One in six patients experience side effects when they stop taking antidepressants, according to a study published in The Lancet Psychiatry.
It’s commonly believed that stopping antidepressants can be highly problematic, but it’s unclear just how common discontinuation symptoms really are. A team from Charité – Universitätsmedizin Berlin and University Hospital Cologne have now conducted a systematic review and meta-analysis to answer this question.
In theory, antidepressants are not addictive. However, many patients report symptoms including dizziness, headache, or insomnia when they stop taking these meds. Despite this well-known problem, this issue has been largely ignored for years, but recently, a few studies have tried to find the reason for these symptoms.
“The results of these studies vary, in some cases widely,” said Prof. Christopher Baethge, from the Department of Psychiatry and Psychotherapy at University Hospital Cologne and the Faculty of Medicine at the University of Cologne. “There has been a great deal of discussion, some of it quite emotional, within the research community and the general public alike in recent years about how prevalent and severe the discontinuation symptoms actually are.”
Now, a team from the Evidence-Based Mental Health research group at the Department of Psychiatry and Neurosciences at Charité conducted a systematic review of existing studies in this area. The team reviewed over 6,000 studies and selected 79 to re-analyse the results. Overall, they analysed data on more than 20,000 people surveyed about their discontinuation symptoms.
About 30% of patients treated with an active drug reported discontinuation symptoms and 17% of those who had received a placebo alone. “Our analysis shows that on average, one in three people will experience symptoms after stopping antidepressant treatment,” said Dr. Jonathan Henssler says. “However, only half of these symptoms are in fact attributable to the drug itself. Drug effects can be ruled out in the placebo group, which means the symptoms either arose by chance, independently of the treatment, or they are the product of the nocebo effect.”
The nocebo effect can be seen as the opposite of the placebo effect. It explains why inactive treatments can have side effects, which are triggered purely by patients expecting adverse effects. “When we take non-specific symptoms and the effect of expectations into account, about one in six or seven people is affected by discontinuation symptoms that occur as an actual consequence of antidepressant medication,” said Henssler. “In most cases, the symptoms are mild. The vast majority of those affected will be able to discontinue antidepressants without relevant symptoms. This means that in most cases, there is no need for a lengthy or gradual tapering process.”
“It’s important for all people wishing to discontinue treatment with antidepressants to be monitored and counselled by healthcare professionals and to receive individual support in the case of withdrawal symptoms. Joint decision-making between the patient and prescriber even before a course of treatment begins is the foundation of good treatment. We hope our data will support patients and healthcare professionals and help alleviate some of the uncertainty surrounding these issues today,” concluded Prof. Baethge.
Henssler J, Schmidt Y, Schmidt U, Schwarzer G, Bschor T, Baethge C. Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis. Lancet Psychiatry. 2024 Jul;11(7):526-535. doi: 10.1016/S2215-0366(24)00133-0.