JAMA Review Finds Antidepressant Withdrawal Rarer and Milder Than Feared

Antidepressant withdrawal symptoms may be less frequent and less severe than previously believed, according to a systematic review of 49 randomised controlled trials published in JAMA Psychiatry. The analysis, led by Sameer Jauhar of Imperial College London, pooled data on roughly 17,800 patients who had been treated mainly for major depressive disorder or anxiety and then either discontinued medication, continued treatment or switched to placebo. People who stopped an antidepressant reported about one additional symptom—most often dizziness—during the first week after discontinuation compared with those on placebo or maintenance therapy. Overall, 7.5% of patients who ceased treatment experienced dizziness versus 1.8% in the placebo group; nausea, vertigo and nervousness each affected fewer than 5%. The review found no link between stopping the drugs and worsening mood or depression, and it detected no significant increases in fatigue, tremor or pain. Incidence varied by molecule: dizziness occurred in 9.4% of venlafaxine users and 17.5% of those on desvenlafaxine, while vortioxetine produced no more symptoms than placebo. The findings contrast with earlier surveys that put withdrawal rates above 30%—and, in some cases, above 50%—figures experts now say may have been inflated by self-selected online reports. Harvard Medical School psychiatrist Ashwini Nadkarni said the new evidence should reassure clinicians and patients, although longer-term studies are still needed, particularly for people who have taken antidepressants for many years.