Study claiming antidepressant withdrawal is less common than thought doesn’t take into account risks in long-term users

a new assessment of research on antidepressant withdrawal has confirmed that it exists, but also reports that it is less common and less severe than previously identified.

These findings fuel a growing debate about how often and how severe withdrawal symptoms occur. But we argue that the researchers are likely underestimating the incidence in long-term users who are most at risk for withdrawal symptoms.

One of the main limitations of this study is that it mainly involved short-term users of antidepressants, which underestimates how common these symptoms are in people who use the drugs long-term. This is a growing group of people – and research shows this is the case are most at risk of experiencing withdrawal.

The systematic review looked at a total of 79 studies. Based on their analysis, the researchers reported that one in three people who stopped taking antidepressants experienced withdrawal symptoms. The authors also found that one in six people who had taken a placebo antidepressant experienced withdrawal symptoms after stopping (often the ‘nocebo’ effect).

Taking this data into account, they concluded that approximately one in six people experienced withdrawal symptoms as a result of the antidepressants. The researchers also reported that only 3% of people showed severe withdrawal symptoms, and they wondered whether some of these withdrawal symptoms were actually a return of people’s underlying mental health problem.

Confirmation of stopping antidepressants will be welcomed by many people. Although the UK prescribing guidelines used to indicate withdrawal symptoms are generally mild and brief in most patients, tens of thousands of people have reported petitions, Newspaper articles and further social mediawho reports experiencing severe withdrawal symptoms. Many describe problems including new panic attacks, obsessive thinking, akathisia (a state of restlessness, agitation and terror) and a high risk of suicide.

In 2019, the first systematic review on discontinuing antidepressants showed that the picture was more in line with what patients reported. The study found half of the patients prescribed antidepressants experienced withdrawal symptoms – and half of these people reported severe symptoms.

Study limitations

The latest findings add to this picture, and it is useful to confirm that antidepressant withdrawal symptoms do occur and are not uncommon. But there are several reasons why they aren’t as comforting as they seem.

First, most of the studies included in the review were short-term studies conducted by drug companies that have no incentive to detect withdrawal symptoms.

Furthermore, many of the studies were not designed to investigate withdrawal symptoms and did so only occasionally or did not thoroughly assess withdrawal symptoms. This probably underestimated the incidence of withdrawal symptoms.

The average time people took antidepressants in the studies included in the review was just 25 weeks. This is a far cry from how long many people use these drugs in clinical practice.

Half of patients in Britain taking antidepressants have taken them over two years– with 2 million people before then five years. In the US, half of people take antidepressants more than five years.

We know that the longer people use antidepressants more common and more serious their withdrawal symptoms are upon stopping. The authors of the paper reported that they found no link between how long people took antidepressants and the risk of withdrawal symptoms, but this is likely because they only looked at short-term studies, with very few studies lasting longer than a year.

One study found that one in three people who had been taking antidepressants for three to six months reported withdrawal symptoms (similar to the results of the current meta-analysis), with a fifth reporting moderate or severe withdrawal symptoms.

Of those who took antidepressants for more than three years, two-thirds reported withdrawal symptoms – and half reported that these were moderate or severe. It is therefore likely that the new review underestimates how common and severe withdrawal symptoms are in long-term antidepressant users.

The other major limitation of this review is that it assumed that the withdrawal effects of placebos and antidepressants were equivalent. However, symptoms were likely less intense in the placebo group.

In the few studies included in the review that did look at severity, people who stopped taking antidepressants were seven times more likely to have severe withdrawal symptoms than those who stopped taking a placebo. Comparing the rates of these two groups is like comparing apples and oranges.

The authors of the review also suggest that some of the reported withdrawal symptoms (such as emotional disturbances) may be a recurrence of the underlying mental health problem that has been incorrectly classified as withdrawal symptoms. But it may be just as likely that some withdrawal symptoms have been misclassified as a relapse, which may have led them to underestimate the withdrawal effects.

And since depression is a fluctuating condition, it is comes and goes over timeit would be unlikely for so many patients to relapse immediately after stopping antidepressants.

Clearly we need better quality research in long-term users to know the risks more accurately. It is concerning that after decades of antidepressants on the market, so little attention has been paid to this major public health problem.

When considering an antidepressant, the risks of severe and prolonged withdrawal symptoms should be taken into account. Because of these risks, these medications should also be stopped more carefully than is normally done.

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