If you’re thinking about getting off antidepressants, the most effective approach is to taper off slowly while continuing therapy, according to a new research review involving more than 17,000 adults.
Published this week in Lancet Psychiatry, the findings show that this approach could provide “meaningful benefit” compared with stopping medications abruptly or tapering quickly.
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The studies in the research review showed that slow tapering limited new episodes of depression or anxiety in 1 out of every 5 individuals — a success rate similar to continuing with antidepressants.
“The key message of our study is that the way people stop antidepressants makes a substantial difference in their risk of relapse,” says Giovanni Ostuzzi, MD, PhD, a coauthor of the study and a psychiatry professor at the University of Verona in Italy.
Support Makes All the Difference
To evaluate different strategies for getting off antidepressants, scientists reviewed findings from nearly 80 studies involving about 17,000 adults who were prescribed antidepressants and were either fully or partially in remission from their depressive or anxiety disorder. Participants were 45 years old on average, two-thirds were female, and nearly 9 out of 10 were white.
Most were taking either a selective serotonin reuptake inhibitor (SSRI) or a serotonin and norepinephrine reuptake inhibitor (SNRI).
Common SSRIs include:
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Citalopram (Celexa)
SNRIs include:
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
- Desvenlafaxine (Pristiq)
Researchers followed study participants for an average of 10 to 11 months, comparing the effects of different approaches to medication, both with and without therapy:
- Abrupt discontinuation
- Fast tapering (completed in four weeks or less)
- Slow tapering (taking more than four weeks)
- Dose reduction (cutting back by half or more, to the minimum effective dose)
- Staying on the antidepressant
Dr. Ostuzzi and his team noted the following after an average of 10 to 11 months of follow-up:
Best treatment to prevent symptom relapse: Continue an antidepressant at a standard dose plus therapy.
Next best treatments to prevent relapse: Continuing the antidepressant without therapy and slowly tapering with therapy both reduced the risk by about half.
Least effective at preventing relapse: Abrupt stoppage and fast tapering were both tied to a roughly 40 percent risk of relapse.
The authors said the quality of evidence was rather poor for slow tapering alone, and they couldn’t demonstrate a clear benefit. Ostuzzi says, however, that pairing slow tapering with therapy made a “meaningful difference.”
What Does a Slow Taper Mean?
In this study, slow tapering was a gradual reduction in antidepressant dosage over the course of four weeks or more. The study authors wrote that in practice, easing off these medications can likely take months, rather than weeks.
Bryan Shapiro, MD, MPH, an assistant professor of psychiatry and human behavior at the University of California Irvine School of Medicine, says the common guidance for slow tapering is to cut dosage by 10 to 25 percent each month to give brain and body time to adapt.
“You need to go extremely slow in order to meaningfully reduce the risk of withdrawal symptoms and relapse,” says Dr. Shapiro, who was not involved in the study.
What Does Psychological Support Look Like?
For Ken Duckworth, MD, a psychiatrist and the chief medical officer for the National Alliance on Mental Illness, this bit-by-bit method aligns with his techniques for weaning patients off antidepressants.
“It’s like landing an airplane,” says Dr. Duckworth, who was not involved in the research. “You descend slowly; nothing is done abruptly. It was reassuring that the study affirmed my process. You taper off and you spend time with the patient, talking through potential implications and discussing early warning signs of relapse.”
In the trials reviewed for this research, psychological support took the form of short-term interventions lasting about 8 to 10 weeks. These consisted of different types of cognitive behavioral therapy, which often involves talking with a therapist to change unhelpful thinking patterns and identify behaviors that affect mood and stress.
According to Ostuzzi, these therapy interventions typically help individuals:
- Understand personal relapse triggers
- Recognize early relapse symptoms
- Build practical strategies to maintain well-being
- Feel more confident and stable as medication is reduced
How Do You Know if You’re Ready to Stop Antidepressants?
Many people do not wish to stay on antidepressants indefinitely, and some experience troublesome side effects from taking these drugs, including nausea, insomnia, weight changes, and sexual dysfunction.
Deciding when to stop taking antidepressants requires careful consideration with a medical professional, according to Shapiro. He recommends asking yourself these questions, along with getting input from a doctor.
Be On the Lookout for Trouble Signs
Shapiro warns patients who are tapering off antidepressants to be aware of withdrawal signs as their brain and body adapt.
Antidepressant withdrawal symptoms include:
- Dizziness
- Irritability
- Mood changes
- Brain fog
- Sleep disturbances
- “Brain zaps,” which are brief, electric shock–like sensations in the head
Shapiro says that withdrawal symptoms do not necessarily mean a person is relapsing, but they should be taken seriously and discussed with a doctor.
“If you have moderate to severe withdrawal symptoms, you may need to reinstate your prior dose,” he says.
Methods Matter When Stopping Meds, but More Research Is Needed
As a review of previous studies, this new research was observational and could not demonstrate effectiveness as well as following patients directly in a clinical trial, the study authors wrote.
Another limitation is that most participants (about 80 percent) had depression rather than anxiety disorders, so findings in relation to anxiety should be interpreted cautiously.
Follow-up durations averaged around one year, meaning that longer-term outcomes remain uncertain.
“Many trials did not adequately measure withdrawal symptoms, limiting our ability to distinguish withdrawal from relapse,” says Ostuzzi.
Even with these limitations in mind, he says the message is clear: “Abrupt stopping or very rapid dose reductions are associated with a substantially higher risk of relapse. A gradual, individualized taper — especially when combined with structured psychological support — offers a safer and more effective pathway for those who wish to stop.”
