The myth that antidepressants are addictive has been debunked – they are an essential tool in psychiatry | Carmine M Pariante

I have been prescribing antidepressants since 1991. Like most medications, they are imperfect tools: they have side effects and don’t work for everyone. Some patients report negative effects, or that their depression does not improve, and they may need to switch to a different antidepressant. For those they do help, antidepressants undoubtedly improve depression and reduce the risk of suicide.

In my clinical practice, patients very rarely complain that they cannot stop their medication because of the symptoms when they try. Unpleasant physical or emotional experiences for a few days or a few weeks after stopping antidepressants, yes: dizziness, headache, nausea, insomnia, irritability, vivid dreams, electricity-like sensations, or rapid mood swings. But patients who could not Stop the antidepressant because of these symptoms? In my 33 years of clinical practice, I can remember them on the fingers of one hand.

This is why I’ve been skeptical – along with what I believe are most psychiatrists, psychiatric organizations and clinical guidelines – about claims some scientific articles and media claim that “millions of people are addicted to antidepressants.”

“Addiction” means that users crave the substance and cannot compulsively stop taking it, as with opioids or street drugs. However, there is no craving or compulsion for antidepressants, and our clinical experience shows that only a small minority of people experience disabling symptoms when they stop taking them. The largest study ever conducted on this subject has been conducted confirmed this.

This analysis, which I did not participate in, looks at 79 previous studies, involving more than 16,000 people who stopped taking antidepressants, and compares them to more than 4,000 people who stopped taking a placebo. Pharmaceutical companies were not involved in this new analysis, although some of the data analyzed came from industry-funded studies.

The key finding is that the percentage of people who stop taking antidepressants and experience severe withdrawal symptoms (which would likely require restarting the antidepressant) is 1 in 30 to 35 patients: much, much smaller than the study’s previous figure. approximately 1 in 4 patients.

Even more fascinating is that about 1 in 3 patients who stop taking antidepressants experience some (not severe) withdrawal symptoms, but so do 1 in 6 patients who stop taking the placebo. This indicates that some of the antidepressant withdrawal symptoms are likely not due to discontinuation of antidepressants per se, but rather to the attribution of some symptoms, especially now that such symptoms are expected to occur.

Of course, I’m not suggesting that people who stop taking antidepressants are making up symptoms, or that the symptoms are “all in the mind” – a useless phrase that serves no purpose, by the way. Rather, the symptoms are real but may not be related to discontinuation of antidepressants but are incorrectly attributed to this.

Where does the discrepancy between previous alarming figures and this new study come from? Previous studies used less robust scientific study designs because they did not include comparisons with a placebo, or they used a study design that preferentially recruited people who volunteered to share their experiences with antidepressant withdrawal symptoms, thus skewing the results. For example, online surveys are more likely to attract people who have stopped antidepressants and experienced symptoms than people who have stopped antidepressants with little discomfort.

This earlier research, although less robust, had the positive effect of drawing attention to the debate over antidepressant withdrawal. This new study is not perfect, and in the coming weeks and months there will be debate about the quality of the data and analyzes presented. However, this work represents one of the best available studies on this crucial topic.

Therefore, doctors should now present these more accurate figures of withdrawal symptoms when discussing antidepressants with their patients. And people who have been advised by their doctor to start an antidepressant – indicating that they have significant depression affecting their lives – should be reassured by the very low incidence of serious withdrawal symptoms. People who have been taking antidepressants for a while (six to nine months of well-being if it’s the first time, longer if it’s the second or third time) should talk to their doctor about stopping them. If they decide to do this, they should taper off slowly over a period of two to four months, while being aware that not all of the unpleasant sensations and emotions they experience are due to stopping the medication. For the small minority who may experience severe withdrawal symptoms, a reintroduction of the antidepressant is required, followed by an even slower taper.

People will make different decisions through an informed conversation with their doctor. Some will decide that antidepressants are not for them. Some will decide they don’t want to stop taking the antidepressant. Many factors will influence these decisions, but at least the now debunked myth that antidepressants are addictive will no longer be one of them.