Antidepressant Withdrawal Symptoms: A Systematic Review Finds Most People Do Not Experience Severe Withdrawal

Strategic Insights -

The largest review of "gold standard" antidepressant withdrawal studies has identified the type and incidence of symptoms experienced by people discontinuing antidepressants, finding most people do not experience severe withdrawal. Researchers from Imperial College London and King's College London conducted a systematic review and meta-analysis of previous randomised controlled trials relating to antidepressant withdrawal, examining data from 50 trials across multiple conditions involving 17,828 participants.

Key Takeaways:

  • The study found that participants who stopped antidepressants experienced an average of one more symptom than those who continued or were taking placebos, but this was not enough to be judged as significant.
  • The most common symptoms were dizziness, nausea, vertigo, and nervousness, with 7.5% of participants experiencing dizziness compared to 1.8% in the placebo group.
  • Depression was not a symptom of withdrawal from antidepressants, and was more likely to reflect illness recurrence.
  • The study found that the number of extra symptoms generally equated to one more symptom on the 43-symptom item scale, indicating that the majority of people did not experience severe withdrawal.
  • The study highlighted the clinical symptoms to look out for, including dizziness, nausea, vertigo, and nervousness, and provided guidance for clinicians, patients, and policymakers.
  • The study found that the type and incidence of symptoms varied between antidepressants, with venlafaxine showing the highest rates of dizziness (20%) and vortioxetine showing fewer than one extra symptom on the standardised discontinuation scale.
  • The study included studies with different discontinuation regimes, but in the majority of studies (44), people either discontinued abruptly or tapered over 1 week.
  • The study highlighted the need for further research on the pharmacological basis for withdrawal symptoms, particularly in those who experienced more severe symptoms.

Statistics:

  • The study involved 50 trials across multiple conditions, examining data from 17,828 participants with an average age of 44 years, of whom 70% were female.
  • The most common symptoms were:

+ Dizziness: 7.5% vs 1.8% in the placebo group

+ Nausea: 4.1% vs 1.5% in the placebo group

+ Vertigo: 2.7% vs 0.4% in the placebo group

+ Nervousness: 3% vs 0.8% in the placebo group

  • The study found that approximately 20% of people suffering from dizziness when discontinuing venlafaxine compared to 1.8% in the placebo group.
  • The study found that fewer than one extra symptom was seen with vortioxetine on the standardised discontinuation scale.
  • The study found that no extra symptoms were seen with agomelatine.

Sources:

  • Imperial College London
  • King's College London
  • University College London (UCL)
  • The study's first author, Michail Kalfas, from the Institute of Psychiatry, Psychology & Neuroscience at King's College London
  • Professor Allan Young, Head of Psychiatry at the Department of Brain Sciences at Imperial College London