A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based?
Level 1 - systematic review of randomized trials
systematic review of 24 studies
PubMed 30292574 · doi:10.1016/j.addbeh.2018.08.027
What was done
A systematic literature review of 24 studies with diverse methodologies and sample sizes was conducted to assess the incidence, severity, and duration of antidepressant withdrawal reactions. The review evaluated whether empirical data support clinical guidance from the UK National Institute for Health and Care Excellence (NICE) and the American Psychiatric Association (APA), which state that antidepressant withdrawal reactions typically resolve within 1 to 2 weeks.
What was found
Across 14 studies reporting incidence, withdrawal rates ranged from 27% to 86%, with a weighted average of 56%. In four large studies evaluating severity, a weighted average of 46% of individuals experiencing withdrawal endorsed the most extreme severity rating on offer. Out of ten studies reporting duration data, seven found that a significant proportion of patients experienced withdrawal for more than two weeks, with symptoms lasting several months not uncommon. The four studies calculating mean duration reported values of 5 days, 10 days, 43 days, and 79 weeks across heterogeneous populations.
Why it matters
Current major clinical practice guidelines understate the frequency, severity, and duration of antidepressant withdrawal symptoms. Updating these guidelines is critical to prevent misdiagnosis of withdrawal as relapse, prevent unnecessary long-term prescribing, and ensure patients receive accurate informed consent.
Limits
The included studies possessed diverse methodologies, variable sample sizes, and substantial population heterogeneity. Only four studies calculated mean duration, and only four large studies evaluated symptom severity. Specific antidepressant drug classes, tapering protocols, and baseline patient characteristics were not reported in the abstract.
Cited by
- supports SSRIs have a side effect rate of approximately 50% and a withdrawal/discontinuation effect rate of approximately 50%.