Review details and key findings

For the review, researchers analyzed data from 79 studies with 21,002 patients. Of the studies, 44 were randomized controlled trials, and 35 were observational studies.

Among the patients, 16,532 discontinued antidepressant use, while 4,470 patients discontinued use of a placebo. The mean age of patients was 45 years old, and 72% were female.

Overall, the researchers found that roughly 15%, or one in six to seven patients, experienced antidepressant discontinuation symptoms after they stopped taking antidepressants. One in 35 (2% to 3%) of these patients experienced severe symptoms.

Some of these symptoms include dizziness, headache, nausea, and insomnia. The incidence of withdrawal symptoms also depended on the type of antidepressant that patients were taking. Imipramine, desvenlafaxine, venlafaxine, and escitalopram were all associated with higher frequencies of withdrawal symptoms. Impramine, paroxetine, and either desvenlafaxine or venlafaxine were also associated with more severe symptoms.

The researchers also found that 17% of patients in placebo groups also reported symptoms after stopping treatment, suggesting not all potential withdrawal symptoms can be attributed to pharmacological causes. According to Christopher Baethge, a senior author of the study and a professor of psychiatry at the University of Cologne in Germany, other factors, such as a heightened awareness of worsening anxiety and depression or symptom fluctuations, may occur in patients, regardless of the medications they're taking.

Baethge also noted that symptoms experienced by patients in placebo groups shouldn't be dismissed. "We are not saying it’s all in their heads," said Baethge. "Even patients that have no pharmacologically driven ADS [antidepressant discontinuation syndrome] do feel, for example, dizzy. If they say dizziness is the problem, they feel dizzy and need to be taken seriously no matter what caused that dizziness."

Commentary

According to Awais Aftab, a professor of psychiatry at Case Western Reserve University, who was not involved in the review, it's "an important and long overdue contribution to the research literature."

The review confirmed that withdrawal symptoms after discontinuing use of antidepressants occur with clinically relevant frequency and should be managed with care, STAT writes. However, researchers found a much lower incidence than in other studies.

Previous estimates, which were based on online surveys, suggested that 56% of patients experienced withdrawal symptoms after stopping antidepressants. Among these patients, almost half of their symptoms were considered severe.

"An incidence of antidepressant discontinuation symptoms of any severity being experienced by one in six patients who discontinue their medication and severe withdrawal symptoms being experienced by around one in 30 patients has more face validity, in my opinion, and better represents what happens in the clinic," Aftab said.

According to Baethge, different doctors and patients will have varying opinions about what incidence of withdrawal symptoms can be considered rare, but the researchers "wanted to provide a number for counseling without causing undue alarm."

Moving forward, the researchers said that more research is needed on the discontinuation effects of antidepressants. "There is still a considerable dearth of high-quality clinical trials investigating antidepressant withdrawal effects," Aftab said.

Paul Keedwell, a consultant psychiatrist and fellow of the Royal College of Psychiatrists, said that people who want to stop taking antidepressants should seek medical advice before doing so. He noted that some people may have a high risk of relapse for depression or that a relapse may be confused with withdrawal symptoms.

Keedwell also noted that withdrawal symptoms can be prevented with proper medical supervision. "It is important to say that withdrawal symptoms are not dangerous and the risk of experiencing them at some future date should not be a reason for refusing antidepressant treatment," he said. "The pros and cons of treatment should always be discussed with your doctor."

Advisory Board's behavioral health resources

For more information on topics related to behavioral health, check out these Advisory Board resources:

This expert insight explains how leaders from FloridaBlue, ShatterProof, and ChristianaCare are driving progress in behavioral healthcare at their organizations.

To measure your own progress with behavioral health, you can use this picklist of key performance indicators, which includes costs and quality goals. Similarly, this infographic outlines how you can grow your organization's behavioral health strategic function. This resource can help you identify focus areas and benchmark your progress.

Anxiety disorders affect a third of U.S. women every year, but only half receive the level of care they need. This cheat sheet can help you improve care for anxiety and depression for women. More broadly, this cheat sheet describes inequities in behavioral health and how they impact both patients and various healthcare stakeholders.  

We also have a featured page on behavioral health, which includes resources on current challenges with behavioral healthcare, ways your organization can track progress, and how to develop cross-industry partnerships. (Merelli, STAT, 6/5; Roxby, BBC News, 6/6; Henssler et al., The Lancet Psychiatry, 6/5)