Early Discontinuation of Antidepressants in Mood and Anxiety Disorders

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PURPOSE: Early discontinuation of antidepressants continues to be a major challenge in treating mood and anxiety disorders, despite strong evidence supporting ongoing pharmacotherapy to prevent relapse and enhance long-term outcomes. This narrative review aimed to identify potential patient-level, medication-level, prescriber-level, and system-level factors of early discontinuation and to highlight strategies to improve long-term adherence. METHODS: First, guideline recommendations from Canada, the United States, the United Kingdom, Europe, and international bodies were reviewed to contextualize recommended treatment durations. Then, a literature search was performed, including studies published from 2000 to 2025. We used PubMed, Google Scholar, PsycINFO, and Web of Science databases. Findings from observational studies, clinical guidelines, and qualitative research were synthesized to identify key factors contributing to early discontinuation and to outline strategies to improve adherence. RESULTS: Early antidepressant discontinuation was often associated with low socioeconomic status, immigrant background, older age, prior substance use, comorbid psychiatric conditions, and misconceptions about treatment, although findings varied depending on the operational definition and study settings. Medication‑related contributors included adverse effect burden, initiation on tricyclic antidepressants, and cost‑related non-adherence. Prescriber‑level and system‑level contributors included limited follow‑up, high workload, variability in prescribing practices, and communication barriers. Several strategies to improve adherence can be adopted, including patient-centered communication, culturally competent care, selecting well‑tolerated first‑line agents, structured follow‑up, pharmacist‑led support, and digital/telehealth‑based interventions. CONCLUSIONS: Early antidepressant discontinuation is common and influenced by intersecting social, clinical, and structural factors, including equity-related determinants. Multifaceted, coordinated approaches, including effective communication, appropriate medication selection, and strengthened follow‑up processes, are needed to improve adherence.

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