This week, Mad in America explores three articles around antidepressant use and discontinuation. The first article questions the evidence base supporting long-term antidepressant use, arguing that withdrawal is often mistaken for relapse. The second study reports that patients and service users often experience a lack of information on withdrawal effects and stopping antidepressants, and a lack of support when discontinuing these drugs. The third study finds that a lack of support from healthcare professionals makes discontinuing antidepressants more difficult. Taken together, these articles tell of patients and service users prescribed antidepressants with dubious efficacy, given little information about the reality of negative effects (especially with long-term use), and left with little support when attempting to stop taking these drugs.
Questioning the Evidence for Long-Term Antidepressant Use
A new article published in the Australian Journal of General Practice argues that the evidence for long-term antidepressant use of more than 12 months is weaker than is often presented. This paper, authored by Mark Horowitz, Kathatine Wallis, and Joanna Moncrieff contends that discontinuation studies of antidepressants often mistake withdrawal for relapse.
Many studies that investigate whether antidepressants prevent relapse begin by recruiting people that are already taking antidepressants and having a subgroup stop these drugs, often rapidly. Any symptom development in the group that discontinues antidepressants is interpreted as relapse. The difference between groups is then presented as evidence that continuing these drugs prevents “relapse.” However, the authors note that many of the symptoms associated with “relapse,” such as low mood, anxiety, insomnia, and agitation are also indicative of the withdrawal state.
These symptoms are often experienced for prolonged periods, with longer durations of antidepressant use linked to longer and more severe withdrawal. The authors argue that these types of studies prove that antidepressant continuation prevents withdrawal rather than relapse.
Most clinical trials for antidepressants last between six to 12 weeks and report relatively small differences between these drugs and placebo. The authors argue that the findings of these short term trials should not be extrapolated to long-term use of antidepressants. They also believe the efficacy of these drugs may be inflated due to problems with maintaining blinding in these trials as well as publication bias in which trials that find no benefit for antidepressants are simply not published.
The evidence base for long-term antidepressant use is thin, especially when looking beyond the two year mark. Many discontinuation trials recruit people with recurrent or chronic depression, a population that may be especially susceptible to relapse when discontinuing antidepressants. The authors note that this population is not representative of most people prescribed long-term antidepressants. They also point to the common negative effects of long-term use, including sexual dysfunction, emotional blunting, cognitive deficits, insomnia, and weight gain.
The authors recommend considering non-drug treatments instead of starting antidepressants, such as therapy, exercise and lifestyle changes, and addressing current stressors. When starting an antidepressant, there should be a clear plan and timeline for reviewing and stopping these drugs. Long-term treatment with antidepressants should include a review every six months that should consider whether or not the drugs are helping, if they are causing negative effects, if there are signs of physical dependence, if there is still a clinical reason to continue, and what the patient or service user wants to do.
When patient and service users choose to stop taking antidepressants, they should be offered a supported, individualized, gradual taper to lower the risk of withdrawal. This is especially important for people that have taken these drugs long-term.
Patients Seek Better Support When Discontinuing Antidepressants
A new article published in Basic & Clinical Pharmacology & Toxicology reports that patients and service users often experience antidepressant discontinuation as difficult and uncertain in part due to insufficient knowledge around discontinuation, poor communication, lack of support, and little collaboration from healthcare professionals. This research, led by Samah Bouarfa from the Amsterdam University Medical Centre, also finds that patients and service users want individualized professional support when discontinuing antidepressants.
The goal of this study was to investigate how patients and service users think about and experience antidepressant discontinuation. The authors also wanted to explore what service users expected from healthcare professionals when stopping antidepressants. They recruited 15 adult participants from the Amselland and Nijmegen regions of Amsterdam to take part in semi-structured interviews around antidepressant use and discontinuation. The interviews were coded for recurring themes. The researchers identified four overarching themes in the interview data.
(1) “Experiences with antidepressant use and discontinuation.” Participants often reported that they had not been told about discontinuation when they were prescribed antidepressants, with some believing they would need to take these drugs for the rest of their lives. One participant said “you get that stuff [antidepressants], and if you don’t say anything you won’t get rid of it for the rest of your life.” Participants reported considering stopping antidepressants due to negative effects such as slowed cognition and emotional blunting: “You have more feelings, when I look back now at how I am now and how I was, I think you are, if you swallow that [antidepressants], a very dull person, in terms of emotions.”
(2) “Attitudes and behavior toward discontinuation.” Many participants did not consider stopping antidepressants unless someone else brought up the topic. Uncertainty and fear of withdrawal, relapse, dependence, and negative effects of antidepressants complicated participants’ decisions around discontinuation. Some participants also believed they would have to take antidepressants for life due to the debunked chemical imbalance hypothesis of depression. Feeling judged and misunderstood by healthcare professionals acted as a barrier to discontinuation. Participants were more likely to consider discontinuation when healthcare professionals took their concerns seriously.
