Stopping antidepressants: when and how

SUMMARY

One in seven Australians takes an antidepressant, with around half taking them long-term (over 12 months). Unnecessarily prolonged antidepressant use should be avoided because of the risk of adverse effects.

A thorough mental health and medication history should inform whether it is appropriate to attempt to stop an antidepressant. The time to stop may be when the recommended duration of therapy is complete and there is no clinical indication for continued use, or where there are adverse effects that outweigh the benefits.

Stopping antidepressants abruptly may precipitate withdrawal symptoms. Withdrawal symptoms may be more likely with longer duration of therapy and with certain antidepressants, such as duloxetine, venlafaxine and paroxetine. Slowly decreasing the antidepressant dose (tapering) can help to minimise withdrawal symptoms.

The optimal antidepressant tapering approach is not yet known. Tapering usually involves decreasing the antidepressant dose in smaller decrements as the dose is lowered. In patients at low risk of withdrawal symptoms, guidelines recommend 25 to 50% dose reductions over 2 to 6 weeks (e.g. sertraline 100 mg tapered at 2-weekly intervals to 50 mg, 25 mg, then stop). In patients at higher risk of withdrawal symptoms, and those who have experienced difficulty stopping, smaller dose reductions over many weeks or months, through to very low drug doses (e.g. sertraline 1 mg), may be necessary; this may require compounded or liquid 'mini doses'.

 

Introduction

In Australia, 1 in 7 people take an antidepressant drug,¹ and this rate is rising.^2,3 Sertraline and escitalopram are in the top 10 drugs prescribed in Australia.⁴ Most antidepressants (92%) are prescribed in general practice,¹ and the most commonly prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs; 61%) and serotonin–noradrenaline reuptake inhibitors (SNRIs; 33%), so this article focuses primarily on these drug classes.³

Antidepressants are used for a range of indications, including depression, anxiety, obsessive-compulsive disorder, posttraumatic stress disorder and neuropathic pain. While long-term antidepressant therapy may be required in some people, in many cases long-term use is not recommended. For example, Therapeutic Guidelines: Psychotropic recommends that, for a patient with a first presentation of major depression, if there is an acceptable response 'continue at the same dose for 6 to 12 months, then consider deprescribing'. For anxiety it recommends treating 'for at least 1 year, then consider deprescribing'.⁵

The average duration of antidepressant therapy in Australia is around 4 years,⁶ and there is evidence that antidepressants are sometimes prescribed in general practice when clinical guideline criteria are not met.⁷

Unnecessary long-term antidepressant use is not harmless. Adverse effects include lethargy, weight gain, sexual dysfunction in both men and women, emotional numbing, sleep disturbance, and in older people increased risk of falls, hyponatraemia, and gastrointestinal bleed.^8-10

Stopping medication, like starting medication, has the goal of improving patient outcomes; it is patient centred with risks and benefits and a need for informed consent and monitoring. Physical dependence to antidepressants can develop, resulting in people experiencing withdrawal symptoms when they attempt to stop.^11,12 There is also a risk of relapse with antidepressant dose reduction and cessation.

The incidence and severity of withdrawal symptoms is still debated. Withdrawal symptoms can be mild and brief, especially after short-term (6 to 12 weeks) therapy,^13,14 but with longer-term therapy withdrawal symptoms can sometimes be severe and protracted.^12,15,16 Some people report being unable to stop antidepressants, despite wanting to, because of withdrawal symptoms.¹²

This article aims to support prescribers by providing an overview of when and how to stop antidepressants in primary care.

 

When to stop antidepressants

The time to consider stopping an antidepressant may be when the patient wants to stop, there is no clinical indication for continued use, the antidepressant is not working, the recommended duration of therapy is complete, or the risk of adverse effects outweighs the benefit of continued therapy.¹⁷ A thorough mental health and medication history will help to determine whether this time has come. Patients under the care of a psychiatrist or with a history of severe mental illness (e.g. hospitalisation, psychosis) should be assessed by a psychiatrist before attempting to stop.

