Slow Supported Antidepressant Taper Matches Continuation for Depression Relapse Prevention
Key Clinical Summary
- A large systematic review and network meta-analysis of 76 trials (17,379 adults) compared antidepressant deprescribing strategies in remitted depression or anxiety.
- Slow tapering plus psychological support and continuation therapy significantly reduced relapse risk versus abrupt or rapid discontinuation.
- Fast tapering, abrupt stopping with support, and slow tapering alone did not demonstrate relapse-prevention benefits over abrupt discontinuation.
A new systematic review and network meta-analysis of 76 randomized trials has found that slow antidepressant tapering combined with psychological support is as effective as continuation therapy in preventing relapse in adults with remitted depression, while abrupt or rapid discontinuation significantly increases relapse risk. Published in The Lancet Psychiatry, the study assessed relapse outcomes associated with various tapering approaches, continuation therapy, and psychological support.
Study Findings
Across 17,379 participants (mean age 45.2 years; 67.5% female), most studies focused on depression (79%), with the remainder on anxiety disorders. Participants were predominantly White (87.9%), and mean follow-up was 45.9 weeks.
Multiple strategies substantially outperformed abrupt discontinuation for relapse prevention. Continuation at standard dose plus psychological support showed the strongest effect (relative risk [RR] 0.40; 95% CI 0.26–0.61; number needed to treat [NNT] 4.3; moderate certainty). Continuation at standard dose alone was also protective (RR 0.51; 0.46–0.58; NNT 5.3; moderate certainty), as was slow tapering plus psychological support (RR 0.52; 0.38–0.72; NNT 5.4; moderate certainty). A reduced-dose continuation strategy also conferred benefit (RR 0.62; 0.42–0.92; NNT 6.8; low certainty).
These approaches similarly outperformed fast tapering, with point estimates between 0.39 and 0.52. In contrast, several strategies failed to show meaningful relapse prevention versus abrupt discontinuation: fast tapering with psychological support (RR 0.52; 0.27–1.01; low certainty), abrupt stopping with psychological support (RR 0.73; 0.30–1.78; very low certainty), and slow tapering alone (RR 0.81; 0.56–1.18; low certainty).
Sensitivity and subgroup analyses aligned with the main findings, and tolerability was similar across all strategies.
Clinical Implications
For adults with remitted depression, the findings reinforce that gradual tapering combined with structured psychological support can achieve relapse-prevention outcomes comparable to antidepressant continuation, an important insight amid concerns about long-term use and overprescribing.
Conversely, rapid or unsupported tapering may leave patients vulnerable to relapse. The data offer clinicians a more evidence-based framework for deprescribing conversations, emphasizing the need for personalized planning, adequate follow-up, and access to psychological support services.
Expert Commentary
While the findings may offer guidance on effective deprescribing strategies, the data “do not provide definitive insights into the optimal antidepressant treatment duration before discontinuation, nor do they clarify the burden of withdrawal symptoms,” noted Debora Zaccoletti, PsyD, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, and study coauthors.
The researchers emphasized that future randomized controlled trials should investigate the comparative effectiveness of personalized tapering strategies, implement validated tools to assess withdrawal, evaluate psychological interventions that are designed specifically for relapse prevention, and provide longer follow-up.