Slow Tapering Plus Therapy Prevents Relapse as Well as Staying on Antidepressants

The question every prescribing clinician faces eventually: when and how to stop antidepressants in a remitted patient. This Lancet Psychiatry network meta-analysis of 76 trials provides the first head-to-head comparison of deprescribing strategies — and the answer is not simply "taper slowly." The answer is taper slowly and add therapy.

What the evidence shows

The analysis pooled data from 17,379 participants across five strategies: abrupt discontinuation, fast tapering (4 weeks or less), slow tapering (more than 4 weeks), reduced-dose continuation, and standard-dose continuation. Each strategy was evaluated with and without adjunctive psychological support — primarily mindfulness-based cognitive therapy (MBCT) and cognitive behavioral therapy (CBT).

The critical finding: slow tapering plus psychological support matched standard-dose continuation in relapse prevention over a mean follow-up of 46 weeks. Neither slow tapering alone nor psychological support alone achieved this equivalence. The combination works because tapering removes the pharmacological safety net while therapy builds the cognitive and behavioral skills to maintain remission without it.

Fast tapering and abrupt discontinuation performed significantly worse, even with psychological support. The withdrawal timeline matters — and four weeks is not enough.

What changes in your practice

If you are managing a patient in stable remission who wants to discontinue antidepressants, the protocol is now clear: extend the taper beyond four weeks and pair it with structured psychological support. MBCT appears particularly well-suited — it was the most frequently studied adjunct and directly targets the ruminative patterns that predict depressive relapse.

For psychologists and therapists: this positions you as an essential partner in deprescribing, not a downstream referral. The data says your involvement during the taper changes outcomes measurably.