Long-Term Antidepressant Users May Need Slower Tapers as Withdrawal Concerns Grow

Psychiatrist Mark Horowitz spent 15 years taking an SSRI antidepressant. When he tried to stop, tapering slowly over four months, he says his 'life fell apart', with panic attacks and sleepless nights that sent him straight back on the drug.

It took him five years, and a much slower, more gradual approach, to finally come off it. His experience, detailed in a new feature published by Nature, has reignited scientific debate over how long-term antidepressant use should be discontinued, and whether current tapering guidance moves too fast for people who have been on the drugs for years.

Why Duration Matters

Horowitz, a psychiatrist at Adelaide University in Australia, argues that treatment duration is one of the strongest predictors of how difficult withdrawal becomes. 'The longer you're on the drugs, the more your brain adapts, and the more severe withdrawal is,' he said.

That view has gained traction among some clinicians, even as it remains contested. Maurizio Fava, a psychiatrist at Massachusetts General Hospital, has separately acknowledged that withdrawal is 'a real phenomenon', though some clinical trialists contest how common or severe it typically is.

A Widely Debated Risk

Estimates of how many people experience withdrawal symptoms vary enormously depending on the type of study. A 2019 analysis found that 56 per cent of people who tried to stop taking SSRIs experienced discontinuation symptoms, with nearly half describing them as severe.

Controlled trials from more recent years suggest a much lower figure, closer to 15 per cent, according to the Nature report. But many of those trial participants had only taken the drugs for a few weeks or months, far shorter than the years or decades typical of real-world use, which may explain the gap.

According to trial data cited in the Nature feature, roughly half of people who stop taking antidepressants relapse within a year. This is one reason most patients are advised to stay on the medication for at least six months after their symptoms stabilise.

The Slow Taper Revolution Nice Is Already Backing

UK guidance has already begun shifting towards slower, more individualised tapering schedules.

The National Institute for Health and Care Excellence updated its recommendations to favour reductions that get smaller as the dose gets lower, an approach researchers call 'hyperbolic' tapering, according to a 2024 analysis in the British Journal of General Practice for primary care doctors.

A separate case study published in The Pharmaceutical Journal noted that around half of patients experience some withdrawal effects, and that symptoms can, in some cases, last for months.

Some imaging and observational studies support the idea that this slower approach eases symptoms, though no randomised trial has proven it safer or more effective than a standard faster taper.

Hyperbolic tapering can also be logistically difficult, since it often requires liquid formulations or customised dosing that standard pill sizes don't allow for.

More than 100 million prescriptions for common SSRIs, including sertraline, escitalopram and fluoxetine, were filled in the United States in 2024 alone. With so many people on long-term treatment, even a modest proportion struggling to stop represents a significant number of patients.

For readers currently taking antidepressants, the emerging consensus isn't that the drugs are unsafe. It's that stopping them, particularly after years of use, may require more time, planning and medical support than standard tapering schedules currently allow.