A new study sheds light on withdrawal symptoms

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

​​​​​​A new analysis published in The Lancet Psychiatry of randomized controlled trials found that 15% of patients will experience one or more withdrawal symptoms that occur directly as a result of stopping the drugs, with severe symptoms suffer from about 2-3%.

Previous research has suggested much higher rates of withdrawal symptoms, with 56% of all patients affected, although experts have said this figure is not robust.

In 2022/23, 86 million antidepressants were prescribed to around 8.6 million patients in England, NHS figures show.

In the new research, it was found that the most commonly used antidepressants in the UK had the lowest rates of withdrawal symptoms across the study.

Stopping an antidepressant can result in a variety of symptoms or no symptoms at all.

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

Withdrawal symptoms usually occur within a few days, and the new study found they lasted from 1·5 to 196 days.

Researchers in Germany looked at a range of antidepressants for the work, including data for 21,000 patients involved in 79 pieces of research.

The majority (72%) of those included were women and the average age was 45.

From a list of 11 different antidepressants, citalopram, sertraline and fluoxetine – the most commonly used in the UK – were least likely to suffer withdrawal symptoms.

According to researchers, fluoxetine, for example, takes more time to leave the body and may have fewer withdrawal effects.

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

Glyn Lewis, professor of epidemiological psychiatry at University College London’s Department of Psychiatry, told PA news agency: “The most commonly used antidepressants in the UK are sertraline, citalopram and fluoxetine – and these are all antidepressants with a higher risk low on withdrawal symptoms.

“However, venlafaxine is also commonly used as a second-line antidepressant for those who have not responded to the first.

“Venlafaxine appears to cause more withdrawal symptoms when stopped and as a result doctors tend to give a longer tapering period when people stop using venlafaxine.

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

In a linked editorial, Professor Lewis and his colleague, Dr Gemma Lewis, said many of the studies in the new overall analysis were small, “often using antidepressants that are not commonly used now, and studying on people who have not taken the anti-depressants for a long time”. .

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

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

“Therefore, it is important that doctors and patients have an accurate, evidence-based picture of what happens when patients stop taking antidepressants.

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

“There is an urgent need for counselling, monitoring and support from healthcare professionals for all patients stopping antidepressants.

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

​​​​The research found that stopping taking 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 had been high.

He added: “This thorough review and meta-analysis shows that rates are significantly lower, and also occur in people coming off placebo, compared to antidepressants.

“When placebo is accounted for, rates of withdrawal symptoms are about 14%, and 2% for acute withdrawal.

“It should be acknowledged that this only applies to those who take part in trials, although this is the best evidence we have.

“Clinically, doctors will still need to have a conversation about stopping medication and doing this safely, although it is reassuring to know that withdrawal rates are not as high as reported.

“This work is a salutary lesson, as some people may have been dissuaded from taking a potentially effective treatment based on poor-quality evidence that did not adhere diligently to the method scientific.

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

The NHS website says people who want antidepressants should talk to their doctor, who will probably advise them to taper off over several weeks.

Professor Oliver Howes, chair of the psychopharmacology committee at the Royal College of Psychiatrists, said: “Antidepressants are a clinically recommended treatment and are effective in reducing the symptoms of moderate to severe depression, particularly when used in along with speech therapies.

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

“If someone chooses not to take their antidepressants, their doctor should help them do so slowly and in a controlled way that limits the impact of any potential withdrawal symptoms.”

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