Systematic Review Finds Antidepressant Withdrawal Common and Potentially Long-lasting

Prominent researchers conduct a review of antidepressant withdrawal incidence, duration, and severity. Results lead to call for new clinical guidelines.

Zenobia Morrill
27
1747

New research by Dr. James Davies and Dr. John Read compares the results of a systematic review of the incidence, duration, and severity of antidepressant withdrawal with current clinical guidelines in the US and the UK. The researchers found that more than half of antidepressant users experienced withdrawal and that, in nearly half of these cases, effects were severe. Their results contradict existing clinical guidelines, which regularly claim that antidepressant withdrawal is typically mild and short-lived.

When asked about his perspective on the current guidelines, Read responded:

“I think there hasn’t been very much research on this issue, which is a real shame, until relatively recently. We are confident that now we know the real figures and we have looked at about 17 studies on the prevalence of withdrawal symptoms.”

“This is particularly important because at the moment, people aren’t being told about withdrawal effects. A lot of people would choose not to have them once they know the seriousness and the potential of those effects. Equally important, people who are trying to come off are not getting any support. In fact, they are told very often that these are not withdrawal symptoms, these are the symptoms of their illness returning.”

Photo Credit: “Cloudy Mind,” by Ross Hendrick (Flickr)

Davies and Read began their article by reviewing the increasing prevalence of antidepressant (AD) usage and duration in the UK and the US. ADs are the most commonly used class of drug in both regions. Data demonstrate that over seven million people in England are on ADs and this number is over 37 million adults in the US.

These figures are rising alongside an increase in the duration at which people are taking ADs. In the UK, research suggests that AD users are increasingly taking the pills for longer than two years. In the US, it is becoming more common for users to take antidepressants for more than five years. Davies and Read report that, in both regions, the duration of use has more than doubled since the early 2000s.

Long-term usage may be particularly concerning because the current research evidence does not support the extended use of ADs in a significant portion of these cases. On this issue, Davies and Read write:

“Previous research on long-term use has estimated that a third of people in the U.K. who take ADs for more than two years have no evidence-based clinical indications for continuing to take them.”

“If we apply the percentages of such non-indicated prescribing to today’s long-term use figures, we could estimate that approximately 1.2 million long-term AD users in England, and 6 million users in the U.S., could be taking ADs without clinical indication and could therefore try withdrawing.”

The rising numbers of people taking antidepressants long-term with a clinical indication suggests that a large percentage of the population may consider tapering or withdrawing from their medication. With this in mind, the researchers explore what kinds of experiences might be expected when withdrawing from ADs.

Previous research finds that a large proportion of users experience withdrawal effects and that the severity and duration of these effects can vary. According to the authors’ research, the following effects of AD withdrawal have been reported in the literature:

  • Increased anxiety
  • Flu-like symptoms
  • Insomnia
  • Nausea, dizziness, and imbalance
  • Sensory disturbances
  • Hyperarousal
  • Electric shock-like sensations
  • “Brain zaps”
  • Diarrhea
  • Headaches
  • Muscle spasms and tremors
  • Agitation and irritability
  • Hallucinations
  • Confusion
  • Malaise
  • Sweating
  • Mania and hypomania
  • Emotional blunting and inability to cry
  • Long-term or even permanent sexual dysfunction

Read explains that these withdrawal effects “can be very severe and people need some help with them.” Going further, he explains that some people can experience “extreme” and “incapacitating” levels of anxiety. Others report the experience of “brain zaps,” which are akin to “an electric shock shooting across the head.” “Insomnia is another big one,” Read says, “and when you’re not doing very well in the first place, not being able to sleep is very disturbing.”

However, current clinical guidelines in the US and the UK indicate that withdrawal reactions tend to be mild and “typically resolve without specific treatment over 1-2 weeks” (APA, 2010, p. 39). In their report, Davies and Read evaluate the accuracy and helpfulness of these guidelines.

The review includes 17 studies. The research drew from different study methodologies to examine AD withdrawal incidence, severity, and duration.

Davies and Read found that more than half (56%) of AD users experienced withdrawal effects. The majority of these experiences were reported as moderate or severe, with nearly half (46%) described as severe. Additionally, 40% of individuals who experienced withdrawal had effects lasting at least six weeks, and 25% had effects lasting 12 weeks or more. Davies and Read comment on these results:

“These findings differ significantly from those implied in both the U.K. (NICE, 2009) and U.S. guidelines (APA, 2010) on AD withdrawal. Furthermore, these findings are not alone in contradicting current guidelines.”

