A recent Lancet Psychiatry study revealed that around 15% or one in six patients who discontinue using antidepressants experience withdrawal symptoms. Antidepressants like desvenlafaxine, venlafaxine, imipramine, and paroxetine were particularly linked to higher frequencies and severity of withdrawal symptoms compared to other commonly prescribed antidepressants. Whereas fluoxetine and sertraline had the lowest rates of withdrawal symptoms.
In a Lancet press release, Jonathan Henssler, lead author of the study and a senior physician from Charité – Universitätsmedizin in Berlin said, “There is 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.”
Clinicians had first reported that their patients were experiencing withdrawal symptoms after going off antidepressants in 1959. However, adverse symptoms like dizziness, headaches, nausea, insomnia, stomach cramps, and irritability remained neglected within the medical community until the late 1990s. These symptoms can occur within a few days after discontinuing antidepressants and can last up to several weeks or months. “Until very recently, guidelines have been criticized for referring to the duration of typical antidepressant discontinuation symptoms as 1–2 weeks, ignoring evidence of longer courses,” the authors noted.
To further investigate how prevalent and severe withdrawal symptoms could be among patients, Henssler and colleagues carried out an analysis of 79 trials that had compiled data from 21,002 patients. Out of that, 16,532 patients had discontinued using antidepressants. And another 4,470 patients had stopped taking placebo pills. The study participants’ average age was 45 years and 72% of them were women. They found that severe withdrawal or discontinuation symptoms occurred in one in 30 patients who discontinued antidepressants.
“Across all studies and antidepressants, we found that approximately every third patient discontinuing antidepressants will have antidepressant discontinuation symptoms of any kind. Even in studies of people receiving a placebo, discontinuation symptoms (which could be called discontinuation-like symptoms) occurred in approximately one in six patients,” the researchers wrote in their Lancet study. “This is not to say all antidepressant discontinuation symptoms are caused by patient expectations; in practice, all patients discontinuing antidepressants need to be counseled and monitored, and patients who report antidepressant discontinuation symptoms must be helped, in particular those who develop severe antidepressant discontinuation symptoms.”
“We did not find a difference between studies that applied tapering of the drug and studies with abrupt cessation of the drug. All trials on venlafaxine and desvenlafaxine were among the studies that applied tapering,” the authors added. “ Tapering of antidepressants is recommended in most guidelines, and there is research suggesting that prolonged and hyperbolic tapering of antidepressants will substantially reduce (although not completely exclude) withdrawal effects and increase the likelihood of successful discontinuation of antidepressants.”
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