A study presented last April showed that mental health problems had increased in Spain and that “up to 27% of Spaniards acknowledge that they consume anxiolytics, sleeping pills or antidepressants at least once a month.” Stress, anxiety and depression are the most prevalent disorders, according to this work, and drugs are taken to control their symptoms. However, they can have unwanted side effects, also when they are stopped.
Several scientific studies show that stopping these medications can be very problematic, and doctors often underestimate the difficulties involved. To find out how common discontinuation symptoms can be, scientists from the Charité – Universitätsmedizin Berlin and the University Hospital of Cologne have carried out a systematic review and meta-analysis that has revealed that one in three people claims to experience symptoms when stopping treatment with antidepressants. although half of these symptoms are due to negative expectations (the nocebo effect).
The formal definition of antidepressants indicates that they are not habit-forming and, therefore, do not cause the body to require increasing doses to obtain the same effect as occurs with ‘true’ addictive substances. Despite this, many patients report symptoms such as dizziness, headache or insomnia when they stop taking these medications. This phenomenon largely went unnoticed by researchers for years, but there are now a relatively large number of studies seeking to quantify the magnitude of discontinuation symptoms.
“The results of these studies vary, in some cases widely,” said Professor Christopher Baethge, researcher at the Department of Psychiatry and Psychotherapy at the University Hospital Cologne and the Faculty of Medicine at the University of Cologne. “There has been a lot of discussion, in some cases quite emotional, both in the research community and the general public, in recent years about how prevalent and serious discontinuation symptoms really are.”
Severe discontinuation symptoms in one in 35 people
A team led by Christopher Baethge and Dr. Jonathan Henssler, head of the Evidence-Based Mental Health research group at Charité’s Department of Psychiatry and Neurosciences, conducted a systematic review of existing studies and reanalyzed them in a meta-analysis. This is the first study of its kind and the most robust evaluation to date of the consequences of stopping antidepressant treatment. “Our analysis shows that, on average, one in three people will experience symptoms after stopping antidepressant treatment,” Henssler says. “However, only half of these symptoms are actually attributable to the medication itself.”
For their article, the researchers reviewed 6,095 studies, of which they selected 79 to review their results using statistical methods. Ultimately, they analyzed data on about 21,000 people who had received an antidepressant or a placebo and were then asked about the prevalence of discontinuation symptoms. About 31% of patients treated with an active medication reported discontinuation symptoms, but so did 17% of those given a placebo. The findings have been published in The Lancet Psychiatry.
“The effects of the drug can be discounted in the placebo group, meaning that the symptoms arose by chance, regardless of the treatment, or are a product of the nocebo effect,” explains Henssler. The nocebo effect is often considered the mirror image of the placebo effect. He explains the observation that inactive treatments may be associated with “side effects.” These effects are triggered purely by the expectation that the treatment people believe they are receiving will have negative effects.
“In most cases, symptoms are mild, which means that a long or gradual process of tapering (antidepressants) is not necessary.”
“When we take into account non-specific symptoms and the effect of expectations, about one in six or seven people is affected by discontinuation symptoms that occur as a real consequence of antidepressant medication,” summarizes Henssler. “In most cases, the symptoms are mild. The vast majority of those affected will be able to stop antidepressants without relevant symptoms. This means that, in most cases, a long or gradual dose tapering process is not necessary.”
The study found that severe discontinuation symptoms are experienced by one in 35 people, or almost 3% of those affected. These types of symptoms were more common after stopping treatment with the drugs imipramine, paroxetine, venlafaxine, and desvenlafaxine. There was not yet enough information available for researchers to evaluate the situation for several widely used antidepressants.
As Baethge points out, “It is important that all people who wish to discontinue antidepressant treatment are monitored and advised by health professionals and receive individual support in case of discontinuation symptoms. Joint decision-making between the patient and the prescribing doctor, even before starting treatment, is the basis of good treatment. “We hope our data will support patients and healthcare professionals and help alleviate some of the uncertainty surrounding these issues today.”
Risks of treating human and everyday discomfort with psychotropic drugs
In statements to SMC Spain Eduard Vieta, researcher at the Mental Health Network Biomedical Research Center (CIBERSAM), Head of the Psychiatry and Psychology Service at the Hospital Clínic of Barcelona and professor at the University of Barcelona, who has not participated in the study , indicates that “this is a high-quality meta-analysis that examines a clinically relevant phenomenon such as the appearance of rebound symptoms and discomfort when stopping treatment with antidepressants” and “confirms what we already knew, that is, that “This is a real phenomenon that occurs with some frequency with some drugs, but not all.”
And he adds: “The implications of the study are that one in six patients may present symptoms derived from stopping antidepressant treatment that may seem like symptoms of relapse, but are actually caused by stopping taking the drug more or less abruptly. and that the medications venlafaxine, desvenlafaxine, paroxetine and imipramine are those most frequently associated with this phenomenon. “Both patients and psychiatrists should avoid abruptly discontinuing these drugs or opting for others that are not associated with this problem.”
In the opinion of Alberto Ortiz Lobo, Doctor of Medicine and psychiatrist at the Carlos III Day Hospital – La Paz University Hospital (Madrid), “the extraordinary increase in the prescription of antidepressants has to put us on alert about how we are transforming human and everyday discomfort. in a medical condition that we treat with psychotropic drugs. A treatment that, logically, causes adverse effects during consumption, but also during withdrawal, a problem that has barely been given visibility until a few years ago.”
