Feeling better while taking an antidepressant can be a sign that treatment is working, rather than a reason to stop it, according to University of Rochester Medicine guidance on reviewing psychiatric medications.
The health system recommends discussing medication changes with a clinician and reassessing treatment regularly. Patients should not change a dose or stop an antidepressant on their own.
The guidance describes medication review as an individualized decision involving symptoms, side effects, health history and the risk of depression returning.
Improvement does not automatically mean treatment is finished
Guidelines generally recommend continuing an antidepressant for at least six months after symptoms resolve, UR Medicine says. What happens after that depends on a person's history, the severity of past illness, other health conditions and response to treatment.
For some patients, a supervised reduction may be appropriate. For others, particularly when depression has returned after earlier attempts to stop, continuing medication longer may be useful.
A review can also help when treatment has produced only a partial response or stopped improving symptoms. New or worsening side effects and the use of multiple medications are other reasons to revisit a plan.
Changes need an individual plan
Stopping or reducing an antidepressant can cause discontinuation symptoms. Their severity depends on the medication, how long it has been taken and how quickly the dose changes, according to UR Medicine.
Symptoms can range from mild to severe enough to interfere with daily life. Patients experiencing symptoms during a reduction should contact their clinician.
Deprescribing is a planned, supervised process of reducing or stopping medicine when it is no longer needed or its risks outweigh its benefits. It does not necessarily mean ending treatment altogether: a clinician may recommend changing the dose or switching medications instead.
The timing and size of dose reductions should be tailored to the person and medication, rather than copied from someone else's experience.
Preparing for a medication review
UR Medicine advises bringing questions, a description of symptoms and recent health changes, and a complete list of prescription medicines, over-the-counter products and supplements.
Patients can discuss their goals, concerns, side effects and any difficulty following the current plan. That conversation can help a clinician assess both benefits and risks before recommending a change.
The guidance concerns treatment discussions with a qualified clinician; it does not provide a universal stopping schedule.
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