Clinicians shouldn’t underestimate risks of antidepressant withdrawal: study

When prescribing antidepressants, clinicians should be aware of the different risks posed by individual medications, when it comes to potential withdrawal symptoms and their severity—and should communicate these risks to their patients, advises a new study. “[W]hen balancing potential benefits and risks for each individual patient, the risk of withdrawal syndrome should not be underestimated, as used to happen with other drugs, such as opioids and benzodiazepines,” read the study, which was published in the journal Drug Safety in November. The study analyzed 31,688 reports of withdrawal syndrome associated with antidepressants, which were sourced from the World Health Organization’s (WHO) global database of adverse drug reactions. It found that reports of withdrawal syndrome from antidepressants were higher than reports of all other drugs, including buprenorphine, an opioid known for having a high potential of causing withdrawal syndrome. This comes as the prescribing and use of antidepressants are increasing worldwide. Canada is one the biggest consumers of antidepressants in the world, behind only Portugal and Iceland, as of 2021, according to Statista. The study found that four antidepressants in particular were disproportionately reported: paroxetine (Paxil), duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq). The most commonly reported symptoms of antidepressant withdrawal were dizziness (13.3% of cases), nausea (9.48%), paraesthesia (8.3%), headaches (7.35%), anxiety (5.72%), feeling abnormal (4.67%) and suicidal ideation (4.66%). While two-thirds of the reports were from women, the study found that men were more likely to experience severe withdrawal syndrome after ending antidepressant use, along with adolescents and younger adults, people who have been treated with antidepressants for more than two years, and those who also take psychotropic medications. Clinicians may need to exercise extra caution for these subgroups of patients, according to the study. The WHO defines severe withdrawal syndrome as resulting in death, hospitalization, a life-threatening event or a permanent sequelae. Of all the reports analyzed by the study, 74.4% were classified as serious. The mean duration of withdrawal symptoms was around six days for non-serious reactions and 24 days for serious reactions. The study also found that antidepressants with short half-lives were more likely to be linked to withdrawal syndrome compared with antidepressants with longer half-lives, supporting an earlier study published in January 2022 in the Journal of Affective Disorders. Medicines with short half-lives are more quickly metabolized and expelled from the body, and include all four of the antidepressants cited earlier for their disproportionate link to withdrawal syndrome: paroxetine, desvenlafaxine, duloxetine and venlafaxine. In addition to being aware of and communicative about the potential effects of withdrawal from specific antidepressants, the study advises clinicians to inform their patients of potential management strategies, “instead of mainly focusing on the relapse risk.”

Clinicians shouldn’t underestimate risks of antidepressant withdrawal: study

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