WITHDRAWAL EFFECTS FROM ANTIDEPRESSANTS

According to the National Center for Health Statistics, 11% of adults age 20-59 have used an antidepressant within the last 30 days. For many patients, the medication was initially prescribed to treat a short-term (6 - 9 months)  mental health episode, and yet they are still taking the antidepressant years later.

Since 2010, the number of patients in the U.S. who have been taking antidepressants for at least five years has doubled, with more than 7% of the population having taken an antidepressant for five years or more. 25 million people in the U.S. have been taking antidepressants for two years or more.

Why such an increase in usage when usually the drugs are only meant to be taken for the short term? Many patients have tried stopping them, only to experience uncomfortable or even unbearable side effects. In New Zealand, three-fourths of patients surveyed said that withdrawal symptoms are the reason they haven't stopped taking their antidepressants.

Clearly, research needs to be done on long-term effects of taking antidepressants along with research on the best way to discontinue them. There is little incentive for a drug company to do either kind of research, however.

A 2017 New York Times research story on the topic put it this way: "Some scientists long ago anticipated that a few patients might experience withdrawal symptoms if they tried to stop — they called it "discontinuation syndrome." Withdrawal has never been a focus of drug makers or government regulators, who felt antidepressants could not be addictive and did far more good than harm."

Contrary to predictions made more than twenty-five years ago, when the first SSRI antidepressant Prozac was introduced, it is more than just a small number of patients experiencing these symptoms. Withdrawal symptoms appear to be the norm rather than the exception.

Recently, a research team from University of Wisconsin conducted a text mining project to classify the side effects of antidepressants, including a separate classification of withdrawal side effects. They used a sampling of AskaPatient postings and assigned medical terminology to the side effects mentioned by patients.

They also divided the withdrawal side effects into four categories: physiological, psychological, cognitive, and social impact. Not surprisingly, physiological and psychological were the most common types of withdrawal effects reported. Also, for each category, SNRIs (Cymbalta and Effexor XR) had about two or three times as many reports of withdrawal side effects than did the SSRIs (Lexapro and Zoloft). Here are the most common withdrawal effects identified:

Chart by AskaPatient.com, June 23, 2019
Source: PsyTar Corpus of Adverse Drug Events, Zolnoori et. Al; based on patient-reported data samples for SSRI (Lexapro and Zoloft) and SNRI (Cymbalta and Effexor XR) antidepressants from AskaPatient database. Report numbers correspond to the number of times the withdrawal effect was reported in the database out of 891 total review posts, with approximately the same number of posts for each of the four drugs. Effects are listed in descending order of frequency for each of the four withdrawal effect types.
SSRI = Selective Serotonin Reuptake Inhibitor
SNRI = Serotonin Norepinephrine Reuptake Inhibitor

Sources and More Reading:
-- "We Need More Research Into Antidepressant Withdrawal" by David M. Perry, April 15, 2019:  Pacific Standard  'Getting off my antidepressant was hell. I'm not alone - and the pharmaceutical industry isn't helping.'

--"Many people taking antidepressants discover that they can't quit" by Benedict Carey and Robert Gebeloff, April 7, 2018: New York Times. Profiles a patient who took nine months to wean off of Zoloft in order to get back to school and routine. A look at withdrawal effects and long-term use of antidepressants.

--"Prescription Drug Use in the U.S.: 2015-2016" by National Center for Health Statistics. Provides statistics on prescription drug use, including antidepressants. NCHS Data Set.

-- A  Health and Social Care Information Centre (HSCIC) study reports that  prescription rates have doubled over the past decade in Britain, where health officials recently began a nationwide review of prescription drug dependence and withdrawal. Prescriptions Dispensed in the Community 2005-2015

-- Zolnoori, M., Fung, K. W., Patrick, T. B., Fontelo, P., Kharrazi, H., Faiola, A.,Hamideh, M. (in press). "A systematic approach for developing a corpus of patient reported adverse drug events: A case study for SSRI and SNRI medications", Journal of Biomedical Informatics. " University of WI study and corpus on the AskaPatient site used for the withdrawal effects charts. 

-- A National Center for Integrative and Complementary Health (NCICH) roundup of research suggests that there is not enough consistent data to support the use of acupuncture for substance use outcomes; however, there are some findings that suggest acupuncture may have positive effects as an adjunctive therapy for withdrawal/craving and anxiety symptoms. Some have found success with "auricular" (ear) acupuncture for reducing withdrawal symptoms.
https://www.nccih.nih.gov/health/providers/digest/mind-and-body-approaches-for-substance-use-disorders-science

-- UMC Utrecht Brain Centre, Netherlands research has shown that the use of tapering strips, which involve a personalized approach to reducing doses of medication over time, can greatly decrease antidepressant withdrawal effects.
https://pubmed.ncbi.nlm.nih.gov/34471516/