs 8% for usual care. Six studies of psychological or psychiatric treatment plus tapering reported cessation rates of 40% to 95%. Two studies reported a higher risk of discontinuation symptoms with abrupt termination. At 2 years, risk of relapse/recurrence was lower with cognitive behavioral therapy plus taper vs clinical management plus taper (15% to 25% vs 35% to 80%: risk ratio = 0.34; 95% CI, 0.18-0.67; 2 studies). Relapse/recurrence rates were similar for mindfulness-based cognitive therapy with tapering and maintenance antidepressants (44% to 48% vs 47% to 60%; 2 studies).

Conclusions: Cognitive behavioral therapy or mindfulness-based cognitive therapy can help patients discontinue antidepressants without increasing the risk of relapse/recurrence, but are resource intensive. More scalable interventions incorporating psychological support are needed.

Keywords: antidepressants; deprescribing; depression; discontinuation syndrome; mental health; prescribing; primary care.

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Figures

Figure 1
Figure 1
Flowchart of study selection.
See this image and copyright information in PMC

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