According to one study, just under one in seven people who stop taking antidepressants will experience withdrawal symptoms.
Researchers in Germany analyzed data from 79 studies involving 21,000 patients and found that 15% of people experienced one or more withdrawal symptoms directly caused by stopping antidepressants, while about 3% experienced severe symptoms.
The findings, published in the Lancet Psychiatry, show that the most common symptoms were dizziness, headache, nausea, insomnia and irritability.
These symptoms usually occur within a few days and can last from a few days to more than six months.
The authors also compared the type of drug taken, and citalopram, sertraline and fluoxetine – the most commonly used antidepressants in Britain – had the lowest risks of symptoms.
But stopping use of imipramine (Tofranil), paroxetine (Paxil or Seroxat), and desvenlafaxine (Pristiq) was associated with a higher risk of severe symptoms.
Dr. Jonathan Henssler, from Charité – Universitätsmedizin Berlin, one of the study’s co-authors, said that while antidepressants can be effective for many people, they don’t work for everyone. Whatever the reason for stopping the medication, doctors and patients need an accurate, evidence-based view of what might happen, he added.
“It is important to note that antidepressant withdrawal symptoms are not due to antidepressants being addictive. It is critical that all patients coming off antidepressants are advised, monitored and supported by healthcare professionals,” he said.
Some critics questioned the findings, as about half of the studies involved patients taking antidepressants for three months or less.
But Christopher Baethge, co-author of the study and professor of psychiatry at the University of Cologne, said that although patients would normally need to take antidepressants for several weeks before a risk of withdrawal symptoms could be expected, the prevalence of symptoms did not increase with longer use: “In our sample of studies, we found no increased risk of withdrawal symptoms in patients who took antidepressants for more than three months.”
An earlier analysis had suggested that as much as 56% of patients experienced withdrawal symptoms in stopping antidepressants, but that has been criticized as not robust.
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Dr. Sameer Jauhar, a consultant psychiatrist at King’s College London, said that although the study only looked at patients taking part in trials, this was “the best evidence we have” and it was “satisfying to know that the number of withdrawal symptoms was not nearly as is high as reported”.
Professor Oliver Howes, chair of the Royal College of Psychiatrists’ psychopharmacology committee, welcomed the findings of the “robust” study, saying that “only about one in 35 could experience serious withdrawal symptoms”.
The researchers identified some limitations of their study, particularly the possibility of depression returning after the medication was stopped, which was interpreted as withdrawal symptoms. The authors also noted that three or more studies had examined only seven antidepressants, and no studies were found on several commonly used antidepressants such as mirtazapine, bupropion, or amitriptyline.