Going off of antidepressants may not come with as many side effects as people think, an extensive new analysis has found.
The study, published in the journal JAMA Psychiatry, is the largest review to date on antidepressant withdrawal symptoms, according to the researchers from the United Kingdom.
It sought to understand what happens when people stop taking antidepressants, and to identify which symptoms come from discontinuing medication and which could reflect a potential relapse of depression or other mental health issues.
“Our work finds that most people do not experience severe withdrawal, in terms of additional symptoms,” Dr Sameer Jauhar, the study’s lead author and a researcher at Imperial College London, said in a statement.
The review included 50 randomised controlled trials – which are considered the gold standard in medical research – spanning about 17,800 people.
On average, people who stopped taking antidepressants experienced symptoms such as dizziness, nausea, vertigo, and nervousness in the first two weeks.
But most people had few enough symptoms that they were considered “below the cutoff” for clinical withdrawal, the study found.
People’s moods also did not appear to get worse as a result of discontinuing their medicine, meaning it could instead be a sign that their depression is coming back, researchers said.
The findings contradict another study published earlier this year that found antidepressant withdrawal symptoms were “common, and severe and prolonged” for many patients.
But Katharina Domschke, chair of the psychiatry and psychotherapy department at the University of Freiburg in Germany, said that study was “methodologically much weaker” because it only included 310 patients and had a higher risk of bias in the results.
The latest analysis is “extremely welcome in terms of helping to destigmatise antidepressants,” added Domschke, who was not involved with the report.
Only one extra symptom for those who stopped antidepressants
The study included several types of antidepressants, including agomelatine, vortioxetine, selective serotonin reuptake inhibitors (SSRIs) such as escitalopram, sertraline and paroxetine, and serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine and duloxetine.
Researchers tracked the number of symptoms that people experienced on a 43-item scale, comparing those who went off antidepressants against those taking placebos, or dummy treatments.
Overall, patients who stopped antidepressants experienced one extra symptom – such as nausea or vertigo – than people who stopped placebos. For example, 20 per cent of people who stopped taking venlafaxine suffered from dizziness, compared with just 1.8 per cent of those on placebos.
Different antidepressants also came with different severity and length of symptoms. People who went off of desvenlafaxine experienced the most symptoms, while patients who stopped vortioxetine were fairly similar to those who took placebo medicines.
The review has some limitations. Most of the studies followed people for up to two weeks after they stopped taking antidepressants, making it difficult to draw conclusions about long-term effects.
“We still need more data on long-term users, individual vulnerability, and best practices for discontinuation,” Dr Christiaan Vinkers, a psychiatrist and stress researcher at Amsterdam University Medical Center who was not involved with the study, said in a statement.
For now, Vinkers said, "the findings promote a more balanced and science-based understanding of antidepressant discontinuation".
