Table 4.
Summary of recommendations on discontinuation and tapering of antidepressants in clinical practice guidelines on depression.
| Source and year | Duration of mADM | Duration of taper | Actions if discontinuation symptoms emerge | Actions if deterioration/relapse occurs |
|---|---|---|---|---|
| BAP 2 | 6 mo–>2 yr | >4 wks–some months | Explanation and reassurance; resume AD and taper more slowly; switch to fluoxetine and stop | Restart an AD; reestablish previous dose |
| RANZCP 3 | >6 mo | Slowly | – | – |
| HSE + ICGP 42 | >6 mo–12 mo | – | – | – |
| CANMAT 37 | 6 mo–>2 yr | Several weeks | – | – |
| WFSBP 44 | >6 mo–lifetime | >3 mo to 4–6 mo | – | Resume full dose for at least 6 months |
| AAP 26 | 6 mo–1 year | Slow taper | – | |
| SIGN + HIS 40 | – | – | – | – |
| VA/DoD 27 | >6 mo–indefinitely | Slow taper | – | – |
| WHO46,47 | >9–12 mo | >4 wk | – | – |
| American Psychiatric Association 28 | 4 mo–indefinitely | Several weeks–a longer period | Reassurance and a more gradual taper; switch to fluoxetine and stop | Resume AD treatment; monitor symptoms |
| APA 29 | – | – | – | – |
| ACP 30 | – | – | – | – |
| NZGG + MoH (NZ) 39 | >6 mo–>2 yr | 4 wk | Resume AD and taper more slowly | – |
| NICE 33 | >6 mo | 6–12 wk | – | |
| WFSBP 45 | >6 mo–lifetime | >6 wk to 4–6 mo | – | Resume full dose for at least 6 months |
| AACAP 48 | >6 mo–indefinitely | Slowly | – | – |
| NICE 1 | >6 mo–>2 yr | 4 wk–longer | Seek advice from practitioner; monitoring and reassurance; resume AD and taper more gradually; start another AD with longer half-life and taper more gradually | – |
| AHCPR 32 | – | – | – | – |
| RCPSYCH 35 | >1–> 3 yr | – | – | – |
| MoH (SI) 41 | 6 mo–lifelong | Abrupt a >4 wk | – | – |
| NCCMH 36 | >6 mo–>2 yr | Abrupt b –4 wk–longer | Seek advice from practitioner; monitoring and reassurance; resume AD and taper more gradually; start another AD with longer half-life and taper more gradually; counsel patients; abrupt withdrawal | – |
AACAP, American Academy of Child and Adolescent Psychiatry; AAP, American Academy of Pediatrics; ACP, American College of Physicians; AD, antidepressant; 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; HIS, Healthcare Improvement Scotland; HSE, Health Service Executive; ICGP, College of General Practitioners; mADM, maintenance antidepressant medication; mo, months; MoH (Si), Ministry of Health, Singapore; NCCMH, National Collaborating Centre for Mental Health; NICE, National Institute for Health and Care Excellence; NZ, New Zealand; NZGG, New Zealand Guidelines Group; RANZCP, Royal Australian and New Zealand College of Psychiatrists; RCPSYCH, Royal College of Psychiatrists; SIGN, Scottish Intercollegiate Guidelines Network; VA/DoD, Department of Veteran Affairs and Department of Defense; WFSBP, World Federation of Societies of Biological Psychiatry; WHO, World Health Organization; wk, weeks; yr, years.
‘Fluoxetine dose of 20 mg can be abruptly stopped and doses of above 20 mg recommended to reduce over a period of 2 weeks’.
‘This is not required with fluoxetine because of its long half-life’.