Antidepressant Deprescribing Tool

You should establish the need for antidepressant deprescribing on an individual basis with your patient. Our article on establishing if a person's antidepressant should be deprescribed can help.

Planning and implementing the desprescribing process should be shared between patient and prescriber. Our articles may help:

• Planning to deprescribe an antidepressant
• Implementing a process to desprescribe an antidepressant

Reduction pace

A normal reduction pace would be for patients to stay on each step of the antidepressant deprescribing regimen for approximately 4 weeks. I.e. patients would stay on each single dose for 4 weeks before reducing the dose further.

Alternate day dosing

It is not good practice to dose antidepressants less often than once daily because, with the exception of fluoxetine, their short half-lives mean that this causes substantial fluctuations in levels which can trigger severe withdrawal symptoms.

Managing withdrawal effects

Patients may experience unpleasant withdrawal effects during their taper off antidepressants. If this happens, they should pause the taper (stay on the same dose) or even go back a step (increase the dose) of their current regimen.

Once stabilised, it may be appropriate to switch regimen or slow the pace of the existing regimen. For example, if the patient was previously on a medium tapering regimen, make subsequent reductions using a slow regimen. Or if they were on a slow regimen, increase the schedule between reduction steps.

Overall the dosing regimens are guides: they are not meant to be enforced rigidly.

Managing relapse

Patients may experience relapse of their original symptoms during their taper off antidepressants. If this happens, they should pause any further tapers and review their treatment with their prescriber.

Speeding up

Less commonly, patients may be able to increase their pace of withdrawal. This is generally only possible where patients have been able to reduce their dose three times, with 4 weeks in between each reduction, and have not experienced withdrawal effects. In these circumstances, consider skipping a step and making a reduction to the next step.

Liquids are necessary

Completing antidepressant deprescribing safely cannot be achieved without the use of liquid medicines.

The prescription of liquid versions of antidepressants has been discouraged previously for cost-saving reasons; however, these products are essential to allow smaller steps at the end of the taper. Tablets alone cannot provide the required dose reductions.

Our process for recommending liquids follows an order

Where at all possible to do so we recommended a licensed medicine.

In some circumstances, to achieve certain doses, we may recommend "off-label" use of a licensed medicine. I.e. the use of a licensed medicines outside its product licence. However, the medicine itself remains a licensed product.

For a small number of doses, usually towards the end of deprescribing regimens, the use of a special medicines may be warranted.

Our approach balances implementing antidepressant withdrawal using hyperbolic tapering regimens with the cost effect use of medicines.

A fuller explanation of our approach to tailoring doses and recommending products to meet a given dose is available on request.