Antidepressant withdrawal affects one in six people

One in six people have symptoms when they stop taking antidepressants – fewer than previously thought, a review of previous studies suggests.

The researchers say their findings will help inform doctors and patients “without causing unnecessary alarm”.

The Lancet Psychiatry review looked at data from 79 trials involving more than 20,000 patients.

Some were treated with antidepressants and others with a dummy drug or placebo, which helped the researchers assess the true effect of drug withdrawal.

Some people have unpleasant symptoms such as dizziness, headaches, nausea and insomnia when they stop taking antidepressants, which, researchers say, can cause significant discomfort.

Previous estimates suggested that antidepressant withdrawal symptoms (ADS) affected 56% of patients, with almost half of cases classified as severe.

But this review, from the Universities of Berlin and Cologne, assesses:

• One in six or seven patients can expect symptoms when they stop taking antidepressants
• One in 35 will have severe symptoms
• Symptoms are more common with some antidepressants than others

Official health guidelines is reducing the dose of antidepressants in stages over time, rather than stopping suddenly or missing doses, which can lead to withdrawal symptoms.

Most people successfully stop antidepressants, the guidance adds.

Other studies suggest that ADS lasts one to two weeks.

Study author Prof Christopher Baethge, from the department of psychiatry and psychotherapy at the University of Cologne, said the findings were “quite strong”.

But the lower review rating for ADS “doesn’t mean it’s all in their head.”

It found that 17% of people experienced symptoms after stopping a placebo or fake medicine.

“One possible explanation is greater awareness of the worsening of anxiety and depression after stopping an apparently beneficial medication,” Prof Baethge said.

Many of the 40 symptoms associated with stopping antidepressants can also be caused by other illnesses.

“This shows the importance of comparing antidepressants with placebo when studying discontinuation,” said Prof Glyn Lewis, from University College London.

The most commonly used antidepressants in the UK – citalopram, sertraline and fluoxetine – had the lowest risk of ADS.

But venlafaxine, which is also used in the UK, was second highest.

Consultant psychiatrist and member of the Royal College of Psychiatrists Dr Paul Keedwell said people planning to stop their medication should always seek medical advice.

“First, depending on your mental health history, there may be a high risk of your depression returning,” he said.

“Sometimes a relapse of depression can be confused with withdrawal symptoms.

“Secondly, unpleasant withdrawal symptoms can be largely prevented with proper medical supervision.

“It is important to state that withdrawal symptoms are not dangerous and the risk of experiencing them at a future date should not be a reason for refusing treatment with antidepressants.

“The pros and cons of treatment should always be discussed with your doctor.”

More than eight million people in England are taking antidepressants for depression, anxiety, obsessive-compulsive disorder and other conditions – up from one million five years ago.