Antidepressants: Course and Duration of Therapy, Withdrawal Syndromes, and Resistance to Therapy

The course and duration of therapy, withdrawal syndromes, and resistance to therapy are important clinical topics in antidepressant therapy. The reviewed clinical evidence may help to guide clinicians and patients when planning the pharmacological part of the therapy. The treatment with antidepressants is typically divided into different phases that each require specific considerations. The recommended course and duration of treatment may vary depending on the respective treatment phase, as well as on individual patient characteristics. Insufficient treatment response occurs frequently and a series of therapeutic options are available such as increase in dosage, combining the current antidepressant with an additional antidepressant, augmentation with another pharmacological substance, and switching to a different antidepressant. When antidepressant therapy is discontinued, patients may experience withdrawal symptoms/syndromes. Symptoms are generally mild and transient, but, depending on the individual drug, can be severe and impairing for individual patients. Recognizing discontinuation syndromes and differentiating those from re-emergence of the primary disorder is of crucial importance and will have major consequences for further treatment. Indications and guidance for gradual tapering of antidepressants will be discussed. © Springer Nature Switzerland AG 2022.