Overview: A Step Toward Safer Antidepressant Deprescribing
Depression and other mental health concerns are among the most common reasons patients visit general practice. As clinicians strive to provide effective treatment while minimizing harm, the Royal Australian College of General Practitioners (RACGP) has released a practical guide in its First do no harm series. This new resource focuses on antidepressant deprescribing—how to reduce or stop antidepressant therapy safely when the risks of continued treatment outweigh the benefits.
Why Deprescribing Matters
Antidepressants can be life-changing for many patients, but long-term use is not without risks. Side effects, withdrawal symptoms, and the potential for relapse during tapering demand careful planning. The RACGP guide emphasizes patient safety, shared decision-making, and individualized care. It supports GPs in recognizing when deprescribing is appropriate, how to communicate options, and how to monitor patients throughout the process.
Key Principles for Safe Deprescribing
The guide outlines practical steps that clinicians can apply in routine care. Core principles include:
- Assess relapse risk: Review the patient’s history, current symptoms, and past responses to changes in therapy.
- Collaborative decision-making: Discuss goals, concerns, and preferences with the patient, family, and care team.
- Plan withdrawal with flexibility: Develop a gradual taper schedule tailored to the specific antidepressant and patient factors.
- Monitor and support: Establish milestones and safety nets, including access to quick reassessment if symptoms worsen.
- Address withdrawal proactively: Be aware of common withdrawal symptoms and strategies to minimize them.
Practical Steps in the Consultation
When considering deprescribing, a GP can follow a structured approach:
- Document baseline symptoms and functional status: Use standardized scales where appropriate and record mood, sleep, energy, and concentration levels.
- Define success criteria: Agree on what improvement or stability looks like and when to pause or reinitiate treatment.
- Customize tapering regimens: Options might include slower dose reductions, alternate-day dosing, or switching to a different formulation if withdrawal risk is high.
- Plan follow-up: Schedule regular reviews to catch relapse early and adjust the plan as needed.
- Safety considerations: Ensure patients have access to crisis support and emergency contacts, especially during transitions.
Communication and Shared Decision-Making
Effective deprescribing hinges on clear, compassionate communication. The RACGP guide emphasizes explaining the rationale, potential benefits, and possible withdrawal effects in plain language. Patients should feel empowered to ask questions and to pause or reverse decisions if symptoms worsen. The guide also highlights the importance of documenting the informed consent process and the agreed taper plan in the patient record.
Who Benefits from This Guide?
Every patient receiving antidepressants in primary care can benefit from careful consideration of deprescribing. Clinicians gain a structured framework to reduce unnecessary medication exposure, improve safety, and optimize long-term mental health outcomes. The guide is also a valuable resource for multidisciplinary teams, pharmacists, and practice nurses involved in medication management and patient follow-up.
Implementation in Everyday Practice
Adopting the RACGP deprescribing guide requires minimal workflow disruption but delivers meaningful gains in care quality. Practices can integrate the steps into routine deprescribing conversations, update patient information leaflets, and train staff on recognizing withdrawal symptoms and when to escalate care. By embedding this approach, GPs support patients in achieving safer, more sustainable mental health management.
