More Psychological Supports Needed to Manage Antidepressant Discontinuation

Study reviews psychological interventions for antidepressant discontinuation.

Hannah Emerson
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In a new study, a team of researchers from the UK investigated what interventions are available for assisting people who are attempting to discontinue antidepressants. The systematic review of the existing literature, recently published in Annals of Family Medicine, identify Cognitive behavioral therapy (CBT) and mindfulness-based cognitive therapy (MBCT) as two psychological interventions that have been found to support discontinuation without increasing the risk of relapse/recurrence when compared with clinical management by primary care clinicians.

“Providing psychological therapies seems to enable significantly higher discontinuation rates as compared with brief guidance on tapering to primary care clinicians alone,” the authors write.

“This approach may work by providing support to patients to manage fears of withdrawal, relapse, and lack of self-efficacy, which are possible barriers to discontinuation. Alternatively, having an effective therapy for the depression or anxiety for which the medication was initially given removes the need for it, without increasing relapse/recurrence risk.”

Photo Credit: Max Pixel

Antidepressant prescriptions doubled in Western countries between 2000 and 2011. This increase is driven by the increasing number of people who are taking antidepressants long-term. Antidepressants are mostly prescribed by primary care clinicians. While some individuals may need the medication to prevent relapse/recurrence, research has indicated 30%-50% of those taking antidepressants have no evidence-based reason to continue long-term use (see, for instance, Cruickshank et al., Ambresin et al., and Piek, Kollen, can der Meer, Penninx, & Nolen).

Discontinuing antidepressants may be daunting because of the potential to experience withdrawal symptoms, which is often mistaken for relapse/recurrence. To lessen the chances of withdrawal, the American Psychiatric Association and the National Institute for Health and Care Excellence suggest tapering the dose over time as opposed to abruptly. CBT and MBCT have also been suggested as alternatives to antidepressants, without increasing the risk of relapse/recurrence. However, “current guidelines for antidepressant discontinuation are based on consensus and nonsystematic reviews,” necessitating more tangible data.

The researchers conducted a systematic review based on the following 2 questions, “what interventions are effective in managing antidepressant discontinuation, and what are the outcomes for patients after discontinuation?” The primary outcomes were discontinuation of antidepressants and associated symptoms. Secondary outcomes were relapse/recurrence, quality of life, antidepressant reduction, and sexual, social, and occupational function.

The authors define relapse as “the return of syndrome-level depression after remission during the first 4 to 6 months of treatment,” and recurrence as “a new episode occurring after recovery and lasting more than 4 to 6 months.” After searching multiple databases with relevant keywords and eliminating articles that did not meet criteria, 12 studies were analyzed.

Their findings suggest that antidepressants be tapered rather than abruptly stopped, although more trials to further evaluate slow tapering are needed. They also found that discontinuation rates for primary care clinicians were only 6%-7%, juxtaposed to 40%-95% for specialist psychological or psychiatric care. Rates of relapse/recurrence were lower in primary care settings than psychiatric or psychological therapy settings, though the research is too scant in primary care settings to clarify this effect.

Psychological interventions concurrent with gradual tapering appeared consistently effective. The combination of CBT and tapering significantly reduced relapse/recurrence as opposed to clinical management and tapering. MBCT combined with tapering “enabled high rates of discontinuation without increasing relapse/recurrence rates, as compared with maintenance antidepressants.”

This systematic review underscores a need for more research to evaluate appropriate interventions and measure the outcomes of antidepressant discontinuation, as evidenced by the low number of eligible studies. Interventions such as CBT and MBCT may not be readily available, so identifying alternative supports is vital in order for effective antidepressant discontinuation to be accessed.

The research team concluded with implications for practice and research. They suggest that primary care physicians, the leading prescribers of antidepressants, may need to become more active in the discussion of antidepressant discontinuation with their clients.

 “It is important for primary care clinicians to discuss discontinuation symptoms with patients at the time of initiation of an antidepressant. Doing so will allows patients to make more informed decisions about whether they want to start an antidepressant in the first place.”

