06/16/2024 – 16:09
A representative study shows that withdrawal symptoms as a result of discontinuing antidepressants are a real problem, but less common than previously thought. Antidepressants are among the most prescribed medications in rich countries, including the United States, Canada, the United Kingdom and a large number of part of Western Europe.
What happens when you stop taking these medications, not normally prescribed for long-term use, has been a controversial issue since the medication was discovered and used in clinical practice in the 1950s.
In a study published on June 5, 2024, in the journal The Lancet Psychiatry, it was found that 14% of those who stopped taking antidepressants experienced withdrawal symptoms, such as dizziness, headaches, nausea, insomnia and irritability. This proportion, of one to seven, is surprising, as it is much lower than what many antidepressant experts expected.
“It will be gratifying to know that the rates of withdrawal syndrome are nowhere near as high as those previously reported, around 50%”, comments Sameer Jauhar, a psychiatrist at King’s College London, specializing in affective disorders, who was not involved. of the study.
However, patients discontinuing medication need to be informed about withdrawal symptoms “which are real and need to be monitored and treated if they occur,” emphasizes lead author Christopher Baethge, a psychiatrist at the University of Cologne in Germany.
Low incidence of severe symptoms
The meta-analysis, which is the most comprehensive research to date to assess the prevalence of antidepressant discontinuation symptoms, included 79 scientific studies with a total of 21,002 adult participants.
The studies included 44 randomized control trials and 35 observational studies related to antidepressant discontinuation symptoms published between 1961 and 2019.
The authors estimate that about one in seven people reported having at least one symptom after stopping antidepressants, while a small number — about one in 35 — reported severe symptoms.
“Severe discontinuation symptoms occur much less frequently, but should be taken seriously and are important as many millions of patients take antidepressants. It is not clear which ones will suffer from withdrawal,” notes Eric Ruhé, a psychiatrist at Radboud University Hospital in the Netherlands.
It was also unclear from the study how long withdrawal symptoms might last after stopping antidepressants, but research indicates that “they generally disappear after two to six weeks, or when antidepressants are resumed,” explains Baethge.
The medications desvenlafaxine, venlafaxine, imipramine and escitalopram were those most frequently associated with withdrawal syndrome. Fluoxetine and sertraline had the lowest rates of symptoms.
What causes antidepressant discontinuation symptoms?
Most antidepressants belong to a group of medications known as selective serotonin reuptake inhibitors (SSRIs). SSRIs work by blocking the reuptake of serotonin in the brain, so that this neurotransmitter is no longer available to act on brain cells.
Scientists don’t fully understand how withdrawal syndrome arises, but one theory is that “taking away the increase in serotonin when stopping SSRIs causes withdrawal symptoms,” explains Baethge.
Fluctuations in the level of serotonin signaling in the brain can affect a number of brain states, such as sensory perception, emotional states, and sleep-wake states. But it’s still unclear how SSRI withdrawal is related to specific symptoms, such as dizziness, headaches or insomnia.
Some theories regarding a link between serotonin and depression have been criticized as too simplistic by researchers. More comprehensive theories about depression are currently being developed.
“Nocebo” effect and symptom expectation
The research also found that nearly one in five participants in the studies’ placebo groups described symptoms similar to those reported by the group who had stopped taking antidepressants.
Baethge believes this is due to a “nocebo” effect, in which “the expectation that bad things will happen when taking or stopping a medication creates a greater awareness of worsening anxiety or depression after taking the medication.” ”: “This effect can be amplified when the doctor warns the patient about possible side effects.”
For Baethge, the findings suggest that non-specific symptoms, similar to normal fluctuations in sensory perception, come into play.
“We’re not saying it’s all in the head. It’s tempting to think that if something happens with a placebo, it’s all imagination. The issue is that patients really feel dizzy, for example, and this needs to be taken seriously, regardless of the cause.”
#stopping #antidepressants #withdrawal #syndrome