“Today, the existence of symptoms emerging after antidepressant discontinuation or dose-reduction is no longer questioned,” write Jonathan Henssler and colleagues at Cologne, Berlin, Freiburg, and Dresden universities, in the latest issue of Lancet Psychiatry.
That would be an outcome worth celebrating. Unfortunately, as the researchers acknowledge, “Medical professionals continue to hold polarized positions on the incidence and severity of antidepressant discontinuation symptoms, and the debate continues in public media.”
Since the late 1980s, when SSRI and SNRI antidepressants were first licensed, argument and controversy has flared over how the condition is described, how long it can last, how severe it may get, how prevalent it is, and why it’s taken several decades of prescribing to answer such fundamental questions.
In an attempt to address the problem, Henssler and colleagues set about quantifying the incidence of antidepressant discontinuation symptoms and their average duration. They hoped to reassure clinicians and prescribers that their findings don’t cause “undue alarm.”
Unfortunately, they still do. While their meta-analysis yields important information about withdrawal symptoms, it is mostly based on short-term industry-funded studies that routinely downplay severity and, by definition, can’t assess longer-term outcomes—the precise factor necessary to quantify longer-term prevalence.
Henssler and colleagues looked at randomized controlled trials (RCTs), other controlled trials, and observational studies assessing the incidence rate of antidepressant discontinuation symptoms—also known as antidepressant withdrawal, antidepressant withdrawal syndrome, and protracted withdrawal syndrome (PWS or PAWS). Of the 6,095 articles screened, 79 studies (44 RCTs and 35 observational studies) covered 21,002 patients (72% female, 28% male, with a mean age of 45 years).
Of these, 16,532 patients had discontinued from an antidepressant, whereas the remaining 4,470 had discontinued from a placebo. The second group helps measure a nocebo effect among unmedicated patients, separating........