Tapering antidepressants: is 3 months slow enough?

Background: Antidepressants are used by 10% of the US population. Amongst these users, most will stop their antidepressant at some point, and about half--over a million people--will experience withdrawal effects, given usual taper rates. Moreover, recent data suggest that relapse rates (in patients with depression, panic disorder, or bipolar disorder) are higher with shorter tapers. How long is long enough? Recent data from narcolepsy research suggest that the physiologic processes associated with antidepressant discontinuation last over three months.

Recent results: Antidepressants have long been used in control of narcolepsy with cataplexy, but their sustained efficacy in this role has been in question. Thus prior to a trial of a new medication for cataplexy, antidepressants were carefully tapered and cataplexy rates monitored. Patients who had never received antidepressants were used as controls. Antidepressant discontinuation was associated with a dramatic increase in cataplexy rates, as anticipated; but importantly, these rates did not normalize, relative to the never-exposed patients, for over 3 months.

Conclusion: These cataplexy data suggest that common antidepressant taper rates may be far too brief. Patients who are doing well and ready to discontinue their antidepressant might experience fewer withdrawal effects and fewer relapses with rates much longer than those now routinely used.