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CNN
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Antidepressants can work wonders for persistent mental health problems. But some people may be reluctant to take these medications, fearing what might happen if they ever want to stop taking them.
This risk has now been quantified, thanks to a new review of 79 studies – called meta-analysis – totaling 21,002 adult participants aged 45 on average.
About 15% of participants who stopped taking antidepressants experienced withdrawal symptoms such as dizziness, headache, nausea, insomnia and irritability, according to the study published Wednesday in the journal The Lancet Psychiatry.
One in 35 participants experienced severe symptoms after stopping taking antidepressants. This review is the first publication of a larger project on antidepressant withdrawal symptoms, the authors said.
“There is strong evidence that antidepressants can be effective for many people with a depressive disorder, either alone or in combination with other treatments such as psychotherapy,” said Dr. Jonathan Henssler, lead author of the study and chief physician of the department of psychiatry and neuroscience at the Charité — Medical University of Berlin, in a press release.
“However, they do not work for everyone and some patients may experience unpleasant side effects. In patients who have recovered with antidepressants, the decision of doctors and patients may be to stop taking them in time,” added Henssler. “Therefore, it is important that doctors and patients have a clear, evidence-based idea of what might happen. »
The onset of withdrawal symptoms was reported or described as early as 1959, but researchers overlooked these reports until the late 1990s, according to the journal.
So far, “there has been a lot of ‘debate’ in recent years about the important issue of antidepressant withdrawal, which has appeared in print and on social media, with very high estimates of withdrawal, around 50 and a half percent (considered) serious,” Dr Sameer Jauhar, clinical lecturer in affective disorders and psychoses at King’s College London, said in a press release. Jauhar was not involved in the study.
“This was based on a very unconventional study,” Jauhar added, “that included data from online surveys, which are notoriously difficult to interpret (ask anyone involved in election polling).”
To more precisely determine the risk of withdrawal, the authors examined data from 44 randomized controlled trials and 35 observational studies published between 1961 and 2019. These studies focused on abruptly stopping or tapering off an antidepressant or medication. ‘an established placebo. More than half of these studies focused on mood disorders such as major depressive disorder or bipolar disorder, and more than a quarter focused on anxiety disorders.
The authors also found that the medications most commonly associated with withdrawal symptoms were desvenlafaxine, venlafaxine, imipramine, and escitalopram. Those with the lowest rate of discontinuation symptoms were fluoxetine and sertraline.
Pharmaceutical companies funded 45 of the studies, but that support did not appear to influence the overall results, according to the analysis. The rate of withdrawal symptoms in studies funded by pharmaceutical companies was about the same as in trials not funded by pharmaceutical companies.
“This work is a salutary lesson because some people may have been dissuaded from taking a potentially effective treatment based on poor-quality evidence,” Jauhar said. “Science is self-correcting and the authors are to be commended for this work.”
The findings also represent an important first step in helping patients responsibly stop taking antidepressants, said Dr. Christiaan Vinkers, a psychiatrist and full professor at the Department of Psychiatry at the University of Amsterdam Medical Center, in A press release.
Another weakness of the review was that many of the included studies did not focus primarily on stopping antidepressants, but rather on the effectiveness of antidepressants compared to placebos, said Dr. Tony Kendrick, professor of primary care. at the University of Southampton in England. Press release.
These studies “also observed patients going through withdrawal who stopped taking their medications at the end of the trials. Therefore, the period of taking the antidepressant was 12 weeks or less in 36 of the 79 included studies,” Kendrick said. “Severe discontinuation symptoms are generally not expected to occur after just a few weeks of antidepressant use.”
Some of the other included studies had much longer treatment periods, some lasting up to a year or more.
Regarding why stopping antidepressants sometimes results in withdrawal symptoms, it’s important to note that these medications are not addictive, Henssler said. The effects could be due to the suddenly lower amount of neurotransmitters in your brain, according to the Cleveland Clinic.
In the review, there was no difference between studies on gradual or abrupt cessation. But the authors cautioned that this result does not constitute a definitive conclusion due to variations in study designs. And other research still indicates that tapering can be helpful in reducing risk and symptom severity, they said.
Although withdrawal rates are not as high as previously reported, when it comes to patients wanting to stop their antidepressants, doctors should always discuss what this would mean for the patient and how to do so in safely, Jauhar said.
“The doctor should help them do this slowly and in a controlled manner that limits the impact of any potential withdrawal symptoms…at a pace that is comfortable for them and that suits their individual needs,” said Dr. Oliver Howes, Chairman of the Psychopharmacology Committee of the Royal College of Psychiatrists of the United Kingdom, said in a press release. Howes was not involved in the study.
It is also important to carefully strategize because of the risk of relapse into the illness being treated, based on a person’s mental health history, said Dr Paul Keedwell, a consultant psychiatrist and fellow of the Royal College of Psychiatrists who did not participate in the study. said in a press release.
The study did not provide information on how long withdrawal symptoms last, but other research suggests they can last up to two weeks in most cases, Keedwell said. Stopping is more difficult for people who have been taking their medications for a year or more, he added: in this case, withdrawal symptoms can last for months, but rarely up to a year.
However, “it’s important to say that withdrawal symptoms are not dangerous and the risk of experiencing them at a later date should not be a reason to refuse antidepressant treatment,” Keedwell said. “The pros and cons of treatment should always be discussed with your doctor. »