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Managing Antidepressant Discontinuation: A Systematic Review

Research output: Contribution to journalArticle

  • Sarah Dawson
  • Emma Maund
  • Beth Stuart
  • Michael Moore
  • Dorwick Christopher
  • Adam WA Geraghty
  • Tony Kendrick
Original languageEnglish
Pages (from-to)52-60
Number of pages9
JournalAnnals of Family Medicine
Volume17
Issue number1
DOIs
DateAccepted/In press - 1 Nov 2018
DatePublished (current) - 7 Jan 2019

Abstract

PURPOSE:
We aimed to determine the effectiveness of interventions to manage antidepressant discontinuation, and the outcomes for patients.

METHODS:
We conducted a systematic review with narrative synthesis and meta-analysis of studies published to March 2017. Studies were eligible for inclusion if they were randomized controlled trials, quasi-experimental studies, or observational studies assessing interventions to facilitate discontinuation of antidepressants for depression in adults. Our primary outcomes were antidepressant discontinuation and discontinuation symptoms. Secondary outcomes were relapse/recurrence; quality of life; antidepressant reduction; and sexual, social, and occupational function.

RESULTS:
Of 15 included studies, 12 studies (8 randomized controlled trials, 2 single-arm trials, 2 retrospective cohort studies) were included in the synthesis. None were rated as having high risk for selection or detection bias. Two studies prompting primary care clinician discontinuation with antidepressant tapering guidance found 6% and 7% of patients discontinued, vs 8% for usual care. Six studies of psychological or psychiatric treatment plus tapering reported cessation rates of 40% to 95%. Two studies reported a higher risk of discontinuation symptoms with abrupt termination. At 2 years, risk of relapse/recurrence was lower with cognitive behavioral therapy plus taper vs clinical management plus taper (15% to 25% vs 35% to 80%: risk ratio = 0.34; 95% CI, 0.18-0.67; 2 studies). Relapse/recurrence rates were similar for mindfulness-based cognitive therapy with tapering and maintenance antidepressants (44% to 48% vs 47% to 60%; 2 studies).

CONCLUSIONS:
Cognitive behavioral therapy or mindfulness-based cognitive therapy can help patients discontinue antidepressants without increasing the risk of relapse/recurrence, but are resource intensive. More scalable interventions incorporating psychological support are needed.

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  • Full-text PDF (accepted author manuscript)

    Rights statement: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via the Annals of Family Medicine at https://doi.org/10.1370/afm.2336 . Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 3 MB, PDF document

    Licence: Other

  • Full-text PDF Supplementary Material

    Rights statement: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via the Annals of Family Medicine at https://doi.org/10.1370/afm.2336 . Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 863 KB, PDF document

    Licence: Other

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