A large international review has found that patients who slowly reduce their antidepressant dosage while continuing psychotherapy are less likely to see symptoms return than those who stop medication abruptly. The findings, published this week in The Lancet Psychiatry, suggest that many patients may be able to discontinue long-term medication safely when supported by a structured withdrawal plan.
Antidepressant use has risen steadily across Europe, with millions relying on these drugs to manage depression and anxiety. Clinical guidelines typically advise remaining on medication for six to nine months after symptoms improve, but many patients stay on treatment for years. That trend is partially driven by fear of relapse and by concerns about long-term side effects, including sexual dysfunction and emotional numbness.
Researchers from France and Italy examined 76 randomised trials involving more than 17,000 participants to assess the safest ways to stop medication. Their analysis indicates that gradual reduction combined with psychological support is “as effective as staying on antidepressants” for preventing relapse in the first year after withdrawal.
Giovanni Ostuzzi, lead author and a professor at the University of Verona, said during a briefing that most patients could consider stopping antidepressants as long as the process is supervised. “This should be discussed with a specialist, and withdrawal plans must be adjusted to each person’s needs,” he said.
The review identified two major factors linked to successful withdrawal: the speed of dose reduction and access to therapy. Slow tapering was defined as a reduction lasting more than four weeks, while very slow tapering extended beyond 12 weeks. The authors estimated that patients who taper slowly while receiving therapy are significantly less likely to relapse than those who stop abruptly or taper over a brief period.
Co-author Debora Zaccoletti noted that therapies such as cognitive behavioural and mindfulness-based approaches can help patients manage symptoms during withdrawal. She said these methods may offer a supportive option for those who feel ready to try life without medication.
The researchers stressed, however, that their findings should not be interpreted as evidence that medication is unnecessary. They warned that many patients will still require continued drug treatment and that psychotherapy cannot replace antidepressants for those at high risk of relapse.
Experts not involved in the study echoed that warning. Sameer Jauhar, a clinical associate professor at Imperial College London, pointed to long-term data showing that 60% to 70% of patients who experience one depressive episode will have another. “Maintenance antidepressants roughly halve that risk,” he said. “These results show that structured tapering works for some, but many still need ongoing medication.”
The authors acknowledged limitations, including a shortage of trials examining psychotherapy during withdrawal and weaker evidence in patients with anxiety disorders.
Despite the gaps, the review offers the strongest indication yet that a carefully monitored withdrawal process—rather than abrupt cessation—may allow many patients to reduce or stop antidepressants without a rapid return of symptoms.
