Approach to stopping an antidepressant

Although long-term antidepressant therapy may be required, rates of antidepressant use in Australia (1 in 10 adults take an antidepressant) suggest antidepressant therapy is continued unnecessarily in some people.

Consider stopping a person’s antidepressant treatment if:

  • the recommended duration of treatment is complete (but consider residual symptoms, comorbidities or other factors that may increase the risk of relapse and warrant a longer duration of treatment)
  • the antidepressant is not effective
  • there are unacceptable adverse effects or a risk of such adverse effects
  • a drug–drug or drug–disease interaction precludes continued use of the antidepressant
  • there is poor adherence
  • it is the patient’s preference to stop.

In some circumstances, it may be appropriate to switch to another antidepressant rather than stopping antidepressant therapy.

Stopping or switching an antidepressant may be considered because a patient wishes to become pregnant, or is pregnant or breastfeeding.

Discontinuation symptoms can occur when stopping an antidepressant. Discontinuation symptoms vary between antidepressants, but can include insomnia, nausea, postural imbalance, sensory disturbances, hyperarousal, influenza-like symptoms and, rarely, delirium. Discontinuation symptoms vary in severity and can last 1 to 2 weeks, or a month or longer in some patients. If severe, restarting the antidepressant will resolve the symptoms promptly; a slower dose reduction can be used to avoid discontinuation symptoms.

If relapse occurs after stopping an antidepressant, consider whether long-term pharmacotherapy is required.

In some circumstances, another psychotropic will be started when the antidepressant is stopped; antidepressant discontinuation symptoms may be mistaken for adverse effects of the new drug. This can lead to the dose of the new drug being inappropriately reduced or the drug being stopped. If clinical circumstances permit, slowly stop the antidepressant, allow time for discontinuation symptoms to manifest, then introduce the new drug.

Note: If possible, reduce the antidepressant dose slowly rather than stopping abruptly.

Plan antidepressant discontinuation with the patient. To facilitate stopping an antidepressant:

  • for patients in remission who wish to stop their antidepressant, avoid stopping during a stressful period (eg exams, significant interpersonal stress, changes in employment)
  • treat problem substance use before reducing antidepressant dose
  • unless there is a need to stop the antidepressant urgently (eg severe adverse effect, mania), gradually reduce the dosage to minimise the risk of discontinuation symptoms. Provide the patient with a copy of the dose reduction schedule
  • advise the patient of the potential for discontinuation symptoms because patients may misinterpret these as a recurrence of their psychiatric disorder
  • offer psychosocial interventions
  • monitor the patient closely for discontinuation symptoms and signs of relapse during drug discontinuation and for 12 months after stopping the antidepressant.