People who stopped taking antidepressants experienced one more withdrawal-like symptom on average than those who discontinued a placebo or stayed on the medications, according to a systematic review and meta-analysis issued today by JAMA Psychiatry today. Among the symptoms, however, mood worsening was not associated with discontinuation.
Michail Kalfas, M.Sc., of King’s College in London, and colleagues undertook the study due to the “lack of consensus and clarity on the evidence relating to incidence and duration of antidepressant discontinuation symptoms,” they wrote. “The proposed high incidence of discontinuation symptoms from [clinical trials] and surveys has had significant effects on policy and attitudes toward antidepressant use.”
The researchers identified 50 randomized clinical trials published before November 7, 2023, that assessed adults with various psychiatric disorders who stopped antidepressant treatment and whose discontinuation symptoms were assessed using standardized measures such as the Discontinuation Emergent Signs and Symptoms (DESS) scale. The 50 studies included 17,828 adults whose symptoms were followed for up to 52 weeks after abrupt or tapered discontinuation.
Kalfas and colleagues reported that discontinuation of antidepressants was associated with one additional symptom on the DESS after one week compared with those who continued an antidepressant or discontinued placebo. This falls significantly below the cutoff point of four or more symptoms considered to be a clinically significant discontinuation syndrome. Across antidepressants, dizziness was the most frequent symptom associated with antidepressant cessation, affecting 6% of participants after accounting for placebo effects. Other symptoms positively associated with antidepressant cessation included nausea, vertigo, headache, nervousness, and diarrhea.
Antidepressant discontinuation was not associated with greater depressive symptoms in the first two weeks compared with placebo, despite being measured in studies specifically examining major depressive disorder; this suggests that later presentation of depression symptoms is more likely to represent depression relapse, researchers wrote.
“The lack of evidence of prolonged withdrawal symptoms could reflect shorter duration of antidepressant use, although our findings do cast a degree of doubt on the need for routine use of longer-term tapering regimens…,” the researchers wrote. “Acknowledgment of the burden of discontinuation effects is crucial; nevertheless, it is important that professional practice and media narratives surrounding discontinuation effects are proportionate. Undue emphasis on discontinuation effects may increase the likelihood of real and debilitating symptoms, which arise (or are maintained) via processes distinct from pharmacological mechanisms.”
For related information, see the Psychiatric News article “About 1 in 6 Who Stop Antidepressants Experience Side Effects, but Rarely Severe.”
(Image: Getty Images/iStock/nicoletaionescu)
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