Just under one in seven people who stop taking antidepressants will experience withdrawal symptoms, according to a study.
Researchers in Germany analysed data in 79 studies involving 21,000 patients and found that 15% of people experienced one or more withdrawal symptoms that were directly caused by coming off antidepressants, while about 3% experienced severe symptoms.
The findings, published in the Lancet Psychiatry, show that the most common symptoms were dizziness, headache, nausea, insomnia and irritability.
These symptoms typically occur within a few days, and can last from a couple of days to more than six months .
The authors also compared the type of medication taken, and citalopram, sertraline and fluoxetine – the most commonly used antidepressants in the UK – had the lowest risks of symptoms.
But stopping taking imipramine (Tofranil), paroxetine (Paxil or Seroxat) and desvenlafaxine (Pristiq) was associated with a higher risk of severe symptoms.
Dr Jonathan Henssler, from Charité – Universitätsmedizin Berlin, one of the co-authors of the study, said that while antidepressants can be effective for many people, they do not work for everyone. Whatever the reason for coming off the medication, doctors and patients need an accurate, evidence-based picture of what might happen, he added.
“It’s important to note that antidepression discontinuation symptoms are not due to antidepressants being addictive. There is a crucial need for all patients stopping antidepressants to be counselled, monitored and supported by healthcare professionals,” he said.
Some critics questioned the findings, as about half the studies involved patients who had been taking antidepressants for three months or less.
But Christopher Baethge, co-author of the research and professor of psychiatry at the University of Cologne, said that although patients normally need to take antidepressants for several weeks before a risk of withdrawal symptoms can be expected, the prevalence of symptoms did not increase with longer use: “In our sample of studies, we found no increased risk of discontinuation symptoms among patients taking antidepressants for a longer period of time than three months.”
A previous analysis had suggested that as many as 56% of patients experienced withdrawal symptoms when stopping antidepressants, but that has been criticised as not robust.
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Dr Sameer Jauhar, a consultant psychiatrist at King’s College London, said although the research looked only at patients taking part in trials, it was “the best evidence we have” and it was “gratifying to know rates of withdrawal are nowhere near as high as reported”.
Prof Oliver Howes, chair of the psychopharmacology committee at the Royal College of Psychiatrists, welcomed the “robust” study’s findings and said that “only about one in 35 might experience severe withdrawal symptoms”.
The researchers identified some limitations of their study, in particular the possibility of the recurrence of depression after medication was stopped being interpreted as withdrawal symptoms. The authors also noted that only seven antidepressants were investigated in three or more studies, and that no studies had been found on several widely used antidepressants such as mirtazapine, bupropion or amitriptyline.