Discontinuation | Right Decisions

All classes of antidepressants can cause discontinuation/withdrawal symptoms, especially when stopped abruptly. Therefore, this advice is intended to provide prescribers and individuals with a range of options to appropriately support and enable successful antidepressant reduction and discontinuation.

Discontinuation/withdrawal effects may also occur to a lesser extent when doses are missed or reduced. It is, however, unknown what the specific incidence and prevalence is – as this can vary by individual antidepressant (e.g. more commonly occurs with paroxetine and venlafaxine), duration of treatment, the condition being treated and study design – studies have indicated that that up to 17% of people receiving placebo and up to 15-56% of people receiving different antidepressants may be affected.^133-136 It is also estimated that 3% of people may experience severe withdrawal effects.¹³⁶ However, some individuals may be more sensitive to withdrawal than others, and unfortunately, it is difficult to know who will or will not experience discontinuation/withdrawal effects.

Discontinuation symptoms

The term ‘discontinuation symptoms’ is used to describe symptoms experienced on stopping medicines that are not drugs of dependence, although there are important semantic differences in the terms ‘discontinuation’ and ‘withdrawal’ symptoms – the latter implying addiction, the former does not.¹⁸ While the distinction is important for precise medical terminology, it is irrelevant when it comes to personal experiences and how an individual may describe their signs and symptoms.

The optimum rate of taper to prevent withdrawal effects is unknown.^23,23 Therefore, the prescriber and individual should discuss and agree on the most appropriate approach to reducing the dose and reviewing progress – for some this will mean ‘low and slow reductions’. This will vary depending on individual’s needs, circumstances, age, clinical condition and other comorbidities being treated, as well as the duration of antidepressant treatment.

However, some individuals who stop antidepressant treatment for depression may experience a depressive relapse. A recent large robust trial by Lewis et al.¹³⁷ assessed the risk of relapse for people who indicated that they were ready to stop their antidepressant which they had taken for two years or more. During a 52 week follow up period, 39% of people continuing antidepressant treatment experienced a depressive relapse, with 56% of those discontinuing treatment. Of the latter group 39% subsequently restarted antidepressant treatment.