Is it difficult to stop taking antidepressants? If we are to believe the countless scientific studies, stopping these medications remains problematic and doctors often underestimate the difficulties that this withdrawal involves for patients. However, the precise frequency of these treatment discontinuation symptoms is unknown. This meta-analysis of published data on the subject leads to a first estimate:
- 1 in 3 patients report symptoms after stopping antidepressant treatment;
- with a nevertheless surprising conclusion: half of these symptoms can be attributed to negative prejudices, this is the nocebo effect.
- On a strictly clinical level, antidepressants do not create dependence. Unlike “real” addictive substances, taking them does not encourage the body to demand higher and higher doses to maintain the same therapeutic effect.
- In real life thoughmany patients report symptoms such as dizziness, headaches, or insomnia when they stop taking these medications.
While much research has been done on these withdrawal symptoms, “the results of these studies vary, and sometimes considerably,” says one of the lead authors, Dr. Christopher Baethge, a psychiatry and psychotherapy researcher at University Hospital. from Cologne: “There have been many discussions, sometimes heated, within the medical community but also on social media, about the real prevalence and severity of these withdrawal symptoms. »
The study is based on the review of more than 6,000 research studies and, ultimately, on the meta-analysis of 79 selected studies, including both randomized placebo-controlled trials and observational studies without a control group. The meta-analysis is carried out on data from a total of 21,002 patients, 16,532 having received an antidepressant and 4,470 a placebo. The analysis provides the most robust assessment to date of the consequences of stopping antidepressant treatment:
- on average, one in 3 patients (31%) experiences symptoms after stopping antidepressant treatment;
- only half of these symptoms are actually attributable to the drug itself;
- 17% of controls, having received a placebo, reported similar “withdrawal” symptoms; this rate suggests that, in controls, symptoms either appeared by chance, independently of treatment, or were the product of a nocebo effect; The nocebo effect is often considered a reflection of the placebo effect. He explains the observation that inactive treatments can be associated with “side effects.” These effects are triggered solely by patients’ expectations – or prejudices – about these effects.
- This ultimately suggests that 1 in 6 or 7 patients experience “true withdrawal symptoms.”
- in most cases, the symptoms are mild;
- symptoms considered serious were noted in only 1 patient out of 35, or 3% of participants;
- finally, symptoms are more common after stopping treatment with imipramine, paroxetine, venlafaxine and desvenlafaxine.
The vast majority of patients taking antidepressants will therefore be able to stop their treatment without showing clinical symptoms. This means, in clinical practice, that in most cases there is no need for a long or gradual reduction process.
“It is important that all patients wishing to interrupt their treatment with antidepressants are monitored by healthcare professionals and benefit from individual support in the event of withdrawal symptoms”conclude the authors.