 

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Maund, E., Stuart, B., Moore, M., Dowrick, C., Geraghty, A.W.A., Dawson, S., & Kendrick, T. (2019). Managing antidepressant discontinuation: A systematic review. Annals of Family Medicine 17(1). (Link)

8 COMMENTS

  1. “It is important for primary care clinicians to discuss discontinuation symptoms with patients at the time of initiation of an antidepressant. Doing so will allows patients to make more informed decisions about whether they want to start an antidepressant in the first place.”

    So true, all this mass drugging of the population, with lies that the psychiatric drugs and opioids are “safe meds,” was a huge betrayal of the population by the medical community.

    I’m not certain more psychological supports are what is needed, however. I think support by knowledgable people who’ve gone through the process of withdrawal, thus understand it, would be more beneficial.

    Withdrawal symptoms can be very bizarre, and mimic the symptoms in the DSM, a book our psychologists still believe in. Thus the psychologists are likely to end up misdiagnosing the withdrawal symptoms, as the DSM disorders, which happened in my case.

    It truly is a shame our “mental health professionals” know so little about the effects of the drugs they were fraudulently claiming to “know everything about” decades ago.

    • With my SMI label I knew better than to let any psychiatrist or even real doctor (Medicaid only covers the go-with-the-flow kind) in on it.

      Hell no! They won’t let us go.

      And shrinks can have no idea how many of us succeed DESPITE their best efforts.

      • I did finally find a doctor with a brain in his head, who took the SMI label off my medical records. But after what I was put through, and all the medical research I’ve done, I’ve largely lost all respect for our allopathic medical community. The system is bad.

        “Hell no! They won’t let us go.” I agree, that’s their goal. I had one psychiatrist spend years fraudulently listing me as her “out patient” at a hospital I’d never been to, according to an insurance company. When I asked her to stop doing that, she started fraudulently listing me as her patient at the hospital that I had the misfortune of meeting her, despite the fact I’d moved out of state.

        Her partner in crime was eventually arrested by the FBI, because he’d defrauded Medicaid/Medicare out of millions for medically unnecessarily harming many patients for profit. The shrinks have less than zero ethics, and do not want to let anyone escape. They’re unscrupulous lunatics.

  2. I read the title, and then I thought, wait a minute…

    What is really needed is the abolition of psychiatry and all of its nefarious accomplices. So many MIA articles focus too far downstream from the source of the problems. Downstream from psychiatry there are all kinds of bandaids to apply. Go to the source, namely, psychiatry itself and the pernicious myth of “mental illness.” Until the false religious of psychiatry is eliminated and until the pervasive myth of “mental illness” is debunked, individuals will continue to suffer from the noxious products that are distributed under the aegis of these tyrannical systems and ideologies.

    Slay the Dragon of Psychiatry, and there won’t be any more need to manage “antidepressant” (a euphemism for a dangerous psychotropic – brain-altering – chemical) discontinuation.

    • Sadly many continue to suffer in the meantime Dragon Slayer.

      A support system for going off these neuro toxins is nice. But good luck finding one in most areas.

      My only support system was the virtual community: Surviving Antidepressants. The folks there know more about SSRI withdrawal than most doctors. Because they actually help people go off. Hard to be good at something you refuse to even permit.

  3. Therapy is a tool to help individuals learn to adapt to adversity so that they can continue to survive under adverse conditions, it’s never been about changing the conditions that caused the adversity.

    I will not assimilate. We must never assimilate to systemic injustices. We are not The Borg.

    Julian Assange was carried out of the Ecuadorean Embassy in London this morning screaming “RESIST!” He is today’s hero. We live in an interventionist culture. Maybe it’s just time to stop the interventions and simply respond to the actual criminal harm being committed against the many by the few.

    • Yes, what I was psychiatrically poisoned for innately knowing in late 2001, that the wrong people were in charge, and were planning on taking this world towards a WWIII (to cover up the fraud based monetary system), is what the “awakened” are now all seeing come to fruition.

      Good thing the ignorant, fraud based money worshipping, “mental health” workers are here to maintain the status quo for the war mongering and profiteering, fiscally irresponsible, bailout needing, home stealing, globalist banksters, who are seemingly hell bent on destroying America.

      I agree, those “screaming RESIST!” are “today’s” heroes.