Challenges And Strategies in Antidepressant Discontinuation for Major Depressive Disorder and Anxiety Disorders: Rationale, Review of Tapering Protocols and Psychological Interventions

Major Depressive Disorder (MDD) and anxiety disorders along with obsessive-compulsive disorder (OCD), and Post-Traumatic Stress Disorder (PTSD), pose significant global health burdens, affecting over 280 million of people globally. Standard care for MDD and anxiety disorders including OCD and PTSD involves antidepressants (AD), Cognitive Behavioral Therapy (CBT), or both in conjunction, tailored to individual patient’s symptom severity. Post-remission, all major treatment guidelines recommend gradual AD tapering with relapse prevention interventions, but antidepressant (AD) discontinuation is complex due to withdrawal symptoms mimicking relapse, physiological dependence from prolonged use, and patient-specific factors like mental health history and treatment duration, further complicated by frequent comorbidity of major depressive disorders and anxiety disorders including OCD& PTSD. Traditional guidelines generally advocate antidepressant (AD) tapering to proceed in fixed schedule linear tapering over few weeks to months, but lack detailed step by step hands on approach or identifying & mitigating antidepressant (AD) withdrawal symptoms; leading to misdiagnosis, prolonged AD use, and reliance on unverified online cessation advice. Updated NICE and Royal college of Psychiatrists guidelines now endorse hyperbolic or proportional tapering, individualized to patient needs, supported by CBT and Mindfulness-Based Cognitive Therapy (MBCT) to mitigate withdrawal, enhance emotional regulation, and reduce relapse risk across these disorders. Effective deprescribing requires meticulous planning, patient education, and monitoring to integrate these evidence-based strategies, curbing unnecessary AD use amid rising global reliance. Gaps in prescriber awareness highlight the need for research into neurobiological mechanism of physical dependence due to antidepressants (AD) and adaptable dosing formulations to refine AD tapering protocols and improve outcomes in MDD and anxiety disorders including OCD & PTSD management