July 2024
Discontinuation symptoms after stopping antidepressants examined
By Melanie Hinze
Antidepressant withdrawal symptoms are common and can be severe, an Australian expert has told Medicine Today.
Professor Katharine Wallis, Mayne Professor and Head of the Mayne Academy of General Practice, and Head of the General Practice Clinical Unit at the University of Queensland Medical School, Brisbane, was commenting on a meta-analysis and systematic review published recently in Lancet Psychiatry. This research reported that the incidence of antidepressant withdrawal symptoms was about 15%, affecting one in six to seven patients who attempted to stop antidepressants.
The researchers assessed data from 79 studies, including 44 randomised controlled trials and 35 observational studies, covering 21,002 patients (72% female; mean age 45 years [19.6 to 64.5]). Overall, 16,532 patients stopped taking an antidepressant and 4470 stopped placebo.
At least one withdrawal symptom was reported in 31% of participants who discontinued taking an antidepressant, compared with 17% of participants who discontinued taking placebo.
Severe withdrawal symptoms were reported in 2.8% of patients who stopped antidepressants compared with 0.6% of patients in the placebo group.
The researchers noted that desvenlafaxine, venlafaxine, imipramine and escitalopram were associated with higher frequencies of discontinuation symptoms, while imipramine, paroxetine, and either desvenlafaxine or venlafaxine were associated with a higher severity of symptoms.
Professor Wallis told Medicine Today that, ‘The “1 in 6” is likely to be an underestimate since most people in the included studies had been taking antidepressants for only a short time – only 12 weeks or less in 36 of the 79 included studies, and only one week for some.’
Professor Wallis said that many people on antidepressants in Australia have been taking them for much longer than this, with a large number of patients having taken them for more than 12 months.
‘We also know that incidence and severity of withdrawal symptoms increases with increasing duration of antidepressant therapy,’ she added.
Additionally, Professor Wallis said that many of the included studies were not set up to study antidepressant withdrawal symptoms but rather were looking at efficacy of antidepressants versus placebo for depressive or anxiety symptoms. As such, many studies did not use a specific measure of discontinuation symptoms.
‘Hence, the findings are not all that relevant for general practice where many patients have been taking antidepressants for longer periods,’ she added.
Despite this, Professor Wallis said the important message for GPs was that antidepressant withdrawal symptoms were common and could be severe.
‘As such it is important for GPs to know that slow tapering of antidepressant drug dose over months can help to minimise withdrawal symptoms and enable people to safely stop antidepressants.’
Lancet Psych 2024; https://doi.org/10.1016/S2215-0366(24)00133-0.