Guidelines Underestimate Antidepressant Withdrawal Effects

Dr. Mark Gold’s Research You Can Use

Woman struggling with grief and antidepressant withdrawalThe systematic review, conducted by the All-Party Parliamentary Group for Prescribed Drug Dependence, reported that half of the patients discontinuing antidepressants experienced antidepressant withdrawal symptoms and one fourth have symptoms which they report as severe.

The literature review was undertaken to ascertain the incidence, severity, and duration of antidepressant withdrawal reactions.

The rising use of antidepressants

According to a report from the US Centers for Disease Control and Prevention, by 2014, about one in eight Americans over the age of 12 had reported recent antidepressant use. Women were found to be twice more likely as men to be taking the antidepressant medications.

Antidepressants are widely prescribed by Psychiatrists, but also by internists, family physicians, OB-GYNs and most prescribers for depression and anxiety but also, an array of other symptoms or conditions. They are also prescribed to patients with obsessive-compulsive disorder and eating disorders such as bulimia, anorexia and binge eating. Some argue that this is not over-prescription but could merely be a sign of decreasing mental health stigma where more people feel at ease to reach out for help against depression and anxiety.

This is, of course, not to negate the fact that life, in general, has become a lot more stressful and more people are diagnosed with depression. With the dramatic surge in the use of social media, people have paradoxically become more isolated and insecure. Over the years, direct-to-consumer advertising and increased willingness to prescribe antidepressants, combined to increase prescriptions.

Also important was the invention and approval of SSRIs which can be given safely without the kind of supervision, testing or blood levels for the older antidepressants. Lastly, antidepressant pills are seen as faster and easier than CBT or other behavioral change-therapy by many.

What was even more troubling was the fact that one-fourth of the 14,000 Americans surveyed who had reported the use of antidepressants in the previous month had been taking the medication for a decade or even more.

The systematic literature review

Published in the Journal of Addictive Behaviors, the review pointed out that the notion of SSRI safety may have neglected how millions of people experienced adverse side-effects trying to cut down or stop using antidepressants. Hence, it is all the more imperative for healthcare practitioners to properly warn the patients even though the provided guidelines say that symptoms are typically mild and fade away within a week.

Lady Sitting on a BenchThe review authors, Dr. James Davies from the University of Roehampton and Prof John Read, from the University of East London, report that about four million people in England may experience symptoms upon withdrawal from antidepressants, and approximately 1.8 million may experience these with greater severity. These symptoms might include anxiety, sleep problems, and hallucinations.

Each antidepressant is accompanied by its potential to cause certain side effects, and these fluctuate from drug to drug. The complex part about this is that even though some side effects are relatively common, many of them are unusual and everyone’s experience varies.

The antidepressant withdrawal literature review results

Twenty-four pieces of research were assessed, with diverse methodologies and sample sizes, including more than 5000 patients.

Fourteen studies depicted withdrawal incidence rates ranging from 27 percent to 86 percent with a weighted average of 56 percent. This meant that more than half of the patients who tried to come off antidepressants experienced withdrawal effects.

Four large studies of severity birthed a weighted average of 46 percent of patients experiencing antidepressant withdrawal effects affirming the most extreme severity rating.

Seven of the ten more diverse studies supplying data on duration of withdrawal symptoms highlighted contradictions against the UK and USA withdrawal guidelines. This was particularly regarding how a significant proportion of people who experience withdrawal did so for more than two weeks and even more troubling was the fact that it was not uncommon for patients to continue to suffer through withdrawal for several months.

The review concluded that the current UK and USA guidelines significantly underestimated the severity and duration of antidepressant withdrawal, with significant clinical implications.

African American Woman with Hat“This new review of the research reveals what many patients have known for years – that withdrawal from antidepressants often causes severe, debilitating symptoms which can last for weeks, months or longer,” said Dr. Davies.

“Existing NICE [National Institute for Clinical Excellence] guidelines fail to acknowledge how common withdrawal is and wrongly suggest that it usually resolves within one week.”

Dr. Davies further continued, “This leads many doctors to misdiagnose withdrawal symptoms, often as relapse, resulting in much unnecessary and harmful long-term prescribing.”

Looking forward

Public Health England has decided to include this review as part of its roundup into prescribed drug dependence, and NICE has been gathering additional evidence to update its advice.

“Antidepressants are an effective, evidence-based treatment for moderate to severe depression, and are a life-saver for many people. But not enough research has been done into what happens when you stop taking them,” said Professor Wendy Burn, President of the Royal College of Psychiatrists. “As this review shows, for many people, the withdrawal effects can be severe, particularly when antidepressants are stopped abruptly.”

“It’s good to see more of a focus on this. We are pleased that Public Health England is prioritizing dependence on, and withdrawal from, prescribed medicines as an area of review and welcome NHS England’s referral to the National Institute for Clinical Excellence (NICE) asking that they do the same.”



About the Author:

Mark GoldMark S. Gold, M.D.  served as Professor, the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry from 1990-2014.

Dr. Gold was the first Faculty from the College of Medicine to be selected as a University-wide Distinguished Alumni Professor and served as the 17th University of Florida’s Distinguished Alumni Professor.
Learn more about Mark S. Gold, MD

About the Transcript Editor:

Sana Ahmed photoA journalist and social media savvy content writer with extensive research, print and on-air interview skills, Sana Ahmed has previously worked as staff writer for a renowned rehabilitation institute, a content writer for a marketing agency, an editor for a business magazine and been an on-air news broadcaster.

Sana graduated with a Bachelors in Economics and Management from London School of Economics and began a career of research and writing right after. Her recent work has largely been focused upon mental health and addiction recovery.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on November 30, 2018.
Reviewed & Approved on November 30, 2018, by Jacquelyn Ekern MS, LPC

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