Overview: A Practical Guide for Deprescribing Antidepressants
With mental health concerns among the most common presentations in general practice, the Royal Australian College of General Practitioners (RACGP) has released a new step-by-step guide to support safe antidepressant deprescribing. This resource is part of the broader “First do no harm” initiative, which aims to help clinicians make wise, patient-centered decisions in long-term treatment plans. The guide emphasizes careful assessment, shared decision-making, and a patient-tailored tapering schedule to minimize withdrawal symptoms and relapse risk.
Why Deprescribing Matters in Primary Care
Antidepressants play a crucial role for many patients, but ongoing use without a clear plan can lead to unnecessary exposure to side effects, interactions, and reduced quality of life. Deprescribing is not about abruptly stopping medication; it is about evaluating the need for continued use, weighing risks and benefits, and implementing a gradual taper when appropriate. The RACGP guide supports GPs in navigating these conversations, particularly for patients who have been on antidepressants for months or years, or who experience adverse effects.
Key Principles for Safe Deprescribing
- <strongPatient-centered assessment: Consider mood history, functional status, and patient preferences before any change is made.
- <strongEvidence-informed tapering: Use gradual dose reductions tailored to the specific antidepressant and duration of use.
- <strongMonitoring and support: Establish a plan for monitoring withdrawal symptoms, mood changes, and relapse risk.
- <strongShared decision-making: Engage patients in the decision, ensuring they understand potential risks and benefits.
- <strongSafety considerations: Be mindful of comorbid conditions, previous withdrawal experiences, and psychosocial stressors.
Practical Steps for GPs
The guide provides a structured approach that clinicians can follow in routine consultations:
- <strongStep 1: Review indication and current status: Confirm the original reason for antidepressant therapy and assess current symptom control.
- Step 2: Discuss deprescribing options: Present tapering plans, including the possibility of temporary dose stabilization if withdrawal symptoms arise.
- Step 3: Create a tapering schedule: Individualize the reduction rate based on drug type, dose, and patient tolerance.
- Step 4: Plan for withdrawal support: Identify coping strategies and consider adjunct therapies or psychosocial supports.
- Step 5: Arrange follow-up: Schedule timely reviews to reassess mood, functioning, and safety.
Who Benefits from This Guide?
Patients who have been on antidepressants long-term, those who experience chronic side effects, or individuals seeking to reduce medication load can benefit from a thoughtful deprescribing plan. By guiding clinicians through careful assessment, the RACGP aims to reduce harm while preserving patient well-being and autonomy.
Communication and Safety: The Patient-Provider Partnership
Effective deprescribing hinges on open dialogue. Clinicians are encouraged to explain the rationale for tapering, address fears about symptom return, and provide practical support. This collaborative approach helps preserve trust and adherence to the deprescribing plan. The guide also highlights the importance of monitoring for relapse and ensuring fast access to care if symptoms worsen.
What’s Next for General Practice
As mental health needs evolve, primary care teams will benefit from ongoing resources and updates in evidence-based deprescribing. The RACGP’s First do no harm series continues to equip GPs with tools to choose wisely, balancing effective symptom management with minimizing medication-related risks. Clinicians can use this guide to align practice with current best-practice standards and patient-centered care.
