Evidence urgently needed on how to safely withdraw patients from antidepressants

Approximately one in seven Australians is currently using antidepressants, but there is a major shortage of research on how to safely withdraw people from the medication, a new literature review has found.

Researchers at the Cochrane Collaboration reviewed 33 studies involving nearly 5000 participants, relating to antidepressant discontinuation.

They found that, given the very short ‘tapering’ period in which participants withdrew from the medication, most studies were unable to distinguish between a genuine relapse of depression and withdrawal from the tablets.

Even studies with a ‘slower’ withdrawal regimen period were insufficient — often capped at just four weeks. Around 30% to 50% of long‐term antidepressant prescriptions are not suitably evidence‐based.

Professor Mieke van Driel, who co-led the study, said this lack of distinction is dangerous because it may cause people to take antidepressants longer than necessary.

“Guidelines for prescribing antidepressants for someone who is being treated for their first episode of depression suggest to take tablets for six to twelve months and then reassess,” she said.

“The problem is, withdrawal symptoms from antidepressants can often mimic feelings of depression — confusing both patients and GPs.

“When the tapering period is too short — say several weeks — it becomes almost impossible to tell if the patient is experiencing temporary withdrawal, or genuinely not ready to stop the course of tablets.

“Patients might experience disturbing feelings, tell their GP they don’t feel well enough to stop the medication and get another script. This pattern can continue for years and even decades.”

Prof van Driel said long-term usage of antidepressants should be avoided wherever possible, with the medication linked to a range of adverse consequences. Weight gain, emotional numbing, sexual dysfunction, sleep disturbance and gastrointestinal bleeding are among the side effects.

“Antidepressants certainly provide relief from intense emotions. But over time these side effects — particularly numbing — can reduce quality of life for individuals. Patients have told me they miss being able to cry and express genuine emotion,” she said.

While the review does not answer the question of how to safely withdraw patients from antidepressant medication, it does highlight the need for further research in this space.

“We need other studies that take a much slower tapering approach to understand how we can take people off antidepressants in a safe and effective way, without the disturbing symptoms,” Prof van Driel said.

One key takeaway for clinicians, though, is to have upfront conversations with patients about withdrawal, from the outset.

“It’s so important to manage patients’ expectations around antidepressant usage. When you start someone on antidepressants you need to remind them that it is not a chronic medication. And this conversation should start with the very first prescription,” Prof van Driel concluded.

Image credit: ©stock.adobe.com/au/fizkes