Stopping SSRI Antidepressants Can Cause Long, Intense Withdrawal Problems

madinamerica;

In the first systematic review of withdrawal problems that patients experience when trying to get off SSRI antidepressant medications, a team of American and Italian researchers found that withdrawing from SSRIs was in many ways comparable to trying to quit addictive benzodiazepine sedatives and barbiturates. Publishing in Psychotherapy and Psychosomatics, they also found that withdrawal symptoms can last months or even years, and entirely new, persistent psychiatric disorders can emerge from discontinuing SSRIs.

The authors analyzed 15 randomized controlled studies, 4 open trials, 4 retrospective investigations and 38 case reports of SSRI withdrawal. They found that paroxetine (Paxil) was the worst, but that all the SSRI antdepressants could cause a wide range of withdrawal symptoms from dizziness, electrical shock sensations and diarrhea to anxiety, panic, agitation, insomnia and severe depression.

The prevalence of such withdrawal syndromes was "variable" and difficult to estimate from the studies, they wrote, but generally seemed very common. "Symptoms typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering. However, many variations are possible, including late onset and/or longer persistence of disturbances. Symptoms may be easily misidentified as signs of impending relapse."

"Clinicians need to add SSRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs," they concluded. "The term ‘discontinuation syndrome' that is currently used minimizes the potential vulnerabilities induced by SSRI and should be replaced by ‘withdrawal syndrome'."

An accompanying editorial noted that, "This type of withdrawal consists of: (1) the return of the original illness at a greater intensity and/or with additional features of the illness, and/or (2) symptoms related to emerging new disorders. They persist at least 6 weeks after drug withdrawal and are sufficiently severe and disabling to have patients return to their previous drug treatment. When the previous drug treatment is not restarted, post-withdrawal disorders may last for several months to years."

The editorial also stated that, "With SSRI withdrawal, persistent postwithdrawal disorders may appear as new psychiatric disorders, in particular disorders that can be treated successfully with SSRIs and SNRIs. Significant postwithdrawal illnesses found with SSRI use include anxiety disorders, tardive insomnia, major depression, and bipolar illness."

While the study authors found no difference between gradual tapering over relatively short periods and abrupt discontinuation of SSRIs, the editorial authors argued that there was evidence to suggest benefits to tapering.

Chouinard G, Chouinard V, -A, New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal. Psychother Psychosom 2015;84:63-71. DOI:10.1159/000371865 (Abstract and full text)

Fava, G.A., A. Gatti, C. Belaise, J. Guidi, and E. Offidani. 

“Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review.” Psychotherapy and Psychosomatics 84, no. 2 (2015): 72–81. (Abstract and full text)

--Rob Wipond, News Editor

This entry was posted in Adverse Effects, Antidepressants, Featured News, In the News, Medication Tapering/Withdrawal. Bookmark the permalink.

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Thank You Mr Wipond and MIA.

The Op-Ed: Antidepressants, Pregnancy & Autism: A Potent Mix

pharmalot has;
The Op-Ed: Antidepressants, Pregnancy & Autism: A Potent Mix
. . . . . . .

[Ed; We're going to cut to the chase here:

November 2013 (Sorensen, et al)

In November 2013, Sorensen and colleagues from Denmark published a study looking at 668,468 births in Denmark from 1996 to 2006.  The rate of exposure to antidepressants during pregnancy is very low in Denmark (about 1.3 percent in Denmark in this study versus 5 percent to 15 percent in the US) but what these researchers found regarding SSRI exposure was concerning. From Table 2 in their paper, one can see that the Adjusted Hazard Ratio for autism spectrum disorder in the children exposed to SSRIs was 1.6.

What this means is that they found a 60% increase in autism in the children of the moms who were using SSRIs during pregnancy.  One way to tell if one thing causes another is to look for a dose –response relationship. For example, if smoking causes lung cancer, then we would expect to see heavier smokers have more lung cancer (and this is, in fact, what we see with smoking.) In this Sorensen study, the researchers looked at whether there was a dose-response relationship with the SSRIs during pregnancy and autism and they found that there was. Women on a low-dose of SSRI had a 40 percent increase in autism (aHR=1.4), while those on a high-dose had an 80% increase (aHR=1.8). 

These results are very concerning and correspond to the prior human studies (as well as the theory and the animal studies presented above.)  But, what the authors also did in this study was to take their initial population of 668,468 and then basically “throw out” more than 662,000 of the study subjects in order to do a substudy that focused only on 6,080 children of moms who had been given a diagnosis of an affective disorder through an in-patient or outpatient psychiatric hospital unit.  When the authors did this much smaller study (about 100 times smaller) they still found SSRIs to be associated with autism spectrum disorder in the offspring but the result was no longer statistically significant. But this loss of statistical significance should come as no surprise given that they removed about 662,000 subjects from their original study.

read the entire op-ed, . . . .


Thank You Mr. Urato and Mr. Silverman