Nikita (name changed), 32, had always hoped to pursue higher studies in literature but was unable to clear the entrance exam for a PhD programme. As she watched her contemporaries move ahead in their careers while she struggled to find a job, she slipped into depression. After a suicide attempt, she began treatment but her response to medication was poor and she often discontinued it. Eventually, her brother moved from Ahmedabad to be with her in Pune. While pills failed, talk therapy with psychiatrists gradually pulled her off the edge.
“Initially, she required in-patient psychiatric care, followed by a year of outpatient follow-up after discharge,” said Dr Nishikant Thorat, Associate Professor and Head of the Department of Psychiatry at B.J. Government Medical College and Sassoon General Hospital. He recalled that Nikita gradually responded to a combination of medication and intensive psychotherapy or talk therapy. “Over one- and-a-half years of treatment, we were able to slowly taper her medications and eventually discontinue them completely after two years. She is now symptom-free and continues psychotherapy for ongoing support,” Dr Thorat added.
His observations from a government-run facility echo findings from a systematic review and network meta-analysis of 76 randomised controlled trials published in The Lancet Psychiatry. Involving 17,000 adults, the study estimated that slow tapering of antidepressants combined with psychological support could prevent one relapse in every five people, compared with abrupt or rapid discontinuation.
However, the authors (University of Verona, University of Rennes, Universitaire de France, and the University of Padova) cautioned that evidence supporting psychotherapy remains limited and requires further confirmation. They also noted that the data supporting its benefits for anxiety disorders is less robust than for depression and must be validated through dedicated trials.
What does the study say
Evidence-based guidelines for moderate-to-severe depression and anxiety disorders typically recommend that antidepressants be taken for six to nine months after a first episode or for up to two years in people who have experienced multiple recurring episodes or have specific risk factors for relapse. But there are concerns about overprescribing, long-term use and withdrawal symptoms.
To address this evidence gap, researchers examined antidepressant de-prescribing strategies up to April 2025. They found moderate-quality evidence that after successful treatment of depression, slow tapering of antidepressants combined with psychological support prevented relapse over the following year. This is similar to remaining on an antidepressant at standard doses (either with or without psychological support). “These were the most effective strategies for reducing the rate of depression relapse,” said lead author Professor Giovanni Ostuzzi, University of Verona in Italy.
Why depression tends to return
According to Dr Thorat (not involved in the study), depression has a high chance of recurrence when medication is discontinued, especially prematurely. That’s because there is a sudden drop in neurotransmitter levels while the brain continues to expect a higher level of stimulation. “Patients generally have more than 2 to 3 episodes during their lifetime. Medications like antidepressants and psychotherapy like cognitive behaviour therapy (CBT) are the treatment of choice. Both are effective. This study shows that a combination is effective and, in fact, has good results. It also shows that we can reduce medication when the patient is in remission and move over to CBT. It is definitely a choice for patients who don’t want to take medication but it takes time to show the results and requires psychological preparedness from the patient’s side,” explained Dr Thorat.
The flip side of overusing antidepressants
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Dr Thorat cautioned against using antidepressants routinely to tackle loneliness. “These are to be used by the elderly people only if they are clinically depressed. We have to factor in the physical health of the patient as antidepressants may have interactions with other medications used in the elderly population. A regular follow-up with the treating doctor is advised when a patient is on antidepressants,” he said.
The need for customised protocols
The authors emphasise that these findings do not suggest that antidepressants are unnecessary or that psychotherapy alone is adequate. Instead, they say the results underscore the importance of tailoring a protocol to each individual. “Clinical guidelines recommend continuing antidepressants for a certain period after remission, then considering discontinuation once the person has remained well. Yet in everyday practice, treatment is often prolonged far beyond what guidelines suggest. Many people do not wish to stay on medication indefinitely, and some experience troublesome side effects. Still, there has been little rigorous research into the safest and most effective approaches to discontinue treatments,” said Professor Giovanni Ostuzzi.
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