Approximately one in seven Australians use antidepressants, often beginning them during a crisis with the intention of temporary use. People typically do not plan to take them indefinitely. Clinical guidelines suggest using antidepressants for six to 12 months following a single episode of moderate to severe depression. However, about half of the users have been on them for more than a year. Discontinuing antidepressants can result in withdrawal symptoms, causing some to restart or continue usage. A recent systematic review by The Lancet found that roughly one in six to seven people experience withdrawal symptoms when stopping antidepressants, though this is probably an underestimate.
The studies reviewed mostly involved individuals who had taken antidepressants for only a few months. Among 79 studies with 21,000 participants, The Lancet review discovered that about 15% of users experienced withdrawal symptoms like dizziness, headaches, nausea, insomnia, and irritability after stopping the medication. Longer-term users are more likely to encounter withdrawal symptoms. However, the study primarily included people on antidepressants for short durations, typically from three to six months, and sometimes as brief as one week. Therefore, the finding that one in six individuals encounters withdrawal symptoms is likely an underestimation, applying only to a small group of antidepressant users. The review also found that about 3% experienced severe withdrawal, including suicidal thoughts. Again, this is likely underestimated, as the study did not focus on long-term users who might face more severe withdrawal symptoms. Some continue using antidepressants long-term, believing they are managing anxiety or depression, but they may actually be addressing withdrawal symptoms, given their similarity to anxiety and depression symptoms.
Long-term use of antidepressants, more than 12 months, is not without risks. A lack of awareness about withdrawal symptoms often leads doctors and patients to mistake them for anxiety or depression relapse, thus continuing medication. This confusion is understandable, as withdrawal, anxiety, and depression symptoms overlap. Withdrawal symptoms include nervousness, irritability, insomnia, fatigue, and agitation. Anxiety symptoms involve feelings of being nervous or easily irritated. Depression symptoms include sleep issues, low energy, and restlessness. However, it is possible to tell withdrawal from relapse apart. In withdrawal, alongside anxiety and irritability, other specific symptoms may be present. Until recently, there was limited information on how to safely minimize withdrawal symptoms to stop antidepressants.
Past advice included halving doses or alternating days, or switching to different antidepressants, but these methods often led to withdrawal. Withdrawal symptoms can begin soon after stopping or reducing doses, lasting weeks or longer. New brain imaging research supports gradual dose reduction to smooth changes in the brain and reduce withdrawal effects. “Hyperbolic tapering” involves progressively smaller dose reductions, such as tapering from 50mg down to 1mg before stopping. This allows the brain to adjust and minimizes withdrawal symptoms. Revised clinical guidelines now promote the hyperbolic tapering method.
At the University of Queensland, we are conducting a trial in general practice to test the effectiveness of specific tapering schedules in helping people safely discontinue antidepressants. In Australia, the mini-doses needed for tapering are not readily available, but compounding pharmacists can create them. Alternatively, under doctor supervision, some antidepressants can be crushed and mixed with water or diluted from liquid formulations to achieve mini-doses.