Cognitive Behaviour Therapy for Withdrawal from Antidepressant Medication: A Single Case Series

Abstract

Research has clearly established the efficacy of pharmacotherapy and cognitive behaviour therapy (CBT) for depression. There is less literature addressing cessation of treatment, such as relapse during withdrawal from antidepressant medication. The current study examines the role of psychological constructs that may influence relapse or fear of relapse and lead to resumption of medication. This hypothesizes that during withdrawal individuals may misinterpret normal variations in mood and dysphoric or other symptoms as reduced levels of medication in their bodies in keeping with a simplistic rationale for antidepressants. The study uses an intensive single case AB style design in three cases during the withdrawal process. All participants had been treated with CBT plus antidepressants and had previously attempted to withdraw from antidepressants. The first part of the study naturalistically tracks belief changes as medication decreases; the second examines changes in these if/when a CBT intervention is introduced due to relapse or potential near-relapse. Daily self-monitoring diaries were used to measure target variables, together with standardized questionnaires up to 6 months follow-up. Changes in symptoms, appraisal of symptoms, and beliefs about medication changed throughout the study. All participants remained medication free at 6 months follow-up. Two cases received CBT intervention due to possible relapse; the third underwent an unproblematic withdrawal. Patterns of change are discussed in terms of current approaches to medication cessation and the role of CBT during withdrawal.