Updated NICE principles on stopping antidepressants

Although gradually reducing and tapering antidepressant doses can minimise the risk of discontinuation symptoms, guidance on how to do this is limited. Many of the manufacturers of antidepressants advise against abrupt cessation in their SPCs but offer little practical advice on how the patient should gradually taper and stop. 

Previously, the general advice was to reduce antidepressant doses over a two- to four-week period, with linear reductions in dosage until stopped. There is now growing research to indicate that this linear dose reduction method may not be the most effective way to prevent discontinuation symptoms. 

Lowering the dose of antidepressant medication over a period of 14 days does not significantly reduce discontinuation symptoms compared to abrupt discontinuation. And it has been found that 60 per cent of people are not able to taper their antidepressants to stop over a four-week period and much longer dose reduction times were needed (up to four months). 

Let us now consider a case study involving a patient who had an unsuccessful antidepressant withdrawal using linear dose reductions.