Choosing Between Rapid and Gradual Tapering: Insights from Research

Discover the evidence-backed benefits of gradual tapering when discontinuing antidepressants. Learn how different tapering speeds impact relapse risk and withdrawal effects. Gain insights from international guidelines and research to make informed decisions about your antidepressant journey.

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International Guidelines and Approaches

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Global antidepressant guidelines advocate for a gradual tapering process when discontinuing medication, aiming for a controlled reduction over time. However, these recommendations often lack specifics regarding the duration of tapering. In the United Kingdom, the Royal College of Psychiatrists suggests tapering could extend for "months or longer," presenting tapering plans spanning up to 2 or 3 years. On the other hand, guidelines in the US  and some other countries advise discontinuation over "several weeks," relying on expert consensus rather than robust evidence.

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Gradual Tapering: Supported by Evidence

A survey of specialized deprescribing services worldwide indicates that most patients require three months to three years to comfortably cease antidepressants. While individuals seeking such services might represent more severe withdrawal cases, gradual tapering has garnered support for better outcomes.

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Risk of Relapse and Gradual Tapering

Research reveals a crucial link between tapering speed and the risk of relapse. Rapid tapering, occurring in under 8 weeks, increases the likelihood of relapse upon discontinuation. Contrarily, studies involving longer tapering periods, up to 6 months, demonstrate no elevated relapse risk compared to continuous medication use.

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Mitigating Withdrawal Effects with Gradual Tapering

Evidence also highlights the role of tapering speed in minimizing withdrawal symptoms. Gradual tapering has shown promise in spreading out symptoms over an extended period, reducing their intensity.

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Understanding the Studies

Various studies, including randomized controlled trials and observational analyses, examine the effects of different tapering rates. Observational studies, although weaker in evidence, reveal valuable insights into longer tapering periods.

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Longer Tapering, Lower Risk

Observational studies have underscored the benefits of tapering over months rather than weeks. One study involving paroxetine, known for challenging discontinuation, compared patients who tapered gradually (over an average of 9 months) to those who abruptly stopped. The gradual tapering group exhibited a significantly lower rate of withdrawal syndrome (6%) compared to the abrupt cessation group (almost 80%).

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Conclusion: Gradual Tapering Prevails

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Collectively, research consistently indicates that tapering antidepressants over several months, and potentially even more than a year, substantially reduces the risk of relapse and withdrawal effects. This approach allows individuals to navigate discontinuation with improved safety and comfort.

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References:

• Taylor, D. (2019). Antidepressant discontinuation: authors' reply. British Journal of Psychiatry, 215(5), 652.
• Davies, J., & Read, J. (2019). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based?. Addictive Behaviors, 97, 111-121.
• Royal College of Psychiatrists. (2019). Coming off antidepressants: information from the Royal College of Psychiatrists.
• Read, J., Cartwright, C., & Gibson, K. (2018). Adverse emotional and interpersonal effects reported by 1,829 New Zealanders while taking antidepressants. Psychiatry Research, 267, 373-382.
• Fava, G. A., Gatti, A., Belaise, C., Guidi, J., Offidani, E., & Withdrawal Study Group. (2015). Withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation: a systematic review. Psychotherapy and Psychosomatics, 84(2), 72-81.
• El-Mallakh, R. S., & El-Masri, M. A. (2007). Tolerance versus withdrawal syndromes. Psychiatric Annals, 37(3), 214-219.
• Hengartner, M. P., & Plöderl, M. (2018). Newer-generation antidepressants and suicide risk in randomized controlled trials: a re-analysis of the FDA database. Psychotherapy and Psychosomatics, 87(3), 183-184.
• Vassileva, I., Milanova, D., & Milanov, I. (2013). Antidepressant induced excessive yawning and indifference. BioPsychoSocial Medicine, 7(1), 16.
• Gøtzsche, P. C. (2019). Why I think antidepressants cause more harm than good. The Lancet Psychiatry, 6(3), 232-234.

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