Introduction to Antidepressant Withdrawal
In early 2023, Liana Shatova began taking low doses of an antidepressant to ease symptoms of a premenstrual disorder marked by mood swings, anxiety, and depression. At first, the difference was remarkable for her.
“I felt full of energy and could juggle multiple things at once,” said Shatova, 40, a business development manager from the Greater Boston area.
Then, after around 18 months on the medication, she started to fear she was becoming emotionally numb.
“My best friend’s mom died unexpectedly, everyone was in shock and sobbing, and I couldn’t cry at all,” said Shatova. “I just felt nothing.”
The Decision to Stop Taking Medication
When Shatova asked her doctor if she could stop taking the medication sertraline, an antidepressant better known by its brand name Zoloft, she said she was reassured that she was on the lowest prescribed dose and that coming off it wouldn’t be difficult.
Initially, all seemed well, but after a month, Shatova said she experienced her first bout of what would become chronic insomnia, followed by panic attacks. Other symptoms emerged, including night sweats, muscle and joint pain, and mood swings that left her unable to work.
She said her doctor told her that the symptoms were a relapse of her premenstrual dysphoric disorder, and suggested a different antidepressant. Shatova declined the new drug.
Antidepressants, primarily SSRIs, or selective serotonin reuptake inhibitors, are some of the most widely prescribed medications in the United States, taken by tens of millions of adults. About twice as many women as men report using an antidepressant in the past 30 days, with antidepressant use highest among women aged 60 and older, according to government data.
The Prevalence of Withdrawal Symptoms
Side effects are a key reason people choose to go off their medication, but stopping the drugs can also lead to withdrawal symptoms, research indicates. Along with the growing awareness, a deprescribing movement is building up in the field of psychiatry, aimed at helping patients reduce or stop their medications when no longer considered necessary.
In a recent large analysis published in The Lancet in November, researchers at King’s College London found that physical side effects, including quick weight gain, significantly increased heart rate or elevated blood pressure, may be more common than once thought, depending on the drug. The review analyzed results from 151 clinical trials and 17 reports from the Food and Drug Administration, involving about 30 different prescription drugs used to treat depression, anxiety, and bipolar and panic disorders.
Understanding the Physical Health Side Effects
The researchers examined the effects of antidepressants on weight, blood glucose, total cholesterol, blood pressure, and heart rate. They didn’t look at emotional changes experienced by patients such as Shatova, although the lead study author said it should be examined further in future studies.
“Not all antidepressants are built the same when it comes to their physical health side effects,” said Dr. Toby Pillinger, an academic clinical lecturer at King’s College London, who led the study. “Up until recently, we’ve approached antidepressant prescribing with a one-size-fits-all policy, and I think we need to move away from that.”
The Complexity of Withdrawal Effects
Separately, in August, psychiatry researchers in the U.K. found that serious withdrawal effects may be more common than previously suspected, especially with longer-term use, although the study was small with just 18% of participants responding to the survey. The results showed that among people who had been taking antidepressants for more than two years, 63% reported moderate or severe withdrawal effects, with a third describing withdrawal issues that lasted more than three months.
Symptoms ranged from insomnia to confusion, electric sensations, muscle cramps, agitation, mood swings, and derealisation or an alteration in the person’s perception of the world.
The Challenge of Discontinuation Symptoms
Dr. Mark Horowitz, a clinical research fellow at University College London who led the withdrawal study, said other research has found that roughly a quarter of patients experience severe symptoms when they abruptly stop taking their medications, from burning pain in the skin or limbs, balance problems, ongoing panic attacks, and sound and light sensitivity.
Abrupt cessation of antidepressants is not recommended, but research has found that withdrawal symptoms can occur even when people attempt to taper. A review of various existing studies published last year by a group of German psychiatrists concluded that as many as 1 in 3 antidepressant users will experience some kind of withdrawal symptoms, with severe symptoms occurring in 1 in 30 users.
The Need for Further Research
Dr. Joseph Goldberg, clinical professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York, said that antidepressants have long been known to cause "discontinuation symptoms," mainly nausea and dizziness, particularly if stopped abruptly.
It’s unclear why some patients have severe symptoms after stopping their medications. Some researchers, concerned by reports of antidepressant withdrawal, suggest that the underlying mechanisms are similar to those faced by people suffering from alcohol and opiate withdrawal.
The Importance of Patient Experience
“Withdrawal symptoms tell you that your brain is trying to restore a balance that it was forced to change by the presence of a drug,” said David Cohen, professor of social welfare at the University of California Los Angeles. “I think it’s the best accepted explanation for why stopping any centrally active drug, whether its antidepressants, coffee or heroin, leads to some discomfort.”
The challenge for psychiatrists is that the drugs, which are often prescribed along with therapy, do help many people, particularly in the short term. Dr. Jonathan Alpert, a psychiatry professor at Albert Einstein College of Medicine, said that anecdotes of extreme withdrawal do not reflect his own professional experience.
Conclusion
In conclusion, the issue of antidepressant withdrawal is complex and multifaceted. While some patients may experience severe symptoms when stopping their medications, others may not. Further research is needed to understand the underlying mechanisms of withdrawal and to develop effective strategies for minimizing symptoms. It is essential to approach the topic with a nuanced perspective, recognizing both the potential benefits and risks of antidepressant use.
FAQs
Q: What are the common symptoms of antidepressant withdrawal?
A: Common symptoms of antidepressant withdrawal include insomnia, anxiety, panic attacks, night sweats, muscle and joint pain, and mood swings.
Q: Can antidepressant withdrawal be severe?
A: Yes, some patients may experience severe withdrawal symptoms, including burning pain in the skin or limbs, balance problems, ongoing panic attacks, and sound and light sensitivity.
Q: How can I minimize the risk of withdrawal symptoms when stopping antidepressants?
A: It is recommended to taper off antidepressants gradually under the guidance of a healthcare professional to minimize the risk of withdrawal symptoms.
Q: Are antidepressants effective in treating depression and anxiety?
A: Yes, antidepressants can be effective in treating depression and anxiety, particularly in the short term. However, they may not be suitable for everyone, and patients should discuss the potential benefits and risks with their healthcare provider.
Q: What is the deprescribing movement in psychiatry?
A: The deprescribing movement in psychiatry aims to help patients reduce or stop their medications when no longer considered necessary, with the goal of minimizing potential side effects and promoting more targeted treatment approaches.