While some patients may ask their general practitioner (GP) about stopping, there is evidence that many patients expect that their doctor would suggest stopping if it were warranted.¹⁸ But in clinical practice there are barriers to doctors raising the issue of stopping antidepressants, including the fast pace of practice, multiple competing demands and the fear of relapse or 'rocking the boat'.¹⁹ However, since even brief interventions can be effective for reducing long-term psychotropic drug use,^20,21 this discussion can be brief. Consistent with the context of general practice, where time may be short but relationships long, this discussion can take place over time and be repeated; for example, at each repeat prescription opportunity. The discussion about stopping antidepressants may include providing information to support informed shared decision-making; for example, using a decision aid that sets out the potential benefits and harms of both stopping or continuing.²² Informed decision-making is important because there are potential benefits and harms associated with both stopping and continuing antidepressants.

 

Withdrawal symptoms

Antidepressant withdrawal symptoms can include both physical symptoms (dizziness or light-headedness, increased sensitivity to light and sound, depersonalisation, brain zaps or electric shock sensations, agitation, vivid dreams, akathisia) and emotional symptoms (anxiety, irritability, worsened mood, tearfulness).^12,16,23 Some antidepressants are known to be at higher risk for severe withdrawal symptoms (e.g. venlafaxine, paroxetine, duloxetine), while some are at lower or moderate risk (e.g. fluoxetine).¹⁶

Withdrawal symptoms may be misconstrued as relapse of the original condition for which antidepressants were initiated, by both patients and clinicians, and then (mis)managed by reinstating or switching and continuing antidepressants.²⁴ The confusion between relapse and withdrawal is understandable as emotional symptoms, including anxiety, irritability, worsened mood and tearfulness, are features of both relapse and withdrawal.^12,25-27 The presence of physical withdrawal symptoms (for example, dizziness) can help to distinguish withdrawal from relapse. Timing of onset (often within a day or 2 for withdrawal symptoms) and ready relief on restarting antidepressants can also help to distinguish withdrawal from relapse since relapse would generally be expected to take longer to both manifest and respond to antidepressant therapy.²⁸

 

How to stop antidepressants

Slowly decreasing the drug dose (tapering) can help to minimise withdrawal symptoms.^17,29 This approach is recommended in clinical guidelines for stopping antidepressants.^17,30-32

The optimal tapering approach is not yet known; clinical trials are ongoing.^33,34 The approach to stopping antidepressants should be individualised, guided by factors including risk of withdrawal symptoms. Some patients can successfully taper and stop their antidepressant over a few weeks, but some may require a slower taper over several months.³⁵

Deprescribing guidance

Therapeutic Guidelines: Psychotropic (updated 2025) recommends:

'Reduce the dose of the antidepressant gradually ... For example, reduce the dose by 25 to 50% every 1 to 4 weeks until the daily dose is half the lowest unit strength available. Continue at the lowest dose for 2 weeks then stop. However, if the reason for stopping the antidepressant is that a serious adverse effect has occurred, reduce the dose more rapidly. Conversely, use a slower dose reduction schedule than described above if discontinuation symptoms are more likely' (Box 1).17

In patients at low risk of withdrawal symptoms, tapering over 2 to 6 weeks may be successful (e.g. sertraline 100 mg tapered at 2-weekly intervals to 50 mg, 25 mg, then stop). However, a recent trial found that in people who had been taking antidepressants for 9 months or longer, a similar tapering approach was not successful in up to 58% of patients.³⁶

In patients who cannot stop over a few weeks, and those at high risk of withdrawal symptoms, it may be necessary to taper using smaller dose reductions over many weeks or months. 'Hyperbolic tapering' involves decreasing the antidepressant dose in smaller and smaller decrements as the dose is lowered ('at lower, go slower'), as the risk of withdrawal symptoms may increase as the dose is lowered. This extended hyperbolic tapering approach is recommended in the Maudsley Deprescribing Guidelines, published in 2023.³² The Maudsley Guidelines recommend tapering at 2- to 4-weekly intervals through to very low doses using compounded capsules or liquid suspension (e.g. sertraline 100 mg, 50 mg, 25 mg, 15 mg, 10 mg, 6 mg, 4 mg, 2 mg, 1 mg, then stop).³²

