The New Script for Mental Health campaign is continually conducting research and policy analysis to create an evidence base and deposit of resources around mental health rights, specifically centred around our Give 5 framework. Step 2 of the New Script for Mental Health’s Give 5 framework calls on government to Be Active in challenging the over-prescription of drugs, respond to individual needs, and provide different, community-based options for healing and creative, peer-led interventions. Both the United Nations and the World Health Organisation have called on governments to prioritise community-based mental health services. However, we know that options currently available for people experiencing mental health challenges are far too narrow and treatment options are often limited to antidepressants.

We are working to advance patients’ rights around prescription of antidepressant medication as part of mental health care. Part of this is collating evidence-based information on the risks and benefits of these medications, the experiences of patients and their families, and alternative and complementary options for treatment.

The ‘system reality’: even when antidepressants are no longer needed, stopping them is often difficult in routine care

This blog summarises a recent research paper by Atkins et al. (2025) mapping the barriers and enablers for healthcare professionals (HCPs) in primary care when supporting patients to stop antidepressants prescribed for mild to moderate common mental health conditions.

Across the 17 studies included, lack of time was one of the biggest barriers. Short appointments often leave little room to review long-term prescriptions or to provide the extra monitoring and support that safe discontinuation can require. In this situation, continuing repeat prescriptions can become the easiest option. The review also noted limited follow-up systems, infrequent medication reviews, and reluctance to change medication due to pressure from nursing staff or relatives.

Fear of relapse was another major concern. Many HCPs reported that continuing antidepressants felt “less risky” than trying to stop them, particularly for older patients or those with other mental health conditions. Some healthcare professionals also worried they would be blamed if a patient’s mental health worsened. This risk-averse culture can unintentionally reinforce long-term prescribing.

The review also found confusion about who should start conversations about stopping medication. Some HCPs expected patients or families to raise the issue. However, many patients assume that if a prescription keeps being renewed, the medication must still be necessary. This mutual hesitation can result in people staying on antidepressants longer than intended.

There were also clear factors that helped HCPs support discontinuation. Access to clear guidance, tapering (slowly reducing dosage) schedules, and practical tools to monitor symptom change can support HCPs to deprescribe safely. Training and education were frequently reported as helpful, as was care continuity and a strong relationship between patient and HCP that allows for shared decision-making on the patient’s medication plan. Multidisciplinary support, including pharmacists, social workers and psychological services was also seen as making antidepressant discontinuation easier.

However, an important finding is that most current interventions focus mainly on education and training. While helpful, these do not address the bigger system pressures HCPs face, such as lack of time, heavy workloads, and fear of relapse. This may explain why many interventions have had little effect on actual discontinuation rates.

The researchers highlight an important contradiction. Stopping antidepressants is often avoided because it is seen as too time-consuming. But continuing them long term without proper review can create more work later, especially if withdrawal problems or side effects appear.

Overall, the findings point to the need for system-level change. HCPs need protected time, clear and practical tapering guidance built into routine care, and reliable access to non-drug supports. Just as importantly, services need to support more proactive, shared decision-making so responsibility for reviewing antidepressants does not fall into a gap between HCP and patient. 

Without addressing these structural barriers, many people may continue to remain on antidepressants longer than clinically necessary, not because of individual clinical need alone, but because the system makes stopping difficult.

You can find a range of evidence sources that support Step 2: Be Active here. These sources are drawn from both international and local levels, including the United Nations and WHO, academic journals and books, parliamentary and NGO reports, and analysis by New Script for Mental Health.