Table 3.
Guidance on tapering and discontinuing antidepressants mentioned in clinical practice guidelines on depression.
| mADM duration | Gradual tapering | Hyperbolic tapering | Duration of taper | Dose-reduction regimen | WS actions | Relapse actions | WS as harm | Relapse as harm | Symptomatic overlap | Benefits mentioned | Psychological barriers | Peer-support | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| N (%) | 17 (81%) | 15 (71%) | 0 (0%) | 9 (43%) | 2 (10%) | 5 (24%) | 4 (19%) | 15 (71%) | 14 (67%) | 4 (19%) | 0 (0%) | 0 (0%) | 0 (0%) |
| American Psychiatric Association 28 | + | + | – | – | – | + | + | + | + | + | – | – | – |
| BAP 2 | + | + | – | + | – | + | + | + | + | + | – | – | – |
| NCCMH 36 | + | + | – | + | – | + | – | + | + | + | – | – | – |
| NICE 1 | + | + | – | + | – | + | – | + | + | – | – | – | – |
| NZGG 39 | + | + | – | + | – | + | – | + | + | – | – | – | – |
| NICE 33 | + | + | – | + | – | – | – | + | – | – | – | – | – |
| WFSBP 44 | + | + | – | + | – | – | + | + | + | – | – | – | – |
| WFSBP 45 | + | + | – | + | – | – | + | + | + | – | – | – | – |
| WHO 47 | + | + | – | + | – | – | – | – | + | – | – | – | – |
| CANMAT 37 | + | + | – | – | – | – | – | + | – | – | – | – | – |
| AAP 26 | + | + | – | – | – | – | – | + | + | – | – | – | – |
| VA/DoD 27 | + | + | – | – | – | – | – | + | + | – | – | – | – |
| AACAP 48 | + | + | – | – | – | – | – | + | + | + | – | – | – |
| RANZCP 3 | + | + | – | – | + | – | – | + | + | – | – | – | – |
| MoH (Si) 41 | + | + | – | + | + | – | – | + | + | – | – | – | – |
| HSE 42 | + | – | – | – | – | – | – | + | – | – | – | – | – |
| SIGN 40 | – | – | – | – | – | – | – | – | + | – | – | – | – |
| RCPSYCH 35 | + | – | – | – | – | – | – | – | – | – | – | – | – |
| AHCPR 32 | – | – | – | – | – | – | – | – | – | – | – | – | – |
| APA 29 | – | – | – | – | – | – | – | – | – | – | – | – | – |
| ACP 30 | – | – | – | – | – | – | – | – | – | – | – | – | – |
AACAP, American Academy of Child and Adolescent Psychiatry; AAP, American Academy of Pediatrics; ACP, American College of Physicians; AHCPR, Agency for Health Care Policy and Research Practice Guidelines; APA, American Psychological Association; BAP, British Association for Psychopharmacology; CANMAT, Canadian Network for Mood and Anxiety Treatments; HSE, Health Service Executive; mADM, maintenance antidepressant medication; MoH (Si), Ministry of Health, Singapore; NCCMH, National Collaborating Centre for Mental Health; NICE, National Institute for Health and Care Excellence; NZGG, New Zealand Guidelines Group; RANZCP, Royal Australian and New Zealand College of Psychiatrists; RCPSYCH, Royal College of Psychiatrists; Relapse actions, guidance on actions if relapse or deterioration in general occurs; Relapse as harm, mention of relapse as a possible harm of tapering or discontinuing antidepressants; SIGN, Scottish Intercollegiate Guidelines Network; Symptomatic overlap, mention of the symptomatic overlap between withdrawal symptoms and relapse; VA/DoD, Department of Veteran Affairs and Department of Defense; WFSBP, World Federation of Societies of Biological Psychiatry; WHO, World Health Organization; WS, withdrawal symptoms; WS actions, guidance on actions if withdrawal symptoms occur; WS as harm, mention of withdrawal symptoms as a possible harm of tapering or discontinuing antidepressants. ‘+’ indicates that the item was mentioned in the guideline. ‘–’ indicates that the item was not mentioned in the guideline.