Withdrawal effects hit up to half of patients on antidepressants

Half of patients who taken antidepressant medication for more than six months experience withdrawal symptoms when stopping that can include ‘brain zaps’, anger and irritability, dizziness, nightmares, anxiety, panic and agitation.

escitalopram (Lexapro) 20mg antidepressant

Half of patients who have taken antidepressant medication for more than six months experience withdrawal symptoms when stopping that can include “brain zaps”, anger and irritability, dizziness, nightmares, anxiety, panic and agitation.

That’s the finding of the most comprehensive analysis to date that confirms withdrawal effects from widely used antidepressant medications are common and increase with longer use.

The systematic review and meta-analysis led by the National Institute on Drug Dependence Unit in Beijing found that 43 per cent of all patients experienced withdrawal effects when stopping their antidepressant.

The findings contradict a recent high-profile study published in the Lancet that was seized upon by many psychiatrists, who downplayed consumer experiences of severe side effects from antidepressants when attempting to stop the drugs.

One in seven Australians take selective serotonin reuptake inhibitor (SSRI) medications, one of the highest rates in the world. Many patients are inappropriately prescribed the drugs, which are not a first-line treatment for mild to moderate depression, and take the drugs for much longer that the recommended six-month time frame.

The latest study published in the journal Molecular Psychiatry found that one in three patients who had used antidepressants for less than three months reported withdrawal effects, while half of those who had taken them for more than six months experienced these effects.

That contrasts with the Lancet study, led by German psychiatrist Jonathan Henssler, which reported that only one in six patients reported withdrawal effects from SSRIs and only one in 35 reported severe withdrawal effects. This study was used by critics to push back against a movement within psychiatry away from over­prescribing.

Co-author of the latest paper in Molecular Psychiatry, Mark Horowitz, a research fellow in psychiatry in the National Health Service and the lead author of the Maudsley Deprescribing Guidelines, said the meta-analysis used much more stringent selection criteria than previous systematic reviews and excluded chart reviews by doctors and studies which did not systematically evaluate withdrawal effects.

“We did not want to make the same mistakes as the recent paper by Henssler that included a very low bar for what counted as a study and which therefore unfortunately underestimated the risk of withdrawal,” Dr Horowitz said. “We hope that clinicians and the health systems will now take forward the challenge of helping patients to safely stop their antidepressants and avoid severe withdrawal effects.”

The slow and careful approach to weaning off antidepressants recommended by the landmark Maudsley Deprescribing Guidelines, which emphasised low evidence of efficacy of SSRIs for many patients, has now been adopted as an evidence-based resource in new guidelines by the Royal College of General Practitioners in Australia. GPs issue 85 per cent of antidepressant scripts in Australia.

According to the new RACGP guidelines, antidepressants should not generally be used as lifelong therapy, and the prevalence and severity of withdrawal is high in Australia. While previous guidelines said dosage of drugs could be reduced over four weeks, the new approach recognises that for some people it needs to be much slower, especially in the final stage of cessation.

David Taylor, a professor of psychopharmacology at King’s College London and head of pharmacy at the Maudsley Hospital, said the latest study on withdrawal effects confirmed that withdrawal symptoms were common and that “brain zaps”, or feelings of electrical shock in the brain were the most frequently experienced symptom of the withdrawal process.

“Brain zaps are not a vague or ill-defined syndrome – they are specific to antidepressant withdrawal, and unlikely to be induced by the nocebo effect, given their rarity as a human experience,” Professor Taylor said. “The estimated incidence of withdrawal of 43 per cent is likely to be a fair estimate of the risk of withdrawal on stopping antidepressants.”