Introduction: Addressing antidepressant deprescribing in primary care
With mental health concerns one of the most common presentations in general practice, clinicians are increasingly navigating when and how to deprescribe antidepressants. The Royal Australian College of General Practitioners (RACGP) has released a new step-by-step guide as part of its First do no harm series to support GPs in patient care. The guide, designed to help clinicians make thoughtful, patient-centered decisions, emphasizes safety, monitoring, and shared decision-making throughout the deprescribing process.
Why deprescribe antidepressants now?
Antidepressants can be lifesaving for many patients, but long-term use may be unnecessary or misaligned with current needs for some individuals. Deprescribing aims to reduce potential side effects, minimize withdrawal risks, and restore patients’ autonomy in managing their mental health. The RACGP guide highlights that deprescribing is a clinical decision, not a one-size-fits-all protocol, and it should be considered whenever a patient’s symptoms are well-controlled or when the risks of continued medication outweigh benefits.
Core principles of the RACGP deprescribing guide
Assess current need and stability
The process starts with a thorough evaluation of symptom control, functional status, and overall goals of care. GPs are encouraged to review dosing history, past responses to treatment, comorbidities, and any contributing factors such as life stressors or sleep disruption that may influence mood.
Plan a gradual taper
Gradual tapering, tailored to the individual, helps minimize withdrawal symptoms and emotional symptoms. The guide provides tapering schedules that consider the specific antidepressant, duration of use, and patient preferences. A slower taper may be appropriate for those on higher doses or with a history of difficult withdrawals.
Monitor and support
Close monitoring during a taper is essential. Regular follow-up appointments enable clinicians to track mood, anxiety, sleep, energy, and functional outcomes. The guide stresses the importance of safety nets, including crisis planning and rapid access to care if symptoms worsen.
Shared decision-making
The RACGP guide reinforces shared decision-making as a cornerstone of deprescribing. Clear, compassionate conversations help patients understand the rationale, expected timelines, potential risks, and available support. Decisions should reflect the patient’s values, preferences, and life context.
Practical tips for general practitioners
- Document goals of deprescribing in a care plan and set realistic timelines with the patient.
- Consider comorbidity interactions, such as anxiety disorders, chronic pain, or sleep disturbances, which can affect withdrawal experiences.
- Coordinate care with other providers, including psychologists, pharmacists, and allied health professionals, to support non-pharmacological strategies.
- Provide patient education on potential withdrawal symptoms and what to do if they occur.
- Develop a clear plan for recurrence of depressive symptoms, including when to reinstate or adjust therapy.
Supporting patients through the deprescribing journey
Patients benefit from clear information, reassurance, and practical strategies. The guide advocates for proactive counseling about expectations, resilience-building techniques, and lifestyle factors that support mental well-being, such as regular exercise, sleep hygiene, and social connection. Clinicians should validate concerns, normalize occasional mood fluctuations during taper, and emphasize collaborative decision-making.
Implications for practice and policy
As mental health presentations in primary care rise, structured deprescribing frameworks like RACGP’s guide help standardize practice, reduce adverse events, and sustain patient trust. By embedding the guide within routine care, GPs can offer safer, more transparent antidepressant deprescribing that aligns with patient goals and clinical guidelines.
Conclusion: A pragmatic, patient-centered approach
The RACGP’s First do no harm guide to choosing wisely in antidepressant deprescribing presents a practical, evidence-informed roadmap for GPs. Through careful assessment, individualized taper plans, vigilant monitoring, and shared decision-making, clinicians can help patients safely reduce or discontinue antidepressants when appropriate while preserving mental health outcomes and quality of life.
