TI Blog Update: July 2025

17 Jul 2025 TI Blog Update: July 2025

Today we post Therapeutics Letter 157 (July 2025): How to stop antidepressants. This complements our recent Therapeutics Letter 156 (June 2025): Antidepressant withdrawal syndrome – Update, by reviewing why stopping an antidepressant is often wise clinical practice, and updating what is known about how best to accomplish deprescribing. The Letter comes with a Plain Language Summary, a Patient Handout, an Abstract, and a video recording of a TI Best Evidence Webinar offered by Dr. Mark Horowitz in May 2024 on this topic. Dr. Mark Horowitz is the author of the original draft of what became Therapeutics Letter 156 and Therapeutics Letter 157.

Only 3 weeks after we posted Therapeutics Letter 156, a new systematic review and meta-analysis was published in JAMA Psychiatry, that at first glance appears to contradict much of the content and conclusions of Therapeutics Letter 156. But we encourage critical thinkers and especially prescribers of antidepressants to take a second look. We were able to add this new reference and a brief description of the JAMA Psychiatry study, so that the current (new) posting of Therapeutics Letter 156 is slightly longer and includes 1 additional reference (#47). This version will be indexed by PubMed, and becomes the official version.

To help readers understand how the new JAMA Psychiatry analysis compares with that of Therapeutics Letter 156, we have posted an Editor’s comment over my own name, and a more detailed comment from Dr. Mark Horowitz.

As in the past, we welcome Comments that are attributed and accompanied by a standard disclosure form as recommended by the International Committee of Medical Journal Editors (ICMJE). Comments likely to interest many readers are more likely to be posted, as we have limited time and resources to handle many. We edit accepted comments for clear English, brevity, and clarity, and ensure that submitters are comfortable with any edits before posting.

If you wish to submit a Comment on either or both of the 2 Letters on antidepressant withdrawal and deprescribing, please submit through the online portal found at the very bottom of the Letter web page.

Next month (August), we will post a detailed analysis of randomized clinical trial evidence about how the single enantiomer escitalopram compares with its racemic parent drug, citalopram. If you are interested to learn how marketing trumped science, or to save money for your jurisdiction or your patients, you won’t want to miss Therapeutics Letter 158: Escitalopram vs. Citalopram: does one enantiomer’s dominance reflect evidence, or marketing?

If you are a primary care physician or nurse practitioner in BC but don’t know about our Portrait program, maybe you should ask yourself why not. Over 1,000 BC family doctors and nurse practitioners have already signed up for Portrait and are receiving personalized, completely confidential information that can help improve their prescribing practice to serve patients better. In addition, participants in the Portrait program can now receive both Mainpro+ Certified Activity credits, as well as much coveted Enhanced Activity credits.

“I found the work of TI incredibly useful during my career, so keep up the good work!”
[P. Aiken, recently retired family physician, Burnaby, BC]

You can learn more about the Portrait project and view samples of completed Portrait topics here: https://www.ti.ubc.ca/portrait/

The Portrait program includes an experimental component (early vs delayed release to subscribed prescribers) to help the TI and others learn effective techniques to improve prescribing that is based on sound medical scientific evidence. In future, pharmacists may be eligible to join. Registration is simple and free: BC family physicians and nurse practitioners can sign up to access confidential prescribing Portraits via our convenient and secure online portal.

Log in to view your Portraits and/or related materials, or sign up if you haven’t already.

Questions? Email the TI Portrait team at portrait@ti.ubc.ca We welcome your feedback.

Over 13,000 people are subscribed to receive email notifications from the TI when new issues of the Therapeutics Letter are posted online, as well as notices of upcoming webinars and other continuing professional development events. Our work is supported by the people of British Columbia through a grant from the BC Ministry of Health.

Yet even in our 31^st year as an independent, unconflicted academic group at UBC, many British Columbia clinicians and students don’t seem to know about us. If you value our contribution to unconflicted information about medications, even if you don’t always agree with our conclusions, please consider letting your colleagues, residents, and students know about us. Our work is relevant to medicine, nursing, pharmacy, other health professions and health researchers, and last year we introduced plain language summaries and abstracts to make our Therapeutics Letters more accessible to lay people and the general public. Therapeutics Letters are now abstracted and referenced by PubMed Bookshelf, and the African Journal of Primary Care and Family Medicine has recently begun to publish Therapeutics Letters relevant to African healthcare.

It’s simple to encourage colleagues, students, and friends anywhere in the world to subscribe to the TI notifications, and it’s free, confidential, and easy to unsubscribe. Just share with them the link to our home page: https://ti.ubc.ca and/or the subscription link.

I hope you can find something of interest among the various things we are offering. And we always welcome your comments and suggestions.

Thomas L. Perry MD, FRCPC
Editor, Therapeutics Letter
Therapeutics Initiative
University of British Columbia, Vancouver