The results of this systematic review provide essential details on the withdrawal effects of ADs. The analysis may also invite further questions about whether the benefits of ADs genuinely outweigh the costs when adverse effects and withdrawal experiences are considered.

It is common, however, for providers to misinterpret AD withdrawal effects as the reemergence of depressive symptoms or depression relapse, Read explains. He notes that individuals withdrawing ought to receive the support of their General Practitioners (GPs):

“People can get off, but they need to do it slowly and carefully, and they need the support of their GPs.”

Finding supportive GPs will be made “far more likely to happen once we get the guidelines changed,” Read explains. Then, “the GPs will understand that these are indeed withdrawal symptoms that people need help with and not the return of their illness.”

Read reports that the Royal College of Psychiatry has welcomed the review on AD withdrawal and that the NICE guidelines are currently being reviewed for an update, adding:

“We’re very confident this is going to be a positive outcome for everybody.”

 

**

 

Millions of Britons who use antidepressants face issues with withdrawal when they try and come off the drugs, and for nearly half of them, the symptoms are severe. That’s the findings of a new review, which contradicts the current clinical guidelines that suggest the symptoms are mild and last just about a week. http://prescribeddrug.org/wp-content/uploads/2018/10/Davies-Read.pdf

 

****

Davies, J., & Read, J. (2018). A systematic review into the incidence, severity, and duration of antidepressant withdrawal effects: Are guidelines evidence-based?. Addictive Behaviors. (Link)

27 COMMENTS

  1. People need to have a method of compensation for having their lives destroyed by all this, never mind new NICE guidlines on these drugs…people have died and have been through utter hell and prolonged hell. Professional people have little chance of getting back to their career. The GP’s know full well what they have done, no excuse for them. Sorry but don’t go near a GP, never get out of the boat. GP is pharma drug pusher in business. THE way to come off SSRI’s is by using liquid titration. Get a pill crusher from Amazon/ebay where ever, dissolve in warm water and then use a syringe to pull out small amounts between say 1ml to 3ml throw that away and take, hold on that for one to two weeks and then progress to 2ml/6ml. The exact amounts depends upon how you react, so that is the basic principle….slow, small amounts in a controlled way. I came off 14 of these vile drugs like this… it works.

    https://www.youtube.com/watch?v=_4dFDBYWuTc

    BTW breaking news…the GMC’s response to all this is to hire a these people:

    http://www.icecreates.com/

    ‘make better happen.’ HA ! Really with what… marketing…. a new sales pitch

    It’s very simple GMC, and not marketing, the ‘doctors’ need to be tried and convicted of drug abuse, especially the psychiatrists beause they force the drugs… major human rights abuse in the context of toxic psychosis/akathisia, prolonged QT interval and all the other multiple harms ! What you do is get un-named doctors to ‘investigate’ (sorry but investigate… that is laughable) ‘doctors’. So long as you have ‘doctors’ ‘investigating’ ‘doctors’ and a system predicated on drug profits we will never have any reforms and you will go on protecting ‘doctors’ for profit. And you know all this.

  2. How many “reviews” does it take before the obvious truth is accepted as truth? This fact has been known for decades – why is it still being “researched?” Not criticizing the researchers here, just the fact that the psychiatric community has not yet accepted the obvious reality that so-called “antidepressants” cause dependence and withdrawal.

    • I refuse to call these SSRI drugs “antidepressants.” My only full blown manic episode was caused by Anafranil. They put me on a cocktail of 3 or 4 drugs for 23 years as punishment for my audacious drug reaction. I was pill shaming by getting sick I guess.

      I still pretend to take them around family and doctors. I also pretend to have FM since I have all the symptoms and every social function I get asked what I “do.” Once they hear I have FM they don’t ask about why I’m still single and childless. (Rural Indiana.)

      Still have a poor quality life. Can’t work–even from home. Irritable a lot which scares me though I try to be sweet and kind. Frequently I break down crying. Glad I’m alone so much.

      On the positives my heart arrhythmia is no worse. May be better. My blood sugar is normal. And I have lost 35 pounds and keep losing. At 45 I have a waist again after 25 years! Not normal but psych drugs are as abnormal as they come!

