Antidepressant Discontinuation: In Need of Scientific Evidence

BACKGROUND: The topic of patients' discontinuing use of antidepressants has received increasing attention. Patients and physicians can encounter challenges regarding the three major questions in the field of antidepressant discontinuation: who can discontinue, what is the best time to discontinue; and what is the best method to discontinue. METHODS: This commentary summarizes the current state of the evidence related to antidepressant discontinuation. RESULTS: There is limited evidence underlying the extremely relevant clinical topic of antidepressant discontinuation. It is poorly understood which patients, after response to antidepressants, benefit (most) from discontinuation. Moreover, established and validated markers of an individual's risk of relapse after antidepressant cessation are lacking, and non-sponsored discontinuation studies are rare. Many discontinuation studies do not distinguish between relapse and antidepressant discontinuation symptoms, and very few studies compared different discontinuation strategies, with none of the compared strategies exceeding 2 weeks of tapering. Finally, blinding of discontinuation strategies is often insufficient to properly address placebo and nocebo aspects, whereas the pharmacological characteristics of different antidepressants in relation to discontinuation have hardly been studied. CONCLUSIONS: Antidepressant discontinuation is a clinically relevant topic. There is a strong need for more robust evidence to indicate who can discontinue antidepressants, when and in which manner (how). Blinded randomized controlled trials are pivotal to optimally advise physicians, patients and policy-makers. This scientific knowledge can guide evidence-based decision making in clinical practice.