---
type: source
title: "Antidepressant Deprescribing NMA: Slow Tapering Plus Therapy Is as Effective as Continued Medication"
author: "The Lancet Psychiatry"
url: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(25)00330-X/abstract
date: 2025-12-01
domain: health
secondary_domains: []
format: research-paper
status: unprocessed
priority: high
tags: [antidepressant, depression, discontinuation, relapse, CBT, psychotherapy, continuous-treatment-model, pharmacotherapy]
---

## Content

Systematic review and network meta-analysis of 76 randomised controlled trials (17,000+ adults) comparing antidepressant deprescribing strategies in clinically remitted depression. Strategies compared: abrupt discontinuation, fast tapering (≤4 weeks), slow tapering (>4 weeks), dose reduction (≤50% of minimal effective dose), and continuation — all with or without psychological support.

**Key findings:**
- Slow tapering plus psychological support is as effective as remaining on antidepressants for relapse prevention (relative risk 0.52; NNT 5.4)
- Continuation at standard dose plus psychological support outperformed abrupt discontinuation (RR 0.40; NNT 4.3)
- Abrupt stopping or very rapid tapering shows clearly higher relapse risk
- Adjunctive psychological support improved outcomes across all pharmacological strategies
- Guideline recommendation: individualised deprescribing with gradual tapering and structured psychological support

**Relapse rates without intervention:**
- ~34.81% at 6 months after antidepressant discontinuation
- ~45.12% at 12 months after discontinuation (meta-analysis of 35 RCTs)

Published December 2025, Lancet Psychiatry. EurekAlert coverage confirmed.

## Agent Notes

**Why this matters:** This is the critical test case for whether the continuous-treatment model (pharmacological benefits revert on cessation) applies to psychiatric medications, and whether behavioral/cognitive interventions are more durable. The finding sharpens rather than disrupts the continuous-treatment model: antidepressants follow it (high relapse on abrupt discontinuation), but structured psychological therapy mitigates the reversion — suggesting that behavioral interventions can be partially substituted for continuous pharmacotherapy in psychiatric conditions in a way they cannot in metabolic ones.

**What surprised me:** That slow tapering + psychological support matches CONTINUED medication (not just partial protection) — this means the continuous-treatment model has a mitigation pathway in psychiatry that doesn't exist for GLP-1 or food-as-medicine (you can't "taper" semaglutide and add a behavioral intervention to prevent weight regain at the same scale).

**What I expected but didn't find:** I expected to find evidence that CBT provides near-complete protection after discontinuation (the "skills remain" framing). The reality is more nuanced — the gains are durable compared to abrupt discontinuation but the tapering protocol matters significantly. Abrupt discontinuation has high relapse risk even after remission.

**KB connections:**
- Relates to [[GLP-1 pharmacotherapy follows a continuous-treatment model]] (Session 20 claim candidate) — confirms the pattern in psychiatric pharmacotherapy but with important CBT-mediated mitigation
- Relates to [[the mental health supply gap is widening not closing]] — reinforces importance of psychological support infrastructure
- Potentially contradicts a simple "behavioral interventions are more durable" framing — the story is more nuanced

**Extraction hints:**
- Primary claim: antidepressant discontinuation follows continuous-treatment pattern (34-45% relapse by 12 months) but psychological support is a structural mitigation — pharmacological and behavioral/cognitive treatments have different durability profiles
- Secondary claim: the continuous-treatment model applies to psychiatric pharmacotherapy but has a mitigation pathway (slow taper + therapy) that metabolic interventions (GLP-1, food-as-medicine) do not
- Consider whether this strengthens or qualifies the Session 20 GLP-1 continuous-treatment claim

**Context:** Published in the context of high rates of long-term antidepressant use — estimated 50%+ of antidepressant users in UK and US on medication for >2 years. There's growing clinical and patient interest in safe discontinuation pathways. This NMA is the largest and most comprehensive evidence base for that question.

## Curator Notes

PRIMARY CONNECTION: [[GLP-1 pharmacotherapy follows a continuous-treatment model requiring permanent subsidized access infrastructure rather than one-time treatment cycles]] (Session 20 claim candidate)
WHY ARCHIVED: Tests whether the continuous-treatment model (benefits revert on cessation) generalizes from metabolic to psychiatric interventions — it does, but with an important difference: psychological support can partially substitute for continuous pharmacotherapy in depression but not in metabolic conditions
EXTRACTION HINT: Focus on the differential durability profiles of pharmacological vs. behavioral interventions — this is the key structural insight. A domain-level claim about intervention type predicting durability after discontinuation