      No longer quite as depressed or suicidal all the time and I can enjoy nature and music again a year after going off the pills to “fix” my unhappiness.

  3. I don’t think mainstream psychiatrists believe that withdrawal is anything other than a rare event.

    Only 6 months ago and in the UK I was involved with a taper from a near maximum dose of an off-label antidepressant in just 3 weeks. It was as much as I could do to negotiate 4. For this particular drug that meant going from 70% reuptake to zero overnight. No talk of withdrawal at all, just the possibility of “your depression coming back”, as if it ever went away.

    • Don’t be fooled, they well know, but they also know they can get away with it, so they do. They do it quickly because they do not want you/whom ever coming off the drugs, they know full well a speedy withdrawal will have a withdrawal side effect and hence the patient has to go back on the drug …it’s all business at the expense of your/whomevers heath. Notice they are not telling people how to withdrawal correctly and there by leaving a door open for the ‘doctors’. So the drug pushers who trashed them/us ruined/killed our lives, seriously affected our families and friends are now on course for a new role in responsible ‘withdrawal’ monitoring…. really. It will be another way of of making patients dependent.

      • The incredible thing was that I was having to negotiate with them to slow the whole thing down, they were in such a rush. And very insistent to review once off them because thats when you will be feeling so crap you will be needing, well, you’ve guessed it. I was made to feel wierd for just asking for a couple of weeks extra, OK I got one. Its very easy to cut the tablets. I still have no idea why they were in such a hurry. When in the immediate aftermath signs of unspecified ill health did start to emerge, out of the blue they started doing blood tests. My feeling is that they don’t know what they are doing, and I have some evidence for that in the non-guideline things they did.

          • It’s OK, if you hang around in one part of the health service long enough you get moved on. I’m not sure you actually get a choice as to whether you have to see your psychiatrist in the NHS anyway.

            On the bright side, I don’t know if I’m imagining it, but I’ve found that if you challenge them with evidence, they do seem to give in more and more. But it still feels like that kind of relationship – they want to do something with you and if you don’t like it, you have to resist – and that feels like a real battle. I was in a meeting once with all the MH people and I heard the psych say to himself “ah, now I know what I am going to do”. That sums it up really.

  4. Just my 2 cents: I was prescribed an SSRI antidepressant some years ago by a psychiatrist. Her argument was that since I had been on an antipsychotic for so many years, that there was a chance I might become depressed. So it was prescribed as a preventative measure. Luckily for me, I stopped after a month, the main symptoms after withdrawal were the so-called brain zaps. If I had followed her advice, I would still be taking them now.

    From this experience, and others, I believe most of these psychiatrists honestly have no idea what these chemicals do. What they are taught and indoctrinated with seems to me very far removed from reality.

  5. Good job by these researchers on getting it right. But here in 2018, the facts about antidepressant withdrawal shouldn’t still be “new research”. For us patients, this has been an established fact for decades.

    As patients, we can no longer simply rely on “science” or “guidelines” to make health-choices. It is clear that many researcher/corporations have a vested interest in over-reporting the efficacy and under-reporting the safety of their products. They have conflated “science” with “marketing” as a means to boosting their pill sales. But the credibility of all medical Science is damaged as a result…

    But when science has failed, what is there then?

    • “But when science has failed, what is there then?

      Faith, if not in God, at least in yourself.

      I do agree, in 2018 this should NOT be “news” to the so called medical professionals. But the fact it is shows how truly blinded and pharmaceutically deluded today’s medical professionals truly are. Which does represent a failure of medical science.

      I’d like to point out one thing not mentioned by anyone else here, which is that it’s likely hundreds of thousands or millions of people have had the common symptoms of antidepressant withdrawal, or the ADRs of the antidepressants, misdiagnosed as bipolar.

      • Psychiatry made me lose faith in God.

        It sounds weird, but I felt like if I needed “meds” to keep me from doing what was wrong I must not have a soul. Ergo religion was fake and God too.

        Went through a lot of existential angst. The shrinks were lying. The drugs made me a worse person morally. This makes sense. Since when did being high all the time cause a moral reformation?

        No one at church even thinks it through. Someone needs to ask Rick Warren if the “mentally ill” have souls like real people. Wonder what the purpose driven psych drug pusher would say to that.