Antidepressant withdrawal: 5 non-physical effects clinicians shouldn’t forget

“Our knowledge of the impacts of antidepressant withdrawal, beyond physical side effects, is limited.” With this observation, researchers from the Universities of Bath and Bristol, in the U.K. begin a study, recently published in the journal Health Expectations.Their goal: to study the experiences and perspectives of patients taking antidepressants and how withdrawal affected their daily lives.The researchers note, “withdrawal effects are experienced by more than half of people who try to stop taking antidepressants,” whether the effects are short- or long-lasting, mild or more pronounced. “One systematic review even found that 46% of people withdrawing from antidepressants considered their symptoms extremely severe, with a considerable number of people experiencing these symptoms for more than two weeks, and in some cases several months.” This sheds light on why some patients continue to take their antidepressants even after recovering from depression.“The patient-general practitioner relationship plays a crucial role” in withdrawal.Stopping antidepressants causes more cases of withdrawal symptoms than any other medication.But even though the difficulty of withdrawal is well documented, especially its physical effects, patients feel many of their symptoms are not sufficiently recognized, understood or managed by their doctors, the researchers found. However, “the patient-general practitioner relationship plays a crucial role in patients’ decision to continue or stop antidepressants,” they point out.They collecting the weaning experiences of 20 patients, via semi-structured interviews carried out between June 2022 and February 2023. After announcing the study on the authors' social networks, on the Bath campus and among research students, participants were selected based on several criteria: being aged 18 to 65, having already been diagnosed with depression and have taken a selective serotonin reuptake inhibitor (SSRI) to treat depression for more than six months.In addition, their withdrawal must have been less than a year old and lasted less than a month. At the time of the interviews about their most recent withdrawal attempt, participants were still taking anti-depressants (11 of 20) or had successfully stopped them—so none were in the process of withdrawal. While seven out of 10 respondents said they had gradually reduced their antidepressant intake at the time of weaning, 13 participants had moderate to severe depression up to a year after their quit attempt.Many consequences on emotional health and human relationshipsAmong the reasons that pushed participants to stop their treatment—in addition to physical side effects (such as sexual dysfunction)—they often mentioned the effects on their personal relationships. Then came the fear of becoming dependent on antidepressants, the alteration of their emotions and the difficulty in obtaining their medications which led to non-compliance.In total, the authors identified five main themes following these interviews:1. The double-edged emotional and cognitive impact After stopping treatment, patients were happy to feel more emotions, although some reported feeling overwhelmed by the intensity of them. Furthermore, patients have seen memories resurface that they thought had been erased. Although negative thoughts and difficulty concentrating were common, several participants noted an increase in positive thoughts. “It was a little unstable and things upset me more easily than before;” “I would say I thought very negatively. So, for example, with my doctoral work, I had a complete crisis of confidence and I thought that not everyone knew what I was doing,” the participants explain, for example.2. The negative impact on social relationsMore than half of the patients reported the deterioration of their intimate relationships due to their inability to regulate their emotions, with some sometimes preferring to hide withdrawal from those close to them. One even admitted to having been “so sensitive and irritable that it became more frightening for [his family] to deal with [him].” Some relatives have also said that they would prefer that the patients resume their treatment.Participants also said they felt more detached and less empathetic and tended to withdraw, making social situations seem "laborious."3. Impacts on physical health According to the testimonies collected, the authors identified both positive and negative consequences on overall physical health. For example, many patients chose to turn to exercise to manage the negative effects of withdrawal, and adopted better eating habits after regaining their appetite. “Every time I tried to stop [the antidepressants], I lost weight and every time I started again, my appetite was never satisfied. I never feel full when I'm on medication. Today, I am much better and I feel full when I have a meal,” explained one of them.However, “all participants reported experiencing physical side effects during withdrawal” that disrupted their social life, such as “fatigue and nausea, sleep problems including nightmares, night sweats and vivid dreams, diarrhea, akathisia (difficulty staying still), vomiting, brain zaps and electrical sensations, sweating, ringing in the ears, headaches, dizziness and joint pain.4. The importance of support from medical and family circles Overall, patients report a lack of support and understanding from those around them, leading to “a feeling of rejection and being misunderstood,” say the authors. “I lost a lot of my friends. And the friends I had, I wasn't very enthusiastic because they didn't really understand my withdrawal problems,” confided one of the participants, for example. Conversely, patients felt real support when their loved ones were already aware of or themselves concerned about mental health problems.But family support is not the only essential during these periods of withdrawal: health professionals have their role to play. “Participants felt that although GPs were overall 'kind and supportive,' their involvement was minimal during withdrawal,” the authors wrote. Comments supported by this testimony: “So I consulted six doctors and I would say that only one in six recognized that antidepressants could cause withdrawal symptoms.”Patients are now demanding more awareness, involvement and emotional support from health professionals, as well as better availability of resources to manage withdrawal as best as possible.5. The importance of tapering treatment gradually and flexibly Timing is essential for weaning: the majority of participants agreed on this point. Choose the right time, and don't rush. The negative and positive effects of withdrawal appeared at different times depending on the patients, immediate for some and late for others. But all affirm that medical support is essential to gradually stop taking antidepressants. “Weaning without supervision was definitely a mistake,” said one of the patients.Thus, “the lived experience of withdrawal has a significant impact on the well-being of individuals,” conclude the authors of the study. In other words, the consequences of withdrawal are not only physical, but indeed psychological, with repercussions on emotional and social life understood differently by each patient.“When discussing withdrawal, GPs should explain to patients the difficulties they are likely to experience emotionally, socially and cognitively, in addition to the physical withdrawal symptoms which may persist for months,” the authors conclude. authors.This article was translated from its original French and was first published in our sister publication Profession Santé.

Antidepressant withdrawal: 5 non-physical effects clinicians shouldn’t forget

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