Antidepressant withdrawal may be more persistent than doctors realize

People who stop taking antidepressants can experience lingering withdrawal symptoms that last months or even years, according to a new study published in the journal Epidemiology and Psychiatric Sciences. The review, which systematically examined the scientific literature on post-acute withdrawal syndrome (PAWS), found that symptoms such as anxiety, mood swings, and sleep disturbances sometimes persist long after medication is discontinued.

The researchers were motivated by growing concerns about the long-term use of antidepressants and the lack of scientific attention paid to what happens when people try to stop. Antidepressants are among the most widely prescribed medications in the world, and a significant number of users stay on them for years.

Although short-term withdrawal symptoms are well-documented, there has been little research into what happens when withdrawal symptoms linger—what some researchers call post-acute withdrawal syndrome. This study aimed to systematically gather and evaluate existing data on how often PAWS occurs, how long it lasts, how severe it is, what factors might influence it, and what treatments are available.

To do this, the researchers conducted a comprehensive search of major scientific databases, looking for original studies that reported persistent withdrawal symptoms after stopping newer antidepressants like selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. They used a predefined protocol and included a wide range of study types—case reports, observational studies, and surveys—so long as they contained original data. Ultimately, the review included seven studies that met their criteria.

The included studies varied widely in methodology and quality. Some were peer-reviewed analyses of posts on online support forums, while others were clinical case reports or small prospective studies. One of the strongest pieces of evidence came from a large real-world randomized controlled trial in the United Kingdom. That trial followed patients who discontinued antidepressants over several months and found that withdrawal symptoms could persist for up to 39 weeks.

In terms of prevalence, one small study provided a rough estimate: in a group of 20 patients who had been prescribed paroxetine for panic disorder and agoraphobia, three individuals (15%) developed PAWS after gradually tapering their medication. This is a limited finding, drawn from a narrow patient population, and cannot be generalized to all antidepressant users. Still, it raises the possibility that persistent withdrawal symptoms are not rare.

When it came to duration, the studies offered a wide range. Reports of PAWS lasting between one and a half months and nearly 14 years were found. On average, durations spanned from several months to a few years. One study based on online self-reports noted an average symptom duration of over two years. The most commonly reported symptoms included mood swings, anxiety, fatigue, irritability, and sleep difficulties. In some cases, the symptom pattern resembled that of other mental health conditions, making it difficult to distinguish withdrawal from a relapse or a new disorder.

As for severity, several studies described PAWS as having a serious impact on quality of life. One case series reported that symptoms such as emotional instability, agitation, and physical discomfort significantly disrupted patients’ daily functioning. In another study, individuals self-identifying as experiencing PAWS reported that their symptoms were severe and persistent, sometimes causing them to seek help in online forums and support groups.

The study also explored possible risk factors. Long-term use of paroxetine—a commonly prescribed antidepressant—was repeatedly mentioned as a potential contributor to prolonged withdrawal. Other factors, such as the speed of tapering, did not consistently predict the severity or duration of symptoms. In some cases, people who tapered slowly still experienced long-lasting symptoms, suggesting that the underlying mechanisms are not yet fully understood.

In terms of treatment, the available options appeared limited and inconclusive. Some individuals found that reinstating the original antidepressant helped alleviate their symptoms, while others did not. A few patients tried other medications like benzodiazepines or beta blockers, with mixed results. One case series reported that cognitive-behavioral therapy seemed to help some patients over the course of several months, but this was based on only a few cases and lacked a control group.

One of the most notable findings of this review was how little high-quality research exists on PAWS. Most studies were based on self-reported data from online communities, which, while valuable, cannot provide definitive evidence due to selection bias and lack of medical verification.

Only one study used a randomized controlled design, and even that study did not include drugs like paroxetine or venlafaxine, which are known to cause more severe withdrawal symptoms. The authors note that this lack of rigorous research makes it impossible to estimate how common or severe PAWS truly is in the general population.

This evidence gap has significant implications for clinical practice. Many doctors may be unaware of PAWS or may misinterpret persistent withdrawal symptoms as a return of the original mental health condition. This can lead to patients being placed back on medication unnecessarily or being diagnosed with a new disorder. Without clearer diagnostic guidelines or validated tools to distinguish PAWS from relapse, clinicians may struggle to provide appropriate care.

The researchers conclude that much more work is needed to understand PAWS. Larger, well-designed studies are necessary to determine how widespread the problem is and to identify which patients are most at risk. Randomized controlled trials are also needed to test potential treatments.

The study, “Post-acute withdrawal syndrome (PAWS) after stopping antidepressants: a systematic review with meta-narrative synthesis,” was authored by Andri Rennwald and Michael P. Hengartner.