How shall we help patients withdraw from depression drugs?

Our systematic review of 13 randomised trials (2085 patients) showed that the length of taper was highly predictive for the risk of relapse (P = 0.00001). All the studies we reviewed confounded withdrawal symptoms with relapse; did not use hyperbolic tapering; withdrew the depression drug too fast in a linear fashion; and stopped it entirely when receptor occupancy was still high. The true proportion of patients on depression drugs who can stop safely without relapse is likely considerably higher than the 50% we found. Offering cognitive behaviour therapy allowed significantly more patients to become drug free without relapse compared with tapering in standard clinical care (P = 0.002). Our full review is here and it is also up at MedRiv.