Antidepressant discontinuation on the rise with patients presenting with discontinuation symptoms: Lancet

Antidepressant discontinuation symptoms have become a significant concern in clinical practice, but their incidence has been unclear, until now. A recent study published in The Lancet Psychiatry quantified these symptoms which providing critical insights to navigate the discontinuation of antidepressant treatments.

The research underwent a thorough investigation by systematically searching major medical databases including Medline, EMBASE and CENTRAL from their inception until October 13, 2022. The focus was on randomized controlled trials (RCTs), other controlled trials and observational studies that assessed the incidence of antidepressant discontinuation symptoms. The studies included needed to involve the cessation or tapering of an established antidepressant drug or placebo in participants with various mental, behavioral or neurodevelopmental disorders. Also, studies involving neonates or those using antidepressants for physical conditions like pain syndromes due to organic disease were excluded.

From an initial pool of 6095 articles, 79 studies were selected that encompassed a total of 21,002 patients. The demographic breakdown of the participants was 72% female and 28% male with a mean age of 45 years. The ethnicity data was not consistently reported across the studies.

Out of these, a total of 16,532 patients had discontinued antidepressants and 4470 patients had discontinued placebos. The results revealed that the incidence of at least one antidepressant discontinuation symptom was 31% (95% CI 27–35%) in the participants discontinuing antidepressants when compared to 17% (14 - 21%) in the participants discontinuing placebos. This equates to an incidence difference of 8% between the two groups. When it came to severe symptoms, the incidence after discontinuing antidepressants was 2.8% (1.4–5.7%), while it was 0.6% (0.2–1.3%) for the patients discontinuing placebos.

The study highlighted that certain medications associated with higher frequencies and severities of discontinuation symptoms. Desvenlafaxine, venlafaxine, imipramine and escitalopram were observed for higher frequencies, while imipramine, paroxetine and either desvenlafaxine or venlafaxine were linked to more severe symptoms. These findings suggest that the type of antidepressant can significantly influence the likelihood and intensity of discontinuation symptoms.

The study concluded that approximately 15% of patients discontinuing antidepressants may experience discontinuation symptoms after considering non-specific effects evidenced in placebo groups that affected roughly one in six to seven patients. This information is critical to consider during the discontinuation process that can ensure being prepared for potential symptoms without causing undue alarm. This comprehensive analysis offers a clearer picture of the prevalence of antidepressant discontinuation symptoms by providing valuable guidance for both clinicians and patients in managing the discontinuation of antidepressant treatments.

Source:

Henssler, J., Schmidt, Y., Schmidt, U., Schwarzer, G., Bschor, T., & Baethge, C. (2024). Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis. In The Lancet Psychiatry. Elsevier BV. https://doi.org/10.1016/s2215-0366(24)00133-0