In a new article published in the Journal of Clinical Psychiatry, Nicholas Waldvogel and Alan Akira present a case study of antidepressant withdrawal leading to a suicide attempt.
The authors state that although “antidepressant discontinuation syndrome” (ADS) (also, and perhaps more accurately, known as antidepressant withdrawal) has been linked to suicidal ideation, no suicide attempt had been reported in the academic literature until the publication of the present work. While the suicide attempt examined here likely had several intertwined causes, the authors argue that antidepressant withdrawal contributed and may have played a central role. They write:
“As the pathophysiology of ADS remains undefined, we cannot draw definite conclusions and deny a multifactorial etiology. This case highlights the importance of close monitoring and suicidality screening while tapering antidepressants and carefully understanding the context of a suicide attempt to determine the likely etiology. “
As the chemical imbalance theory of depression has been debunked, the use of antidepressants to correct that fabled imbalance has come under increased scrutiny. Research has shown that antidepressants show no clinically significant difference from placebo in treating depression. The clinically insignificant treatment effect of antidepressants likely only applies to 15% of the population, meaning 85% of people prescribed antidepressants are exposed to the risks with no hope of benefit.
One study found that antidepressants do not improve the quality of life in users. Another piece of research found that antidepressants worsened long-term outcomes for sufferers of depression. Antidepressants pose health risks to babies when exposed during pregnancy, may blunt our ability to feel empathy, and can lead to sexual dysfunction.
Multiple studies have linked antidepressants to increased suicide risk, with one reporting that using antidepressant drugs more than doubles the risk of suicide. These drugs have also been linked to increased instances of violence. Overall, suicide rates did not decrease with the advent of antidepressants. However, suicide rates have risen as the use of antidepressant drugs has become more common.
Likely, antidepressants do not prevent suicide. Moreover, due to the lack of evidence of efficacy in treating depression, and the numerous ill effects linked to antidepressant use, some researchers have even declared that antidepressants should not be used to treat depressive disorders in adults.
A meta-analysis found that antidepressants are ineffective for children and adolescents. In addition, these drugs are linked to increased suicide risk and more attempts at self-harm in children. However, that did not stop psy-professionals from increasing antidepressant prescriptions for children by 41% between 2015 and 2022.
Past research has likely misclassified symptoms of antidepressant withdrawal as a relapse of the initial depression. Another study indicated that antidepressant withdrawal is frequently mislabeled as medically unexplained symptoms, functional neurological disorder, and bodily distress syndrome.
Research has shown that stopping antidepressants can have dangerous long-term effects, with the safest method being very slow tapering of these medications.
The current work presents a case study of a 22-year female previously diagnosed with major depressive disorder, generalized anxiety disorder, alcohol use disorder, and anorexia nervosa. Seven days after stopping her antidepressant, which she had used for two years, she was admitted to an emergency room after taking half a bottle of acetaminophen with alcohol in a suicide attempt.
She reported no suicidal ideation before withdrawing from antidepressants. 4 days after her withdrawal, she began to experience intermittent dizziness, muscle aches and pains, and the sensation of electric shocks. She also reported fatigue, anhedonia, loss of appetite, and suicidal ideation during her stay in the emergency room.
She was admitted to a voluntary inpatient treatment facility where antidepressants were given. After four days, her depressive and ADS symptoms had subsided, and she was discharged from the inpatient facility with a new prescription for antidepressants.
The authors note that ADS is typically linked with antidepressants with a short half-life. However, in the current case study, ADS was observed in a patient taking an antidepressant with a longer half-life. The authors conclude that the risk of ADS is not binary, with some antidepressants posing a risk while others are safe. Instead, the danger of ADS lies on a spectrum. Given individual differences in metabolizing antidepressants, the authors report that all antidepressant medications could cause ADS.
The authors then point to this case study as exemplifying the difficulty in pinpointing the causes of suicidality. While diagnostic criteria may be helpful to some extent, there are no diagnoses for ADS or suicide. So diagnoses are greatly limited in their ability to predict and trace the causes of suicidal behavior.
In the current case, substance-induced depressive disorder was considered as a possible cause of the suicide attempt. However, the patient reported that her alcohol use was unchanged. It is also possible that chronic alcohol use, as well as ADS, contributed to her suicide attempt. As these threads are impossible to tease apart, the authors state that they cannot rule out multiple causes for her suicide attempt.
They conclude that suicide is difficult to predict and causes are mysterious, so anyone considering withdrawal from antidepressants should do so while under close monitoring.
Waldvogel, N., & Akira, A. (2022). Antidepressant discontinuation syndrome resulting in a suicide attempt. The Journal of Clinical Psychiatry, 83(6). https://doi.org/10.4088/jcp.22cr14562 (Link)