For someone who stops taking antidepressantsthe risk of experiencing one or more withdrawal symptoms (also called withdrawal symptoms), such as dizziness, headache, nausea, insomnia and irritability due directly to stopping the drug is 15% (equivalent to one in six to seven people), according to a systematic review and meta-analysis published in The Lancet Psychiatry.
Antidepressants: the risks of suspension
The analysis also found that withdrawal symptoms that patients describe as severe, and which may have led patients to drop out of a study or restart antidepressant treatment, occurred in about 3% (one in 35) of the patients who have stopped antidepressants.
“There is strong evidence that antidepressants can be effective for many people suffering from a depressive disorder, alone or together with other treatments such as psychotherapy. However, they don’t work for everyone, and some patients may experience unpleasant side effects. In patients who have recovered with the help of drugs, the decision of doctors and patients may be to stop taking them in time.
Therefore, it is important that both doctors and patients have an accurate, evidence-based picture of what might happen when patients stop taking medications. ” says Dr. Jonathan Henssler of the Charité-Universitätsmedizin in Berlin.
He continues: “Our study confirms that a number of patients who discontinue antidepressant therapy will experience withdrawal symptoms and, for some, these will be more severe. It is important to note that drug withdrawal symptoms are not due to drug dependence.”
“It is vital that all patients who stop taking antidepressants are counselled, monitored and supported by healthcare professionals. However, our findings, which consolidate data from a large number of studies, should also provide reassurance that rates of withdrawal symptoms are not that high. as some previous studies and reviews have suggested.”
Previous studies have estimated that more than half of patients experience withdrawal symptoms when they stop medications, and that half of the symptoms are severe. However, many of these estimates are based on observational studies that cannot reliably determine cause and effect.
On the other hand, well-conducted randomized controlled trials (where half of the study population is offered a placebo, or dummy pill, and the other half is offered the drug) can more reliably distinguish between directly caused symptoms by the drug and those not caused by the drug. specific symptoms that may be driven by patient or professional expectations.
The purpose of this study was to review all available evidence to establish the likely incidence of withdrawal symptoms caused directly by stopping antidepressant use, the likely incidence of severe symptoms, and the differences between different types of medications.
The researchers conducted a review and meta-analysis of 79 studies (44 randomized trials and 35 observational studies) that included data from 21,002 patients, 16,532 who discontinued treatment and 4,470 from placebo, with a mean age of 45 years and with 72% women.
Overall, the analysis found that a third (31%) of people who stopped taking an antidepressant experienced at least one symptom, such as dizziness, headache, nausea, insomnia or irritability. Severe symptoms occurred in approximately 3% (one in 35). Withdrawal from imipramine (Tofranil), paroxetine (Seroxat), and (des-)venlafaxine (Pristiq) has been associated with a higher risk of severe symptoms than other medications.
Looking specifically at the results of randomized controlled trials, one in six patients (17%) experienced withdrawal-like symptoms when stopping a placebo drug. This suggests that about half of all symptoms seen in those who discontinue antidepressants could be due to negative expectations (the “nocebo effect”) or nonspecific symptoms that could occur at any time in the general population.
In conclusion, the authors estimate that one in six to seven (15%) patients will experience one or more withdrawal symptoms directly caused by discontinuation of therapy.
The analysis found no differences between studies that applied gradual reduction of the antidepressant and studies with abrupt discontinuation of the drug. However, the authors caution that substantial variations in study designs – such as length of reduction and type of antidepressant used – mean that these are not definitive conclusions and that further research is needed.
They also highlight how findings from previous individual studies indicate that tapering may be helpful in reducing the severity and incidence of withdrawal symptoms.
“We hope that the results of this study will inform healthcare professionals and patients about the risk of experiencing withdrawal symptoms when stopping antidepressants without causing unnecessary alarm.
Like all medications, antidepressants have important benefits, but they also carry risks, including withdrawal symptoms that are also common among a variety of general medications, such as high blood pressure medications or mild pain relievers, and it is important that patients are able to access accurate, evidence-based information under a doctor’s care to discuss the balance of benefits and risks for them personally.
