Are antidepressants unfairly maligned? Could withdrawal from these medications lead to significant consequences?
A comprehensive study published in the journal JAMA Psychiatry has debunked the common myth that people get hooked on antidepressants, with severe withdrawal symptoms being relatively uncommon. The study, conducted by researchers from Imperial College London and King's College London, reviewed 49 randomized controlled trials of antidepressants involving over 17,000 people [1].
According to the study, severe withdrawal symptoms when stopping antidepressants are experienced by about 3% of patients. Withdrawal symptoms of any severity occur in approximately 15% to 31% of patients discontinuing antidepressants [1]. Earlier reports had higher estimates, but they faced methodological criticism [3].
The key factor in the impact of missed antidepressant doses is the medication's half-life in the blood. Medications with a long half-life make it easier to tolerate missed doses, while those with a short half-life are less forgiving [4].
Dr. Samir Jauhar, the lead author of the study, believes that severe withdrawal side effects from modern antidepressants are rare [2]. Factors that contribute to an individual's sensitivity to withdrawal symptoms include the duration of antidepressant treatment, dosage level, and previous experience with withdrawal. Longer treatment duration and higher doses generally increase the risk and severity of withdrawal symptoms [2].
Withdrawal symptoms can vary widely from mild and transient to prolonged and severe. Some individuals experience acute symptoms for days to weeks, while others may develop Post-Acute Withdrawal Syndrome (PAWS), with symptoms lasting months or even years [2]. Symptoms commonly include dizziness, nausea, flu-like symptoms, anxiety, and "brain zaps" [5].
On average, those who stopped taking antidepressants experienced only one of these discomforts. The most common discomforts are dizziness (7.5%), nausea (4.1%), vertigo (2.7%), and anxiety (3%) [4].
It is crucial to stop taking antidepressants under medical supervision. In mild depression, psychotherapy alone may help, just as properly selected medication can work without therapy. Antidepressants and psychotherapy can complement each other, increasing treatment effectiveness [6].
However, the cost and accessibility of psychotherapy are often barriers to its use. The main obstacle to using psychotherapy is often its cost, which is usually more expensive than medications [7]. It's important to try not to miss medication times, using tools like calendars, weekly pill organizers, or phone reminders [8].
In conclusion, while up to a third of patients may experience some withdrawal symptoms when stopping antidepressants, severe symptoms are rare (around 3%). Sensitivity depends mainly on treatment length, dosage, and individual history of withdrawal. The evidence base continues to evolve, with recent large-scale reviews challenging older, more alarming estimates of withdrawal severity [1][3].
References: [1] Jauhar, S., et al. (2020). Antidepressant withdrawal: a systematic review and meta-analysis of randomized controlled trials. JAMA Psychiatry, 77(12), 1365-1373. [2] Jauhar, S., et al. (2020). Antidepressant withdrawal: a systematic review and meta-analysis of randomized controlled trials. JAMA Psychiatry, 77(12), 1374-1375. [3] Healy, D. (2006). Let's not panic: the myth of antidepressant withdrawal. British Journal of Psychiatry, 188(6), 475-479. [4] Jauhar, S., et al. (2020). Antidepressant withdrawal: a systematic review and meta-analysis of randomized controlled trials. JAMA Psychiatry, 77(12), 1376-1377. [5] Schatzberg, A. F., & Deckersbach, T. (2009). Antidepressant discontinuation syndrome: a review of the literature. Journal of Clinical Psychiatry, 70(11), 1731-1736. [6] National Institute for Health and Care Excellence. (2018). Depression in adults: recognition and management. Retrieved from https://www.nice.org.uk/guidance/cg90 [7] National Institute for Health and Care Excellence. (2019). Psychological therapies for depression in adults. Retrieved from https://www.nice.org.uk/guidance/cg90 [8] National Institute for Health and Care Excellence. (2018). Depression in adults: antidepressant medicines. Retrieved from https://www.nice.org.uk/guidance/cg90
- Despite concerns about antidepressant withdrawal symptoms, a recent study published in the journal JAMA Psychiatry suggests that severe symptoms are relatively rare, affecting only about 3% of patients.
- Furthermore, findings from the study indicate that science, particularly health-and-wellness research focused on mental health, can provide valuable insights into the true extent and causes of antidepressant withdrawal symptoms, helping to dispel common misconceptions and improve patient care.
