Stopping antidepressants: when and how

One in seven Australians takes an antidepressant, with around half taking them long-term (over 12 months). Unnecessarily prolonged antidepressant use should be avoided because of the risk of adverse effects. A thorough mental health and medication history should inform whether it is appropriate to attempt to stop an antidepressant. The time to stop may be when the recommended duration of therapy is complete and there is no clinical indication for continued use, or where there are adverse effects that outweigh the benefits. Stopping antidepressants abruptly may precipitate withdrawal symptoms. Withdrawal symptoms may be more likely with longer duration of therapy and with certain antidepressants, such as duloxetine, venlafaxine and paroxetine. Slowly decreasing the antidepressant dose (tapering) can help to minimise withdrawal symptoms. The optimal antidepressant tapering approach is not yet known. Tapering usually involves decreasing the antidepressant dose in smaller decrements as the dose is lowered. In patients at low risk of withdrawal symptoms, guidelines recommend 25 to 50% dose reductions over 2 to 6 weeks (e.g. sertraline 100 mg tapered at 2-weekly intervals to 50 mg, 25 mg, then stop). In patients at higher risk of withdrawal symptoms, and those who have experienced difficulty stopping, smaller dose reductions over many weeks or months, through to very low drug doses (e.g. sertraline 1 mg), may be necessary; this may require compounded or liquid 'mini doses'.