Antidepressant withdrawal symptoms may be less common than we thought

Antidepressant withdrawal symptoms may be less common than we thought, at least for short-term use – but questions remain about what happens to people who stop taking the drugs after much longer periods.

We know that people taking antidepressants for conditions such as depression, anxiety and phobias may experience withdrawal symptoms that can last for a few weeks, such as nausea, headaches, anxiety and depression, but while doctors may warn people about this possibility, it is unclear how often they actually occur.

To find out more, Sameer Jauhar at Imperial College London and his colleagues reviewed 49 randomised controlled trials of antidepressant use. They first analysed a subset of studies that tracked the number of withdrawal symptoms participants experienced one week after either stopping antidepressants, coming off placebo pills or continuing to take antidepressants. The researchers found that those who stopped taking the drugs experienced one extra symptom compared with those in the other two groups.

In another analysis, the team looked at another subset of studies that tracked the types of withdrawal symptoms participants experienced after coming off antidepressants or placebo pills. Dizziness was found to be the most common symptom, followed by nausea, nervousness or irritability, and vertigo.

Specifically, 7.5 per cent of people in the antidepressant group experienced dizziness, while this figure was 1.8 per cent in the placebo group. Nausea, nervousness or irritability, and vertigo were each reported by less than 5 per cent of people in the antidepressant group, and less than 2 per cent in the placebo group.

These figures are lower than two prior estimates of withdrawal symptoms. One 2019 review found more than half of people experienced symptoms, but that included data from online surveys, so may be skewed by people with more severe symptoms being more likely to respond, says Michael Browning at the University Oxford.

Another estimate, published last year, found that 31 per cent of people reported withdrawal symptoms, compared with 17 per cent in placebo groups. But they didn’t give details on the types of symptoms experienced, says Jauhar.

Susannah Murphy at the University of Oxford says the new review addresses some of these issues. “This is really important for the field: it’s collecting together and summarising data from many, many robust studies involving more participants than previous ones,” she says.

But John Read at the University of East London points out that most studies in the review included participants who were on antidepressants for only eight to 12 weeks, while people often take them for years. “There’s a strong relationship between how long you’re on these drugs and whether or not you end up with withdrawal, so short-term [use] studies aren’t going to tell you much about real-world effects,” he says.

As such, you would need more studies involving long-term use to get a true answer, says Mark Horowitz at University College London. “It’s like crashing a car into a wall at 5 kilometres an hour, and saying it’s safe, but ignoring the fact that people are driving around on the roads at 60 kilometres an hour.”