Symptoms of antidepressant withdrawal were first identified in the 1950s — but since then, psychiatrists and professional organizations have disagreed about how common or severe these symptoms may be.
But some experts are skeptical of the findings.
“The review shows that SSRIs and SNRIs [selective serotonin reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors, the most common antidepressants] cause withdrawal effects after just a few weeks,” says Joanna Moncrieff, MD, a professor of critical and social psychiatry at University College London.
But concluding that most people don’t have symptoms that affect their well-being or ability to function based on the included studies would be a mistake, says Dr. Moncrieff, who wasn’t involved in the study.
The trials used to reach that conclusion were almost all short-term, lasting 8 to 12 weeks, she says. “Since we know that withdrawal symptoms are more likely to develop after long-term use, such trials are completely uninformative about the risks of withdrawal for people who use the drugs for months and years — as many, many people do,” she says.
The Most Common Symptoms of Stopping an Antidepressant
For the new review, researchers analyzed 50 randomized controlled trials (considered the gold standard), which included a total of nearly 18,000 people. Participants were 44 years old, on average, and 70 percent were female.
The review showed that the most common symptoms of antidepressant withdrawal were:
- Dizziness
- Nausea
- Vertigo
- Nervousness
These symptoms usually appeared within the first few days of discontinuation.
The researchers also calculated how many people taking antidepressants experienced each symptom, compared with how many people had those symptoms when stopping a placebo:
- Dizziness: 7.5 percent in people stopping an antidepressant, versus 1.8 percent in people stopping a placebo
- Nausea: 4.1 percent versus 1.5 percent
- Vertigo: 2.7 percent versus 0.4 percent
- Nervousness: 3 percent versus 0.8 percent
The authors wrote that these symptoms were more likely to reflect depression symptoms coming back, rather than symptoms of medication withdrawal.
Moncrieff also takes issue with that finding, saying that “this conclusion was based on a small number of studies” and wasn’t systematically measured, but rather gathered from the reports of individual doctors or patients. She says that it means the data likely isn’t reliable.
On average, compared with those stopping a placebo, people stopping antidepressants reported just one additional withdrawal symptom, a difference that falls below the threshold for clinical significance, which was determined to be experiencing four or more symptoms, the authors wrote.
In this case, clinically significant refers to a person having noticeable symptoms that would impact their well-being, ability, or daily life.
Moncrieff also points out that the “clinically significant” cutoff of having four or more symptoms isn’t a universally agreed on definition.
The authors do acknowledge that the majority of the studies were short-term and only followed people up to two weeks after discontinuing the medication (though they say that’s the period one would expect most withdrawal symptoms to occur), which limits long-term conclusions.
Does the New Review Put Concerns Over Antidepressant Withdrawal to Rest?
Gerard Sanacora, PhD, MD, a professor of psychiatry at Yale School of Medicine, in New Haven, Connecticut, who was not involved in the study, says that the new review findings were “consistent with what we see clinically” among people taking antidepressants on a short-term basis.
“These symptoms are real, but they’re not as dramatic or dangerous as they’re sometimes portrayed,” says Dr. Sanacora. “The data provides valuable context for conversations with patients. It shows that withdrawal is possible, but in most cases, it’s limited and manageable.”
Sanacora says that it’s not clear whether the study findings would apply to people who have taken antidepressants for a longer time. Placebo-controlled studies on longer-term use and discontinuation just aren’t available, he says.
And it’s hard to compare what people might experience or report in the “real world,” because there’s no placebo control there either, Sanacora adds.
What You Feel vs. What You Expect to Feel
Just as believing that a treatment will help can improve outcomes (the placebo effect), expecting problems can make people more likely to feel worse.
“How we talk about these issues really matters,” says Sanacora. “It’s a balance between giving patients the information we have to set reasonable expectations, but also not putting it in their head that they’re going to have a really hard time,” he says.
Sanacora believes that the study offers a valuable tool to help guide these conversations. “It’s not about downplaying people’s experiences. It’s about giving them accurate, balanced information,” he says.
What You Should Know if You’re Thinking About Stopping Your Antidepressant
“There’s no one-size-fits-all approach,” says Sanacora. “Some medications carry more risk of withdrawal than others, and some people are more sensitive to changes.”
The findings should not be interpreted to mean that stopping your antidepressant is no big deal or that it can be managed on your own. “You should talk with your doctor if you want to stop your medication, and you can decide together how to discontinue your antidepressant to minimize the risk of withdrawal symptoms or a relapse of your depression,” Sanacora says.