Why did antidepressant deprescribing fail? A scoping review of contributing factors.

BACKGROUND

Antidepressant use continues to rise in primary care, often beyond recommended durations. Previous reviews have found insufficient evidence to support long-term antidepressant discontinuation compared with maintenance treatment.

OBJECTIVE

To describe how antidepressant deprescribing interventions have been designed in primary care and identify features that explore potential reasons for limited effectiveness.

DESIGN

Scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidance.

DATA SOURCES: PubMed, Web of Science and PsycINFO were searched through August 2025.

ELIGIBILITY CRITERIA: We included randomised controlled trials and cohort studies of patients prescribed antidepressants despite the absence of current depressive symptoms. Studies were excluded if they were reviews, protocols, case reports, database studies, editorials or commentaries.

DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened records, with disagreements resolved by a third reviewer. Findings were synthesised descriptively to identify characteristics of study populations, interventions, healthcare professionals and care processes that may help explain the limited effectiveness reported in antidepressant deprescribing trials.

RESULTS

Nine studies were included. RCTs mainly enrolled patients with recurrent depression or major depressive disorder and generally used short tapering schedules. General practitioners led most interventions, while other health care professionals were variably involved. No study reported structured interprofessional collaboration, sustained communication between professionals, or patient and public involvement. Across trials, adherence to deprescribing protocols was moderate to low and relapse rates remained high in most studies. The two cohort studies used longer, more gradual, including hyperbolic, tapering strategies and reported higher discontinuation rates.

CONCLUSION

This review identifies population and methodological gaps in antidepressant deprescribing research in primary care. Future studies should include patients with unclear long-term indications or less severe depressive symptoms, use more adaptive tapering strategies and strengthen collaboration between healthcare professionals.