Therapeutic Guidelines: Psychotropic (2025 update) states that 'Hyperbolic tapering ... may be an option for some patients at high risk of discontinuation symptoms. The use of hyperbolic tapering is limited by the availability of formulations that allow for administration of small doses. Randomised controlled trials on hyperbolic tapering of antidepressants are ongoing.'¹⁷

For patients who are not known to be at high risk of withdrawal symptoms, it may be appropriate to start with a faster taper (over 2 to 6 weeks), monitor regularly and, if withdrawal symptoms occur, pause or revert to the previous dose until symptoms settle and then restart tapering more slowly using smaller dose reductions.

Practical tips for antidepressant dose tapering

Choose a time to stop that is right for the patient; they will know when it is a good time for them. Provide step-by-step instructions, such as a tapering plan, to guide the patient in reducing their dose.^22,37

Allow at least 1 to 2 weeks to evaluate the effects of each dose reduction before considering further reductions.³¹

Regular follow-up and monitoring are important, especially for people at higher risk of relapse or withdrawal symptoms. People may not recognise withdrawal symptoms in themselves. Promote a healthy lifestyle including sleep hygiene, physical activity, social support and minimising alcohol.

If a person has mild withdrawal symptoms when they reduce their dose or stop taking antidepressant medication, reassure them that these symptoms are common and usually time-limited, and that even if they start taking an antidepressant medication again, or increase their dose, the withdrawal symptoms may take a few days to disappear.³¹ If a person has more severe withdrawal symptoms, they may return to their previous dose for symptom relief, and when ready to try again, attempt dose reduction at a slower rate with smaller decrements after symptoms have resolved.³¹

If tapering through very low doses is required, provide prescriptions and advice for accessing antidepressant 'mini doses' (less than one half of the lowest tablet strength). In Australia, currently only escitalopram is available in liquid formulation. Compounded mini-dose capsules are available on prescription via a compounding pharmacy but can be expensive.²² The lack of approved 'mini-dose' formulations has led people to use a range of creative methods to achieve smaller dose reductions than can be achieved by halving tablets (e.g. by cutting, shaving or filing tablets; opening capsules and counting or weighing the beads; or dispersing tablets in water or juice then taking a portion of the liquid). These approaches are not approved because they may lead to inaccurate dosing, but pharmaceutical guidance advises that, for people with swallowing difficulties, some antidepressant tablets may be crushed and dispersed in water for administration.^38,39

 

Conclusion

Patients should be supported to make an informed choice about continuing or attempting to stop their antidepressant. To safely and successfully stop antidepressants, people at higher risk of withdrawal symptoms may need support to slowly taper their antidepressant dose over many weeks or months, sometimes including the use of very low antidepressant doses.

This article was finalised on 6 April 2026.

Conflicts of interest: Katharine Wallis co-leads RELEASE: REdressing Long-tErm Antidepressant uSE in general practice, which is funded through the Australian Commonwealth Department of Health, Medical Research Future Fund (MRFF) 2020 Clinician Researchers Applied Research in Health – MRFAR000079, and the National Health and Medical Research Council (NHMRC) 2021 Partnership Projects PRC3 – 2015744. A sub-study (RELEASE antidepressant drug dose tapering protocols in practice – a mixed methods study with general practitioners), which is being conducted by an academic general practice registrar supervised by Katharine Wallis, is supported by funding from the Royal Australian College of General Practitioners. Katharine Wallis has also received funding from the NHMRC for a study titled: Finding the genetic variants influencing antidepressant withdrawal symptoms – Ideas 2038383.

Katharine received funding from the European College of Neuropsychopharmacology (ENCP) for travel, as an invited speaker, to the 38th ECNP congress, Amsterdam, October 2025.

This article is peer reviewed.

 

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