“There is strong evidence that antidepressants can be effective for many people suffering from a depressive disorder, alone or together with other treatments such as psychotherapy. However, they don’t work for everyone, and some patients may experience unpleasant side effects.
In patients who have recovered with the help of antidepressants, the decision of doctors and patients may be to stop taking antidepressants in time.
Therefore, it is important that both doctors and patients have an accurate, evidence-based picture of what might happen when patients stop taking medications. ” says Dr. Jonathan Henssler of the Charité-Universitätsmedizin in Berlin.
On the other hand, well-conducted randomized controlled trials (where half of the study population is offered a placebo, or dummy pill, and the other half is offered the drug) can more reliably distinguish between directly caused symptoms by the drug and those not caused by the drug. specific symptoms that may be driven by patient or professional expectations.
Continuing to take antidepressants long-term reduces the risk of relapse
When people stop taking antidepressants after a long period of use, just over half (56%) experience a relapse within a year, compared to 39% of those who continue the drugs, finds a new study by UCL researchers .
The researchers say their findings, published in the New England Journal of Medicine, can help doctors and patients together make an informed decision about whether or not to stop taking antidepressants after recovering from a depressive episode.
The study is the first publication of a large treatment discontinuation study of people taking antidepressants for multiple years in the primary care setting.
Lead author Dr Gemma Lewis (UCL Psychiatry) said: “Antidepressant prescriptions have increased dramatically in recent decades as people now take antidepressants for much longer. Until now we didn’t know if antidepressant treatment was still effective when someone has been taking them for many years.
“We have found that continuing to take antidepressants long-term effectively reduces the risk of relapse. However, many people can stop treatment without relapse, although we cannot currently identify who these people are.”
The National Institute for Health Research-funded study involved 478 primary care patients in England who had been taking long-term antidepressants (citalopram, sertraline, fluoxetine or mirtazapine) and who felt well enough to consider stopping them. 70% had been taking the drug for more than three years.
In a randomized, double-blind controlled trial, half of the study participants stopped taking the drug and the other half continued. Those who stopped antidepressants received reduced dosages for up to two months as part of a tapering regimen, before receiving only placebo pills.
Over the next year, 56% of participants who stopped taking antidepressants relapsed (a new episode of depression), compared to 39% of participants who continued taking them. Of the 56% who relapsed after stopping, only half later chose to return to the antidepressant prescribed by their doctor. Researchers say some relapses, as well as possible withdrawal symptoms, may not have been severe enough for the person to decide they need to go back to the drugs.
Those who stopped antidepressants were more likely to experience withdrawal symptoms. Despite this, at the end of the study, 59% of the group who stopped treatment were not taking antidepressants.
Dr Gemma Lewis said: “Our findings confirm that for many patients long-term treatment is appropriate, but we also found that many people were able to effectively stop taking the drugs when they were tapered over a period of time. two months.
“Since 44% of those who stopped taking antidepressants had no relapse after a full year, our findings suggest that some patients may decide to stop taking antidepressants, knowing the risk of relapse, but we recommend discuss it with your doctor.”
Senior author Professor Glyn Lewis (UCL Psychiatry) said: “Antidepressants are effective but, like many drugs, they are not ideal for everyone. In our study, 39% of people who continued taking the drug still relapsed, although stopping antidepressants increased the risk of relapse.” risk of further recurrence. There are also other ways to prevent relapse that might help, including cognitive behavioral and mindfulness-based therapies.
Co-lead author Dr Louise Marston (UCL Institute of Epidemiology & Health Care) said: “We don’t yet know why some people seem able to stop taking antidepressants and others don’t, so further research could help us predict who can stop taking antidepressants”. antidepressants in complete safety.”
Paul Lanham, co-researcher with lived experience experience, said: “Many patients on antidepressants long-term have absolutely no idea what they would be like without antidepressants. Some won’t want to find out, but others will. These findings show that continuing antidepressants does not reduce the risk of relapse, but it does not guarantee well-being, and some people can stop antidepressants without experiencing a relapse.”
The study involved researchers from UCL, the Universities of York, Southampton and Bristol and McMaster University (Canada).
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