Antidepressant Withdrawal: What the Latest Research Really Says
The medical guidance for a long time has been that if you want to get off your antidepressant, you have to slowly wean yourself off it slowly. In other words, lessen the dosage over time. Don’t just stop taking it cold turkey, or you will suffer severe side-effects.
But the largest review of antidepressants to date finds most people do not experience severe withdrawal.
The Depressant Withdrawal Study
In a systematic review and meta-analysis of previous randomized controlled trials relating to antidepressant withdrawal, a team of researchers led by Imperial College London and King’s College London reached the following conclusions:
- While participants who stopped antidepressants did experience an average of one more symptom than those who continued or were taking placebos, this was not enough to be judged as significant.
- The most common symptoms were dizziness, nausea, vertigo and nervousness. Importantly, depression was not a symptom of withdrawal from antidepressants, and was more likely to reflect illness recurrence.
- Importantly, depression relapse was not linked to antidepressant withdrawal in these studies, suggesting that if this does occur, people will need to see their health professional to rule out a recurrence of their depressive illness.
Clearer Guidance About Antidepressant Withdrawal
Researchers at Imperial College London, King’s College London, UCL and UK collaborators say their study provides much-needed, clearer guidance for clinicians, patients and policymakers.
Dr. Sameer Jauhar, lead author, at Imperial College London, said, “Our work should reassure the public because we replicated other findings from high-quality studies, and have highlighted the clinical symptoms to look out for. Despite previous concern about stopping antidepressants, our work finds that most people do not experience severe withdrawal, in terms of additional symptoms.
Clinical academics from around the UK worked collaboratively to conduct the largest and most rigorous analysis of randomized controlled trials in antidepressant withdrawal, examining data from 50 trials across multiple conditions.
Specifics of the Data Review
- The study analyzed data from 17,828 participants, with an average age of 44 years, 70% of whom were female.
- Researchers conducted two meta-analyses: one used the standardized Discontinuation Emergent Signs and Symptoms scale (DESS), and the other used various other scales.
- Across different antidepressants, participants reported, on average, one additional symptom on the 43-item symptom scale. In placebo-controlled randomized controlled trials, the most common symptoms were dizziness (7.5% vs. 1.8%), nausea (4.1% vs. 1.5%), vertigo (2.7% vs. 0.4%), and nervousness (3% vs. 0.8%).
- Experiencing just one symptom falls below the clinical threshold of four or more symptoms needed to diagnose discontinuation syndrome.
Variation in Symptoms by Drug Type
Symptom types and rates varied among antidepressants, and some symptoms also appeared in placebo groups. This distinction helped identify symptoms that likely indicated illness recurrence, such as a relapse into depression.
The data included various antidepressants, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine and duloxetine; selective serotonin reuptake inhibitors (SSRIs) such as escitalopram, sertraline, and paroxetine; agomelatine, a melatonin receptor agonist and selective serotonin receptor antagonist; and vortioxetine, which blocks serotonin reuptake and acts as a partial agonist and antagonist on different serotonin receptors.
Discontinuing venlafaxine led to the highest symptom rates, with about 20% of users experiencing dizziness compared to 1.8% on placebo. Vortioxetine users experienced fewer than one additional symptom on the standardized scale, while no extra symptoms appeared with agomelatine.
Including studies without placebo controls slightly increased symptom rates: dizziness (11.8%), nightmares (8.1%), nervousness (7.6%), and nausea (5.8%).
Expert Insights and Clinical Implications
The review found no evidence of depression relapse in people withdrawing from antidepressants, even among those with existing depression.
Most studies (44 out of 50) involved participants who either stopped abruptly or tapered the medication over one week.
Michail Kalfas from King’s College London highlighted, “Although rare, some people may develop more severe withdrawal symptoms than the broader antidepressant user population.”
He added, “Our next step must explore the pharmacological reasons behind this reaction and whether it relates to how individuals metabolize these drugs.”
This study addresses recent concerns about stopping antidepressants and changes in prescribing guidelines. The meta-analysis confirms that withdrawal symptoms occur and vary by drug type, but they are not inevitable for all users.
Professor Allan Young, Head of Psychiatry at Imperial College London, stated, “Depression and anxiety are common, and antidepressants remain effective and generally well tolerated. However, patients and clinicians have raised concerns about stopping these treatments.”
He continued, “Guideline changes may have influenced antidepressant use. This comprehensive review clarifies the evidence and should reassure everyone about using and discontinuing these medications. Official guidelines should now update to reflect these findings.
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