(3) “Expectations and perceptions towards antidepressant discontinuation.” Participants generally believed five factors were needed for successful discontinuation: gradual reduction of the drug, a clear tapering schedule, professional guidance, a support system, and the flexibility to adjust the taper if necessary. Lack of time, insufficient knowledge, poor communication, limited support, and a lack of collaboration from healthcare professionals were all factors that discouraged discontinuation. Some participants also reported increased fear from reading about discontinuing antidepressants online, as many accounts involved severe and prolonged withdrawal. The authors note that exposure to stories about difficult withdrawal could make discontinuation more challenging as a result of the nocebo effect. Participants also emphasized the importance of autonomy during discontinuation, with one saying “after all, I am the boss of my own body, if I say it is okay, I want to get rid of it, then of course I can get rid of it”
(4) “What patients wanted from discontinuation care.” Most participants wanted professional guidance in discontinuing antidepressants. Participants were most comfortable attempting discontinuation when their healthcare professionals were knowledgeable about the drugs, experienced with discontinuation, accessible, supportive, able to provide continuity of care, willing to spend adequate time, and able to adapt the taper to the individual. Participants also wanted healthcare professionals to suggest discontinuation proactively, review drug regimes regularly, and provide information about negative effects of antidepressants and what to expect when tapering.
While this study found that participants wanted professional help when attempting to stop antidepressants, past research has found that healthcare professionals are often reluctant to provide such support.
This study had four main limitations. The small sample size, while appropriate for a qualitative study, limits generalizability. Participants were recruited exclusively from two regions in Amsterdam, further limiting genberalizability. Some participants were recalling experiences from years in the past and could have misremembered details. The interviews were translated from Dutch to English, possibly obscuring some of the nuance in the accounts.
Inadequate Support Makes Antidepressant Discontinuation More Difficult
A new study published in the Journal of Public Health finds that antidepressant discontinuation is often difficult due to inadequate information and poor support. This research, authored by Matteo Bessone and Barbara I. Nicholl from the University of Glasgow in the UK, also reports that good healthcare, peer and community support, and a sense of recovery and autonomy can make discontinuation and withdrawal more manageable.
The goal of this study was to examine and map patients’ and service users’ experiences of antidepressant discontinuation and withdrawal. The authors also wanted to identify factors that hinder and facilitate discontinuation. They conducted a narrative systematic review of previous research around the experience of antidepressant discontinuation and withdrawal. Included studies had to examine people 13 years old or older that were currently, or had in the past attempted to discontinue antidepressants. In total, the authors used data from 12 studies.
Patients and service users often expressed ambivalent views about antidepressants, with many questioning the appropriateness of their original prescription and expressing uncertainty about the drugs’ necessity. Stopping antidepressants was often described as difficult, risky, and frightening. Withdrawal symptoms were common and many patients and service users reported unsuccessful attempts to discontinue these drugs. Multiple attempts at discontinuation were common. Included studies found large discrepancies in how often discontinuation was successful, with some reporting success rates as low as 14.3% and some as high as 70%.
Patients and service users often felt healthcare support was inadequate. They reported receiving little information about withdrawal, a lack of support from healthcare professionals, difficulty finding clinicians that were knowledgeable about tapering, feeling dismissed, and uncertainty about whether symptoms during discontinuation were due to withdrawal or relapse.
Patients and service users generally had positive experiences with community, peer, and online support groups. These groups acted as sources of information, reassurance, validation, and much needed practical advice that was often unavailable in healthcare settings.
The authors identify the main barriers to antidepressant discontinuation as lack of social and professional support, insufficient information, and inadequate resources. The main facilitators were social support, health literacy, and expectations of recovery.
This study had three main limitations. Only 12 studies were included, with significant variation in methods and samples. Most participants from included studies were female, white, and resided in high income countries, limiting generalizability. The included quantitative studies relied on self-report measures, which can be biased due to misremembering and reporting what is more socially acceptable rather than what is accurate.
Discontinuation and Tapering
Many patients and service users choose to discontinue antidepressants due to negative effects, such as anxiety and suicidal thoughts. Research has found that abruptly stopping and quick tapering of antidepressants often leads to withdrawal effects. Due to healthcare providers lack of knowledge around antidepressant discontinuation, withdrawal is often attributed to relapse or misdiagnosed as other disorders. According to experts, negative effects that start within a few days of stopping or lowering an antidepressant dose, and the presence of physical symptoms such as “brain zaps” and dizziness, is likely indicative of withdrawal rather than relapse. Recent research has found that tapering off antidepressants slowly with psychological support prevents relapse just as well as continued “maintenance treatment” in patients and service users with remitted depression. Slow, hyperbolic tapering of these drugs can minimize or completely prevent withdrawal effects.
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Bessone, M., & Nicholl, B. I. (2026). Patients’ experiences of antidepressant withdrawal: A narrative systematic review from a health promotion perspective. Journal of Public Health. (Link)
Bouarfa, S., Göttgens, W., Ligthart, S. A., Maarsingh, O. R., Kooij, M. J., Bet, P. M., & Hugtenburg, J. G. (2026). Patients’ perspectives on antidepressant discontinuation and the pharmacists’ role. Basic & Clinical Pharmacology & Toxicology, 138(4). (Link)
Horowitz, M. A., Wallis, K. A., & Moncrieff, J. (2026). Continuing antidepressants or not: Evaluating the potential benefits and harms. Australian Journal of General Practice, 55(6), 366–368. (Link)
Discontinuation of an antidepressant is further complicated by the fact that tapered doses are not readily available. I’ve had to create my own from the contents of capsules, dividing and placing reduced quantities in empty capsules. Pharmaceutical companies should be required to produce their antidepressants in reduced dosages.
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