Withdrawal risk when stopping antidepressants

To more precisely determine withdrawal risk, the authors reviewed data from 44 randomized controlled trials and 35 observational studies published between 1961 and 2019. These studies investigated the abrupt discontinuation or tapering of existing antidepressants or placebo. More than half of these studies focused on mood disorders, such as major depressive disorder or bipolar disorder, and more than a quarter concentrated on anxiety disorders.

The authors also found that the drugs most frequently associated with withdrawal symptoms were desvenlafaxine, venlafaxine, imipramine, and escitalopram. Fluoxetine and sertraline were associated with the lowest incidence of discontinuation symptoms.

The study found that pharmaceutical companies funded 45 of the studies, but this support did not appear to affect the overall results: the incidence of withdrawal symptoms in the pharmaceutical-funded studies was roughly the same as in the non-pharmaceutical-funded trials.

“This study is a valuable lesson because some people may have been deterred from receiving a potentially effective treatment based on poor quality evidence,” Jauhar said. “Science corrects itself, and the authors should be commended for carrying out this study.”

The findings are also an important first step in helping patients stop taking antidepressants responsibly, Dr. Christiaan Winckers, a psychiatrist and professor of psychiatry at the Amsterdam University Medical Center, said in a news release.

Another weakness of the review is that many of the included studies did not focus primarily on antidepressant withdrawal, but rather compared the effectiveness of antidepressants with a placebo, Dr. Tony Kendrick, a professor of primary care at the University of Southampton in the UK, said in a news release.

These studies “looked at patients stopping the medication during the washout period at the end of the trial, and found that in 36 of the 79 included studies, patients were on antidepressants for 12 weeks or less,” Kendrick said. “We believe that taking an antidepressant for only a few weeks would not usually result in serious withdrawal symptoms.”

Some of the other included studies had much longer treatment durations, some of them more than a year.

As for why stopping antidepressants can cause withdrawal symptoms, Hensler said it's important to note that these drugs are not addictive. The effect could be due to a sudden decrease in the amount of neurotransmitters in the brain. Cleveland Clinic.

The review found no differences between studies of tapering and abrupt cessation. However, the authors cautioned that this is not a firm conclusion because of variability in study design. And other studies still show that tapering may help reduce the likelihood and severity of symptoms, they said.

Although dropout rates are not as high as previously reported, Jauhar said that if patients want to stop taking their antidepressants, their doctors should have a conversation about what that means for them and how to do it safely.

“Doctors should help patients minimise the effects of potential withdrawal symptoms in a slow and controlled way – at a pace that suits the patient and their individual needs,” Dr. Oliver Howes, chair of the British College of Psychiatrists' committee on psychopharmacology, said in a news release. Dr. Howes was not involved in the study.

Dr. Paul Keedwell, a RCP and consultant psychiatrist who was not involved in the study, said in a news release that it's important to plan your strategy carefully, as depending on an individual's psychiatric history, there may be a risk of symptoms returning during treatment.

The study didn't provide information on how long withdrawal symptoms last, but other research suggests they last up to two weeks in most cases, Keedwell said. Quitting is more difficult for people who have been taking the drug for a year or more, he added. In those cases, withdrawal symptoms can last for a few months, but rarely up to a year.

But “it's important to remember that withdrawal symptoms are not dangerous, and the risk of experiencing withdrawal symptoms in the future should not be a reason to refuse antidepressant treatment,” Keedwell said. “The pros and cons of treatment should always be discussed with your doctor.”