Gradually reducing the dose of antidepressants, together with psychological support, can be as effective in preventing depression relapse as continuing medication treatment. Researchers reached this conclusion after analyzing the results of 79 randomized clinical trials. The study was published in the journal The Lancet Psychiatry.
As the authors emphasized, this does not mean that antidepressants are unnecessary. On the contrary, research confirms their effectiveness. However, for some patients who have successfully achieved remission and wish to stop treatment because of side effects or a desire to avoid long-term medication use, safe alternative strategies exist. A key requirement is gradual dose reduction combined with psychological support.
The meta-analysis included data from 17,379 adults who had achieved partial or full remission from depression or anxiety disorders and were followed for an average of about one year. The researchers compared five strategies: abrupt discontinuation of antidepressants (with replacement by a placebo), rapid dose reduction (four weeks or less), slow dose reduction (more than four weeks), dose reduction without full discontinuation, and continuation of standard therapy.
Two of the strategies showed the best outcomes: slow dose reduction with psychological support and continuation of antidepressants at the standard dose. Both approaches prevented relapse with comparable effectiveness.
According to the authors’ calculations, gradual tapering of antidepressants prevents one relapse for every five individuals compared with abrupt discontinuation or rapid dose reduction.
Interestingly, even reduced doses were more effective than abrupt discontinuation. The inclusion of psychotherapy improved outcomes across all treatment options, although the quality of evidence in this area remains low.
While no significant differences in side effects were found between strategies, the researchers noted a lack of data on symptoms and on the impact of different approaches on quality of life.
According to the study authors, the conclusion is clear: antidepressants are effective, but not everyone needs to take them for years. If discontinuation is desired, it should be done gradually and always under professional supervision.
