Once you've managed your depression and stopped taking medication, you may still experience discontinuation syndrome.
Patients experiencing major depression may receive a variety of antidepressants until one proves most effective. The search for a medication that may work for them is both frustrating and emotionally stressful. This trial-and-error method will continue until a biomarker shows which medication is best for each patient.
Even with successful medication and depression management for a time followed by medication cessation, the mental health journey continues, renewing concerns about the effects of antidepressant discontinuation. In a variety of medications, there is a discontinuation syndrome, and it is now being seen in antidepressants; patients and research are searching for answers.
Depression is experienced along with anxiety, and I have called them "The Ugly Twins." For some patients after receiving an anxiolytic medication for their anxiety for extended periods of time, their healthcare professionals enter a thorny forest of prescribing. I say that because I know of one young man who had been taking an anxiolytic medication for 30 years. He began to have multiple nighttime awakenings with panic attacks and severe anxiety upon awakening in the morning. His healthcare provider had recently switched him to another psychiatrist who failed to notice that he needed a longer period of taping than was being provided at that time. Ultimately, he was switched to another medication primarily meant for depression.
Another woman, who had been on an antidepressant and had gained a significant amount of weight while on it (30 pounds), experienced a brief, totally unexpected, period of paranoia where she believed she was in danger. Fortunately, it passed within one day, but it was something that she had never experienced in her life, and it was due to the medication cessation.
How many patients are advised that discontinuation symptoms may result once they begin to taper antidepressant medications? This would seem to be an important point in treatment planning. It is my opinion, however, that professionals may believe that, in telling the patient about these potential side effects, they may create a psychological environment that may precipitate them.
This might be true, but patients need to be made fully aware of what may occur in the future, and then both the patient and the professional can deal with it together. The patient, after all, is a participant in this treatment and needs to be included in all aspects.
In North America and Europe, the prescription rates for antidepressants range from roughly 6% to 16%, making them the most often prescribed psychiatric medications globally. An ever-growing percentage of the population is currently undergoing (indefinite) long-term medication because of the steadily increasing prescription rates and average durations of antidepressants during the 1990s.
Many patients taking antidepressants for an extended period of time may not need maintenance treatment, according to the research. Antidepressants tend to induce physical dependence and withdrawal symptoms upon dose reduction or cessation, discouraging termination, which may lead to inappropriate long-term pharmaceutical use.
A small number of case reports have detailed prolonged withdrawal syndrome (PWS) following antidepressant discontinuation; this condition is often called post-acute withdrawal syndrome (PAWS). On the other hand, there has not been a comprehensive quantitative study of antidepressant PWS symptoms.
Antidepressants are similar to other CNS medicines that might cause dependence, such as benzodiazepines, opioids, gabapentinoids, or psychostimulants, in this regard. But the research that has been conducted to date is proving to be inadequate because of problems in methodology and possibly bias on the part of some researchers.
Researchers evaluated 33 research studies with 4995 people. These studies involved people with recurrent depression and were almost exclusively carried out in specialized mental healthcare facilities. The risk of bias was significant in all of the included trials.
Confusion between withdrawal symptoms and symptoms of return of depression is the primary source of bias in the reviews. Adverse events, quality of life, social functioning, sickness severity, and withdrawal symptoms (such as low mood, dizziness) may impact nearly every result.
Antidepressant sudden cessation was documented in thirteen trials. Insufficient evidence supports its impact on adverse events versus continued antidepressant use, especially regarding withdrawal and relapse.
Trials that properly account for withdrawal confounding bias and differentiate between withdrawal symptoms and relapse are urgently required. People who have experienced one or no bouts of depression in primary care, those who are older, those who use antidepressants for anxiety and utilize tapering schemes longer than four weeks, and studies that include these populations in future research should disclose important outcomes, including the effective cessation rate.
It remains to be seen how many people will experience discontinuation syndrome at varying degrees, and how this may best be addressed by prescribing healthcare professionals. There is no question that careful taping, or even possibly a switch to another medication for a brief period of time, may be something to consider. In the meantime, patients are suffering a symptom of a different kind, in fact, iatrogenic in nature.