RT Journal Article
SR Electronic
T1 Antidepressant Tapering Is Not Routine But Could Be
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP jabfm.2022.220239R1
DO 10.3122/jabfm.2022.220239R1
A1 Phelps, James
A1 Nguyen, James
A1 Coskey, Olivia Pipitone
YR 2023
UL http://www.jabfm.org/content/early/2023/01/12/jabfm.2022.220239R1.abstract
AB Introduction: When antidepressants are discontinued, severe withdrawal symptoms are possible. Some patients have few or no problems stopping, whereas others struggle. That struggle can be minimized or prevented with careful dose tapering. How often is that done?Methods: Using 7 years of medical records, we determined the percentage of patients who received a prescription for the lowest available dose of their antidepressant before it was discontinued, as an indicator of a deliberate taper.Results: Over that period, 8.9% of patients had evidence of tapering. The percentage increased from 4.9% in 2014 to a plateau around 10% in the past 4 years.Discussion: While reports of severe withdrawal are increasingly recognized and must be addressed, our data suggest that many patients can discontinue their antidepressants without a taper through the lowest dose. However, it is difficult to identify which patients will struggle without a careful taper. A “one-size-fits-all” taper approach is recommended, balancing the need for withdrawal prevention with the need to avoid unnecessary complexity for the majority of patients. The first decrement is key for all patients: it must go well. Thereafter many patients may accelerate but all should receive a prescription for the lowest available dose of their antidepressant.