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Stopping antidepressant therapy: plan tapered withdrawal

When stopping antidepressant therapy, reducing the dose stepwise over a period of more than 4 weeks helps to limit withdrawal symptoms.

The clinical effects (or withdrawal symptoms) that occur when antidepressant therapy is stopped abruptly are frequent and varied. They include physical disorders (such as headache, fatigue, palpitations, nausea, and abdominal pain), sleep disturbances and mental disorders (such as anxiety, panic attacks, aggressiveness, and suicidal ideation). These disorders are more common or more severe the longer the patient was on treatment and the higher the dose they were taking. The resemblance between some of these withdrawal symptoms and the symptoms that led to the patient taking an antidepressant in the first place means that they can be mistaken for a relapse, sometimes causing the patient to resume antidepressant therapy unnecessarily.

Withdrawal symptoms have been reported with antidepressants of all types. They seem more common with antidepressants that generally have a short half-life (less than 24 hours), such as paroxetine (Paxil° or other brands), duloxetine (Cymbalta° or other brands) or venlafaxine (Effexor° or other brands).

Tapered withdrawal over a period of more than 4 weeks helps patients successfully come off antidepressant therapy. Generally, the recommendation is to reduce the daily dose by 5% to 10% every 1 to 4 weeks. The rate of dose reduction should be adjusted on the basis of the patient's symptoms and the level of support available to them.

It is in patients' best interests that, as soon as they start antidepressant therapy, they are aware of the risk that they will experience withdrawal symptoms if they come off their treatment rapidly and of the benefits of keeping the treatment duration as short as possible. Some patients, informed of the temporary symptoms they may face, manage to come off antidepressants without support. Others may benefit from help in organising their withdrawal.

©Prescrire 1 September 2021

Source: "Stopping antidepressant therapy. Plan tapered withdrawal" Prescrire International 2021; 30 (229): 215-216. Subscribers only.

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