by Eugene Rubin MD, PhD and Charles Zorumski MD
Discontinuing medications can be associated with withdrawal symptoms. This is true when stopping antidepressants. What are these symptoms and how common are they? These questions are addressed in a recent study published by Michail Kalfas and colleagues in JAMA Psychiatry.
Study Design
After an extensive review of the literature, the research team included data from 50 randomized controlled trials that included assessment of symptoms following discontinuation of antidepressant medications. Most of the 17,828 individuals in these studies were taking antidepressants for depressive or anxiety disorders.
To evaluate withdrawal symptoms, the studies either utilized the Discontinuation-Emergent Signs and Symptoms scale (DESS) or recorded specific adverse events following discontinuation. Of the 50 studies, 19 utilized the DESS and 45 recorded individual symptoms following discontinuation.
Statistical methods known as meta-analyses were utilized to analyze the large amount of data from these studies. Meta-analytic methods allow multiple studies on a specific topic to be combined so that results are based on a much larger number of participants than individual studies. While there are limitations with this approach, these kinds of studies can enhance the generalizability of observed findings.
Symptoms following discontinuation of antidepressants were compared to symptoms following “withdrawal” from placebo or those following maintained antidepressant treatment.
Major Findings
More symptoms were experienced by those withdrawing from antidepressants than by those withdrawing from placebo during the first two weeks after discontinuation. Symptoms that occurred significantly more often included dizziness or lightheadedness (7.5% versus 1.8%), nausea (4.1% versus 1.5%), vertigo (2.7% versus 0.40%), and nervousness or irritability (3.0% versus 0.85%). Overall, those withdrawing from active medication experienced only one more symptom than those not withdrawing from active medication.
When compared to withdrawal from placebo, no significant increase in depressive symptoms was found during the first two weeks after discontinuing antidepressants. The authors suggest that if depressive symptoms reappear within weeks or months after stopping antidepressants, it suggests a return of the underlying disorder and not a depressive-like withdrawal syndrome.
Nervousness was more common one week after discontinuing an antidepressant. This could represent a withdrawal symptom or relapse of an underlying anxiety disorder.
The authors investigated symptoms associated with specific antidepressants. They found that the “antidepressants associated with the highest incidence of individual discontinuation symptoms were venlafaxine and desvenlafaxine, consistent with previous studies and its rapid clearance. The most commonly experienced symptom following discontinuation of desvenlafaxine and venlafaxine was dizziness, which affected 9.4% and 17.5% of participants, respectively.”
The authors note that results were mixed about whether slowly tapering the dose of antidepressants is better than abrupt discontinuation in helping minimize withdrawal symptoms.
Thoughts
Most people will experience few, if any, withdrawal symptoms after discontinuing treatment with an antidepressant. Symptoms that do occur are likely to be transitory. However, the occurrence of even transient withdrawal symptoms such as dizziness, nausea, vertigo, or nervousness can be uncomfortable. Individuals should take care to avoid falls and other sequalae of dizziness or vertigo, and physicians should caution patients about potential problems with these symptoms when attempting drug withdrawal.
Withdrawal symptoms can vary among individuals. Some will not experience any symptoms, and others may experience more severe, longer-lasting symptoms.
Current evidence is mixed about whether slowly tapering antidepressants, including slowly tapering even smaller doses, helps prevent withdrawal symptoms. Some individuals and physicians prefer slow tapering instead of acute cessation.
To summarize: Most people can discontinue an antidepressant medication successfully though they may experience relatively minor, short-term withdrawal symptoms. Should symptoms of depression or anxiety reappear within weeks or months after discontinuation, such symptoms likely represent relapse and not withdrawal symptoms. This possibility highlights the importance of timely clinical follow-up.
