As antidepressant use grows, so does the need for personalised deprescribing

Since coming to market in the 1980s, antidepressants have become some of the most widely used medications in the world. A recent study found that use of antidepressants grew 33% in OECD countries from 2010 to 2020.[1] Australia is no exception to this trend. Roughly 3.5 million Australians are prescribed antidepressants each year.[2]

Our knowledge of the side effects of these medications has grown alongside their use. Prolonged use of antidepressants has been linked with emotional blunting, memory and concentration difficulties, cardiac arrhythmia, weight gain, gastrointestinal problems and more. 

But discontinuing use of antidepressants when they are no longer medically indicated can be difficult. Withdrawal symptoms range from mild to severe and may be more common the longer a patient has used the medication. Safe deprescribing requires slow, individualised tapering, but dose flexibility is limited for many commercial antidepressants.

Dose flexibility is a particular hurdle because of the tapering strategy used for antidepressants. This is called hyperbolic  tapering, after relationship between drug concentration and neuroreceptors in the brain, which makes a hyperbola on a graph . In effect, low doses are much more pharmacologically potent per milligram than high doses. A small reduction at a low dose feels much bigger to the patient than the same reduction at a high dose.

Mass production of antidepressant medication at the range of doses required for hyperbolic tapering is challenging because the “one size fits all” nature of manufacturing millions of tablets or capsules in a factory is ill-suited to the needs of antidepressant deprescribing.

Building better tools for safe, personalised deprescribing of antidepressants is a burgeoning field of research. Scientists at the University of Tasmania, for example, are working on liquid formulations of 11 of Australia’s most deprescribed antidepressants right now.[2] 

Their work will build on other recent deprescribing resources, such as the Maudsley Deprescribing Guidelines, the University of Queensland’s RELEASE toolkit, and the Royal College of Psychiatry’s guidance on stopping antidepressants.

All this work on safe deprescribing has one thing in common: it seeks to empower medical professionals with tools to personalise the deprescribing plans they make for their patients.

Personalisation sits at the center of safe deprescribing. This means compounding pharmacies have a unique role to play here. 

Compounding pharmacists prepare custom medications for each patient, in collaboration with other healthcare professionals, to meet the patient’s needs. This includes the dose, which can be adjusted precisely to fit a patient’s unique needs for their hyperbolic tapering schedule.

Compounding’s role in safe antidepressant deprescribing highlights the growing importance of precision, quality, and collaboration across the healthcare ecosystem. As personalised tapering strategies continue to evolve, compounding pharmacists can help support healthcare professionals and patients through customised dosage solutions tailored to individual needs.

For patients undergoing hyperbolic tapering, personalisation is not simply a preference; it can be an important part of supporting safer and more manageable deprescribing journeys.

“The future of deprescribing cannot rely on one-size-fits-all medicine. Patients tapering antidepressants often require levels of dose precision and flexibility that traditional manufacturing was never designed to deliver. That is where quality compounding can play a critical role, helping healthcare professionals personalise care in ways that better support patient safety, adherence, and long-term outcomes.” — Patricia Ullmann, B.Pharm., MPS, Director of Public Affairs & Education, Medisca

References:

1. National Library of Medicine – Antidepressant consumption in OECD countries
2. University of Tasmania - Liquid formulations set to transform antidepressant deprescribing in Australia
   

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