About 1 in 6 individuals who stop taking their antidepressant experience at least one withdrawal symptom such as dizziness, headache, insomnia, or irritability, according to the results of a study published yesterday in Lancet Psychiatry. About 1 in 33 individuals experience severe withdrawal symptoms such that they would drop out of a clinical trial or restart their antidepressant.
“Today, the existence of symptoms emerging after antidepressant discontinuation or dose reduction is no longer questioned: Recent national and transnational clinical practice guidelines recommend informing patients on the risks of abrupt antidepressant discontinuation and suggest tapering of antidepressive agents,” wrote Jonathan Henssler, M.D., of the University of Cologne in Germany and colleagues.
“What remains controversial is the incidence and severity of symptoms,” they continued.
To address this, Henssler and colleagues collected data from 79 studies that assessed adverse symptoms following antidepressant discontinuation whether patients did so intentionally or unintentionally as part of a clinical trial. Medication “discontinuation” included both abrupt stopping and dose tapering (typically over one to four weeks). The researchers included patients taking antidepressants for any psychiatric illness except for pain due to an organic disease such as cancer.
Their final sample encompassed 44 randomized clinical trials and 35 observational studies, encompassing 16,532 patients who discontinued an antidepressant, and 4,470 patients who discontinued a placebo.
After factoring in potential placebo effects, the researchers calculated that a little over 15% of people stopping their antidepressant experienced at least one discontinuation symptom, while around 3% experienced severe symptoms.
Some findings related to specific medications were as follows:
- Desvenlafaxine, venlafaxine, imipramine, and escitalopram were associated with a higher frequency of symptoms.
- Desvenlafaxine, venlafaxine, imipramine, and paroxetine were associated with a higher severity of symptoms.
The incidence of discontinuation symptoms was similar in people who stopped abruptly and those who tapered, though Henssler and colleagues cautioned that since tapering protocols were varied, no firm conclusions should be drawn. Residual or reemerging psychiatric illness also should be considered when interpreting the results, they wrote, “but our findings can inform clinicians and patients about the probable extent of antidepressant discontinuation symptoms without causing undue alarm.”
For related information, see the Psychiatric News article “To Minimize Medication Withdrawal, Taper Slowly.”
(Image: Getty Images/iStock/ALEKSEI BEZRUKOV)
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