Antidepressant discontinuation syndrome occurs in 15% of cases

Their study confirms that many people will experience discontinuation symptoms when they stop taking antidepressants, and a few will experience more severe symptoms.

It should be noted that these withdrawal symptoms are not due to antidepressant addiction.

There is a critical need for people who stop taking antidepressants to be counseled, monitored and supported by healthcare professionals.

However, their findings, which consolidate data from many studies, should provide reassurance that treatment discontinuation symptom rates are not as high as some previous individual studies and reviews have suggested.

Previous studies have estimated that more than half of patients experience withdrawal symptoms when stopping antidepressants, with half of these symptoms being severe. Yet many of these estimates are based on observational studies, which cannot reliably determine cause and effect.

In contrast, well-conducted randomized controlled trials (RCTs), in which one group receives a placebo and the other group receives the drug, can more accurately identify symptoms directly caused by the drug versus nonspecific symptoms influenced by expectancies. patients or practitioners. .

The aim of this study was to review all available evidence to determine the likely incidence of discontinuation symptoms directly caused by stopping antidepressants, the likely incidence of severe symptoms, and the differences between different types of antidepressants. .

The researchers conducted a review and meta-analysis of 79 trials (44 RCTs and 35 observational studies), which included data from 21,002 individuals – 16,532 who stopped antidepressants and 4,470 who stopped placebo.

The average age of participants was 45 years, 72% of whom were women.

The analysis found that 31% of people who stopped taking an antidepressant experienced at least one symptom, such as dizziness, headache, nausea, insomnia or irritability.

Serious symptoms occurred in about 3%, or one in 35 people. Stopping imipramine (Tofranil), paroxetine (Paxil or Seroxat), and venlafaxine (Effexor)/desvenlafaxine (Pristiq) was associated with a higher risk of serious symptoms compared to other antidepressants.

In randomized controlled trials, 17% of participants experienced symptoms similar to those of stopping a placebo, suggesting that about half of the symptoms in those who stopped taking antidepressants may be due to negative expectations – the so-called nocebo effect – or non-specific symptoms that might arise. in the general population.

Joao L. de Quevedo, MD, PhD, a psychiatrist at UTHealth Houston, not involved in this research, spoke with Medical news today on its conclusions.

He noted that “understanding this topic is crucial to improving patient care, because symptoms due to discontinuation of antidepressants are not uncommon in practice, usually triggered by patients self-discontinuing their medications without inform their service providers. »

“The incidence of antidepressant discontinuation symptoms is around 15%, affecting one in six to seven patients who stop treatment. Knowledge of potential withdrawal symptoms can guide doctors and patients in determining optimal times to start, adjust, and stop medications.

– João L. de Quevedo, MD, PhD

De Quevedo also pointed out that “antidepressant discontinuation syndrome (ADS) can last not only 1-2 weeks as previously thought, but also months.”

It is also “clinically useful to understand which antidepressants are most likely to cause severe withdrawal symptoms, allowing for more informed and careful management of treatment discontinuation,” de Quevedo explained.

David Merrill, MD, PhD, a geriatric psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center at Providence Saint John’s Health Center in Santa Monica, California, also not involved in the study, also noted that it was an important topic to cover. .

“It is helpful to be able to tell patients that treatment discontinuation symptoms are possible but not inevitable, and even less likely to be serious. So if stopping a medication becomes a problem, they should let their doctor know so they can help them figure out what to do,” Merrill said.

“It is often possible to alleviate medication discontinuation symptoms by temporarily resuming the discontinued medication and retrying the medication discontinuation process. Ideally, the second stop can be done more gradually over a longer period of time to ease or prevent side effects from recurring.

–David Merrill, MD, PhD

De Quevedo added that “awareness of withdrawal symptoms is crucial to understanding the safety and effectiveness of antidepressants, as well as recognizing that these symptoms, if they occur, are a normal part of the process.”

“This understanding can help reduce the stigma around mental health treatment and encourage more people to seek help when needed,” he said.

“Although studies show no difference between tapering the medication and stopping it abruptly, tapering is probably safer,” de Quevedo explained.

“Desvenlafaxine, venlafaxine, imipramine, and escitalopram were associated with higher frequencies of discontinuation symptoms, and imipramine, paroxetine, and desvenlafaxine or venlafaxine were associated with higher severity of discontinuation symptoms. symptoms. Understanding the symptoms of antidepressant discontinuation syndrome (ADS) can also prevent abrupt medication cessation.

– João L. de Quevedo, MD, PhD

Merrill agreed, noting that the study “highlights some ‘usual suspects’ that are better known for causing side effects when stopping.”

“It may be especially important to warn patients of the risks of stopping these medications and to do so under the guidance of an experienced provider,” he added.