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Withdrawal symptoms after stopping antidepressants are less common than previously thought, but they are still a real problem, according to a large meta-analysis.
Antidepressant drugs are among the most commonly prescribed medications in wealthy countries, including the United States, Canada, the United Kingdom, and much of Western Europe.
The question of what happens when a person stops taking these drugs, which are not usually prescribed for long-term use, has been controversial since they were identified in the 1950s.
Now, a new study published Wednesday in the journal The Lancet Psychiatry found that 14% of people — nearly one in six — who stopped taking antidepressants experienced withdrawal symptoms such as dizziness, headache, nausea, insomnia and irritability.
This figure is lower than what some researchers studying antidepressant drugs had expected.
“It will be heartening to know that withdrawal rates are nowhere near as high as reported.” [at around 50%]Samir Johar, a psychiatrist at King’s College London who specializes in affective disorders, said in a press statement. Johar was not part of the study.
Still, for those who experience them, withdrawal symptoms “are real and patients need to be informed, monitored, and helped.” [they] “It could be so,” lead author Christopher Baethge, a psychiatrist at the University of Cologne in Germany, stressed in a press statement.
Low incidence of severe symptoms
The meta-analysis, which is the most comprehensive analysis to date assessing the prevalence of antidepressant drug discontinuation symptoms, included 79 scientific studies involving a total of 21,002 adult participants.
The studies included 44 randomised control trials and 35 observational studies related to antidepressant drug discontinuation symptoms published between 1961 and 2019.
The authors estimate that about one in seven people reported experiencing at least one symptom after stopping antidepressant medications, while a smaller number – about one in 35 – reported experiencing severe symptoms.
“Severe treatment discontinuation symptoms are rare, but they should be taken seriously, and they are important because millions of patients take antidepressant medications. It is not clear which patients will suffer from (severe) treatment discontinuation symptoms,” said Erik Ruhe, a psychiatrist at Radboud University Medical Center in the Netherlands, who was not involved in the study.
The study also did not clarify how long symptoms may persist after stopping antidepressant medications, but Bethge said research “shows they often resolve after two to six weeks or when antidepressant medications are resumed.”
The authors found that desvenlafaxine, venlafaxine, imipram, and escitalopram were the drugs most frequently associated with withdrawal symptoms. Fluoxetine and sertraline had the lowest rates of discontinuation symptoms.
What are the symptoms of stopping antidepressants?
Most antidepressants belong to a group of drugs known as selective serotonin reuptake inhibitors (SSRIs).
SSRIs work by blocking the reabsorption of serotonin in the brain, which means more serotonin is available to act on brain cells.
Baethge said scientists don’t yet fully understand how withdrawal symptoms arise, but one theory is that “if you remove the increased serotonin by stopping SSRIs, that causes withdrawal symptoms.”
Fluctuations in the levels of serotonin signaling in the brain can affect many brain conditions, such as sensory perception, emotional state, and sleep-wake cycles. But how discontinuing SSRIs relates to specific symptoms such as dizziness, headaches, or insomnia is still unclear.
Some theories about the link between serotonin and depression have been criticized by researchers as being overly simplistic. Scientists are now developing more comprehensive theories about depression.
The ‘background noise’ of symptoms
The study also found that about one in five people in the placebo group reported symptoms that were similar to those reported by participants in the group who stopped taking antidepressant drugs.
Baethge said this is likely due to the “nocebo” effect, in which “the expectation that bad things will happen when you take or stop taking a medication leads to an increased awareness of increased anxiety or depression after taking a helpful medication. This effect may be heightened in patients whose doctors told them to expect symptoms.”
Baethge said the findings suggest that many people have a general “background noise” of non-specific symptoms in their everyday lives, similar to normal fluctuations in sensory perception.
“We’re not saying it’s all in their minds. It’s tempting to think that if something happens under placebo, it’s all imagination. The point is that patients are really feeling dizzy, for example, and that should be taken seriously, regardless of the cause,” Baethge said.
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