Cochrane · systematic review · CD013495
Approaches for discontinuation versus continuation of long‐term antidepressant use for depressive and anxiety disorders in adults
Van Leeuwen, E, van Driel, ML, Horowitz, MA, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Common Mental DisordersAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
32
current version
GRADE rated
22
No studies
10
Included studies
NR
No studies 10 · 31.3%Ungraded 0 · 0%Very low 16 · 50%Low 6 · 18.8%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Abrupt discontinuation compared to continuation of long‐term antidepressants for depressive and anxiety disorders in adults
Population: participants with depressive or anxiety disorders
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Successful discontinuation rate Abrupt discontinuation vs continuation of long‐term antidepressants | no estimate extracted | NR | No studies |
Relapse (as defined by study authors) (HR) Abrupt discontinuation vs continuation of long‐term antidepressants | HR 2.09 [1.59, 2.74] | 10 studies · 1373 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Withdrawal symptoms Abrupt discontinuation vs continuation of long‐term antidepressants | no estimate extracted | 1 study · 182 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Adverse events Abrupt discontinuation vs continuation of long‐term antidepressants | OR 1.11 [0.62, 1.99] | 7 studies · 1012 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Depressive symptoms Abrupt discontinuation vs continuation of long‐term antidepressants | no estimate extracted | 3 studies · 330 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Anxiety symptoms Abrupt discontinuation vs continuation of long‐term antidepressants | no estimate extracted | 3 studies · 439 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Quality of life Abrupt discontinuation vs continuation of long‐term antidepressants | no estimate extracted | NR | No studies |
Social and occupational functioning Abrupt discontinuation vs continuation of long‐term antidepressants | no estimate extracted | NR | No studies |
Discontinuation by "tapering" compared to continuation (or usual care) for depressive and anxiety disorders in adults
Population: participants with depressive or anxiety disorders
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Successful discontinuation rate Studies without co‐intervention Discontinuation by "tapering" vs continuation (or usual care) | no estimate extracted | NR | No studies |
Relapse (as defined by study authors) (HR) Discontinuation by "tapering" vs continuation (or usual care) | HR 2.97 [2.24, 3.93] | 13 studies · 1546 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Withdrawal symptoms Discontinuation by "tapering" vs continuation (or usual care) | no estimate extracted | 1 study · 176 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Adverse events Discontinuation by "tapering" vs continuation (or usual care) | OR 1.06 [0.82, 1.38] | 7 studies · 1479 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Depressive symptoms Discontinuation by "tapering" vs continuation (or usual care) | no estimate extracted | 6 studies · 1017 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Anxiety symptoms Discontinuation by "tapering" vs continuation (or usual care) | no estimate extracted | 3 studies · 526 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Quality of life Discontinuation by "tapering" vs continuation (or usual care) | no estimate extracted | 3 studies · 502 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Social and occupational functioning Discontinuation by "tapering" vs continuation (or usual care) | no estimate extracted | 3 studies · 502 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Discontinuation with high‐intensity psychological interventions compared to continuation for depressive disorders in adults
Population: participants with long‐term antidepressants for depressive disorders
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Successful discontinuation rate: proportion (%) of participants who successfully stopped use of antidepressants at the end of the trial Discontinuation with high‐intensity psychological interventions vs continuation | no estimate extracted | 3 studies · 690 participants | Very low Downgraded: imprecision, indirectness |
Risk of relapse (as defined by study authors) (HR) Discontinuation with high‐intensity psychological interventions vs continuation | HR 0.89 [0.66, 1.19] | 3 studies · 690 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Withdrawal symptoms Discontinuation with high‐intensity psychological interventions vs continuation | no estimate extracted | NR | No studies |
Adverse events Discontinuation with high‐intensity psychological interventions vs continuation | no estimate extracted | 3 studies · 690 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Depressive symptoms Discontinuation with high‐intensity psychological interventions vs continuation | no estimate extracted | 2 studies · 484 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Anxiety symptoms Discontinuation with high‐intensity psychological interventions vs continuation | no estimate extracted | NR | No studies |
Quality of life Discontinuation with high‐intensity psychological interventions vs continuation | no estimate extracted | 2 studies · 455 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Social and occupational functioning Discontinuation with high‐intensity psychological interventions vs continuation | no estimate extracted | NR | No studies |
Discontinuation of long‐term antidepressant with minimal intervention compared to usual care for depressive and anxiety disorders in adults
Population: participants with long‐term antidepressants for depressive or anxiety disorders
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Successful discontinuation rate: proportion (%) of participants who successfully stopped use of antidepressants at the end of the trial Defined as no antidepressant use during the preceding 6 months and absence of a depressive or anxiety disorder Discontinuation of long‐term antidepressant with minimal intervention vs usual care | no estimate extracted | 1 study · 146 participants | Low Downgraded: risk of bias, imprecision |
Relapse rate Discontinuation of long‐term antidepressant with minimal intervention vs usual care | no estimate extracted | 1 study · 146 participants | Low Downgraded: risk of bias, imprecision |
Withdrawal symptoms Discontinuation of long‐term antidepressant with minimal intervention vs usual care | no estimate extracted | NR | No studies |
Adverse events Discontinuation of long‐term antidepressant with minimal intervention vs usual care | no estimate extracted | NR | No studies |
Depressive symptoms Discontinuation of long‐term antidepressant with minimal intervention vs usual care | no estimate extracted | 1 study · 106 participants | Low Downgraded: risk of bias, imprecision |
Anxiety symptoms Discontinuation of long‐term antidepressant with minimal intervention vs usual care | no estimate extracted | 1 study · 104 participants | Low Downgraded: risk of bias, imprecision |
Quality of life Discontinuation of long‐term antidepressant with minimal intervention vs usual care | no estimate extracted | 1 study · 146 participants | Very low Downgraded: risk of bias, imprecision |
Social and occupational functioning Discontinuation of long‐term antidepressant with minimal intervention vs usual care | no estimate extracted | NR | No studies |