New research sheds light on withdrawal symptoms

About one in six people who stop taking antidepressants will experience withdrawal symptoms as a direct result of the drug – lower than previous estimates, according to the largest study of its kind.

A new analysis published in The Lancet Psychiatry of randomized controlled trials shows that 15% of patients will experience one or more withdrawal symptoms caused directly by stopping the drugs, while about 2-3% will experience severe symptoms.

Previous research has shown that withdrawal symptoms are much more common, with 56% of all patients experiencing them, although experts have said this figure is not robust.

In 2022/2023, 86 million antidepressants were prescribed to an estimated 8.6 million patients in England, NHS figures show.

The new research found that the most commonly used antidepressants in Britain had the lowest withdrawal symptoms across the study.

Stopping antidepressants can lead to various symptoms or no symptoms at all.

The most commonly reported are dizziness, headache, nausea, insomnia and irritability.

Withdrawal symptoms typically occur within a few days, and a new study found that they lasted from 1.5 to 196 days.

Researchers in Germany looked at a range of antidepressants for their work, including data from 21,000 patients involved in 79 studies.

Most participants (72%) were women and the average age was 45 years.

Of a list of eleven individual antidepressants, citalopram, sertraline and fluoxetine – the most commonly used in Britain – had the lowest risk of withdrawal symptoms.

For example, according to researchers, fluoxetine takes longer to leave the body and may cause fewer withdrawal symptoms.

However, venlafaxine, which is also used in Britain, was the second highest for people experiencing symptoms.

Glyn Lewis, professor of epidemiological psychiatry at University College London Division of Psychiatry, told the PA news agency: “The most commonly used antidepressants in Britain are sertraline, citalopram and fluoxetine – and these are all antidepressants with a lower risk of withdrawal symptoms.

“However, venlafaxine is also relatively often used as a second-line antidepressant in people who have not responded to the first line.

“Venlafaxine appears to lead to more withdrawal symptoms when stopped and as a result, doctors will tend to recommend a longer taper period when people stop taking venlafaxine.

“There is also a slow-release form of venlafaxine that will reduce the chance of withdrawal symptoms.”

In a linked editorial, Prof. Lewis and his colleague Dr. Gemma Lewis said that many of the studies in the new overall analysis were small, “often using antidepressants that are not yet commonly used, and studying people who have the haven’t used antidepressants in a long time.” .

But they added: “Despite these limitations, the results here are a substantial improvement over anything previously published.”

Dr. Jonathan Henssler, from Charite – Universitatsmedizin Berlin, an author of the study, said: “There is strong evidence that antidepressants can be effective for many people experiencing depressive disorder, alone or in addition to 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 of doctors and patients may be to stop taking them in time.

“That’s why it’s important that both doctors and patients have an accurate, evidence-based view of what can happen when patients stop taking antidepressants.

“It is important to note that antidepressant withdrawal symptoms are not due to antidepressants being addictive.

“It is crucial that all patients stopping antidepressants are advised, monitored and supported by healthcare professionals.

“However, our findings, which consolidate data from a large number of studies, should also provide reassurance that rates of discontinuation symptoms are not as high as some previous individual studies and reviews have suggested.”

The study found that stopping use of imipramine, paroxetine and venlafaxine was associated with a higher risk of severe symptoms compared to other antidepressants.

Dr. Sameer Jauhar, a consultant psychiatrist at King’s College London, said previous estimates of withdrawal symptoms were high.

He added: “This new in-depth review and meta-analysis indicates that the rates are much lower, and also occur in people coming off placebo, as opposed to antidepressants.

“If we take placebo into account, the percentages of withdrawal symptoms are around 14%, and 2% for severe withdrawal symptoms.

“It must be recognized that this only covers those participating in trials, although this is the best evidence we have.

“Clinically, doctors will still need to have conversations about discontinuing medications and doing so safely, although it will be gratifying to know that withdrawal rates are not nearly as high as reported.

“This work is a salutary lesson, as some people may have been deterred from receiving a potentially effective treatment based on poor quality evidence that was not rigorously consistent with the scientific method.

“Science corrects itself, and the authors are to be congratulated for this work.”

The NHS website says that people who want to stop taking antidepressants should consult their doctor, who will likely recommend tapering off them gradually, over a number of weeks.

Professor Oliver Howes, chairman of the Royal College of Psychiatrists’ psychopharmacology committee, said: “Antidepressants are a clinically recommended treatment and they are effective in reducing the symptoms of moderate to severe depression, especially when used in combination with talking therapies .

“It is important that patients discuss their treatment options with a qualified physician, including the benefits, risks and side effects…

“If someone chooses to stop taking their antidepressants, their doctor should help them do so slowly and in a controlled manner so as to limit the impact of any withdrawal symptoms.”

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