JUNE 5, 2024
by Lancet
Credit: Pixabay/CC0 Public Domain
For someone stopping taking antidepressants, the risk of experiencing one or more discontinuation symptoms (also called withdrawal symptoms), such as dizziness, headache, nausea, insomnia and irritability due directly to stopping the medication is 15% (equivalent to one in six to seven people), according to a systematic review and meta-analysis published in The Lancet Psychiatry.
The analysis also found discontinuation symptoms that patients describe as severe, and which may have led to patients dropping out of a study or restarting on antidepressants, occurred in about 3% (one in 35) of patients stopping antidepressants.
“There’s strong evidence that antidepressants can be effective for many people who are experiencing a depressive disorder, either alone or alongside other treatments such as psychotherapy. However, they do not work for everyone, and some patients may experience unpleasant side-effects. In patients who have recovered with the help of antidepressants, the decision from doctors and patients may be to stop taking them in time. Therefore, it’s important both doctors and patients have an accurate, evidence-based picture of what might happen when patients stop taking antidepressants,” says Dr. Jonathan Henssler from Charité-Universitätsmedizin Berlin.
He continues, “Our study confirms that a number of patients coming off antidepressants will experience discontinuation symptoms, and for a few, these will be of a more severe extent. It’s important to note that antidepression discontinuation symptoms are not due to antidepressants being addictive. There is a crucial need for all patients stopping antidepressants to be counseled, monitored and supported by heath care professionals. However, our findings, which consolidate data from a large number of studies, should also provide reassurance that rates of discontinuation symptoms are not as high as some previous single studies and reviews have suggested.”
Previous studies have estimated that over half of patients experience discontinuation symptoms when stopping antidepressants, and that half of the symptoms are severe. However, many of these estimates are based on observational studies which cannot reliably determine cause and effect.
On the other hand, well-conducted randomized controlled trials (where half of the trial population is offered a placebo, or dummy pill, and the other half is offered the medication) can more reliably distinguish between symptoms directly caused by the medication and non-specific symptoms that might be driven by patients’ or practitioners’ expectations.
The aim of this study was to review all available evidence to establish the probable incidence of discontinuation symptoms caused directly by stopping antidepressant use, the probable incidence of severe symptoms and the differences between different types of antidepressant. The researchers conducted a review and meta-analysis of 79 trials (44 RCTs and 35 observational studies) which included data from 21,002 patients, 16,532 discontinuing from antidepressants and 4,470 from placebo, with an average age of 45 years, and with 72% women.
Overall, the analysis found that a third (31%) of people who stopped taking an antidepressant experienced at least one symptom, such as dizziness, headache, nausea, insomnia or irritability. Severe symptoms occurred in about 3% (one in 35). Stopping imipramine (Tofranil), paroxetine (Seroxat) and (des-)venlafaxine (Pristiq) was associated with a higher risk of severe symptoms compared with other antidepressants.
More information: Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis, The Lancet Psychiatry (2024). DOI: 10.1016/S2215-0366(24)00133-0 , www.thelancet.com/journals/lan … (24)00133-0/fulltext
Journal information: The Lancet Psychiatry
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