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Managing Antidepressant Discontinuation: A Systematic Review.

Emma Maund1, Beth Stuart1, Michael Moore1

  • 1Primary Care & Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, United Kingdom.

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|January 24, 2019
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Summary

Cognitive behavioral therapy and mindfulness-based cognitive therapy aid antidepressant discontinuation without raising relapse risks. More scalable psychological support interventions are needed for effective antidepressant management.

Keywords:
antidepressantsdeprescribingdepressiondiscontinuation syndromemental healthprescribingprimary care

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Area of Science:

  • Psychiatry and Mental Health
  • Pharmacology
  • Evidence-Based Medicine

Background:

  • Antidepressant discontinuation can be challenging for patients.
  • Effective management strategies are crucial to minimize adverse outcomes.
  • Previous research has explored various interventions for managing antidepressant discontinuation.

Purpose of the Study:

  • To evaluate the effectiveness of interventions for managing antidepressant discontinuation.
  • To assess patient outcomes associated with antidepressant discontinuation interventions.

Main Methods:

  • Systematic review with narrative synthesis and meta-analysis of studies up to March 2017.
  • Included randomized controlled trials, quasi-experimental, and observational studies.
  • Primary outcomes: antidepressant discontinuation and discontinuation symptoms; Secondary outcomes: relapse/recurrence, quality of life, and functional outcomes.

Main Results:

  • Twelve studies involving 8 randomized controlled trials, 2 single-arm trials, and 2 retrospective cohort studies were synthesized.
  • Psychological or psychiatric treatment combined with tapering achieved cessation rates of 40% to 95%.
  • Cognitive behavioral therapy plus tapering showed a lower risk of relapse/recurrence (15%–25%) compared to clinical management plus tapering (35%–80%).

Conclusions:

  • Cognitive behavioral therapy and mindfulness-based cognitive therapy can facilitate antidepressant discontinuation without increasing relapse risk.
  • These psychological interventions are effective but resource-intensive.
  • There is a need for more scalable interventions that incorporate psychological support for antidepressant discontinuation.