Longer antidepressant use linked to more severe, long-lasting withdrawal symptoms, study finds

A new study published in Psychiatry Research provides evidence that the longer people take antidepressants, the more likely they are to experience withdrawal symptoms when they try to stop. These symptoms are often more severe, longer-lasting, and make it harder for people to come off the medication—especially after more than two years of continuous use. The results suggest that the challenges associated with stopping antidepressants are more common and more difficult than has often been portrayed in earlier research, especially for long-term users.

Concerns about withdrawal symptoms from antidepressants have grown in recent years, particularly as many people now take these medications for years at a time. Earlier research, often funded by drug manufacturers, suggested that withdrawal symptoms were usually mild and short-lived. But these studies typically included only short-term users and relied on spontaneous reports of symptoms, which can underestimate the problem.

At the same time, more people are staying on antidepressants for longer periods. In the United Kingdom, half of all users have been on the drugs for over a year, and in the United States, 70% have taken them for more than two years. The current study aimed to examine withdrawal symptoms in a more representative group of long-term users and to clarify how duration of use relates to the severity and persistence of withdrawal.

“I almost died coming off my antidepressant (Lexapro, or escitalopram) – the agitation and terror it caused me I had never experienced in my life before,” said study author Mark A. Horowitz, a lecturer at King’s College London, clinical research fellow at the National Health Service, and co-author of the Maudsley Deprescribing Guidelines.

“This was nothing like the textbooks or what my training as a psychiatrist had taught me. I soon realized that there were 100,000s of other patients going through a similar experience. There has been huge debate about how common, severe and long-lasting withdrawal symptoms are for people coming off antidepressants. Most studies only look at withdrawal symptoms in people who have been on these drugs for 8 weeks (the studies down to get the drugs approved for the regulators).”

“But in the United States, for example, half of people use them for more than 5 years (i.e. 25 million Americans) and a growing proportion for 10 years,” Horowitz said. “We wanted to see how common, severe and long-lasting withdrawal effects were for people using them for longer periods, this reflecting more common use. So we surveyed a group of people in the public health system to get a more representative sample of antidepressant users.”

The research team surveyed 310 adults who had received psychological treatment for anxiety or depression and who had tried to stop taking an antidepressant at some point. Participants were drawn from four NHS Talking Therapies clinics in the United Kingdom and were mostly female (78%) and white (75%), with an average age of 39.

Respondents completed a one-time online questionnaire, which included questions about their history with antidepressant use, the process of discontinuation, and the symptoms they experienced while trying to stop. The survey incorporated a shortened version of a widely used checklist designed to assess withdrawal symptoms, with added items like “brain zaps” and depersonalization, based on feedback from clinicians and patients.

The researchers analyzed the data to determine how common withdrawal symptoms were, how severe they were, how long they lasted, and whether people were able to stop taking the medication successfully. They also looked at how these outcomes were related to factors such as how long people had been taking the medication, how they tried to taper off, and what kind of antidepressant they had used.

The researchers found that the longer someone had been taking an antidepressant, the more likely they were to experience severe and long-lasting withdrawal symptoms—and the harder it was for them to stop.

Among those who had used antidepressants for less than six months, about 64% reported some form of withdrawal, but these symptoms were usually mild and short-lived. Only 7% in this group reported severe symptoms, and most were able to stop the medication without major difficulties.

For those who had been on antidepressants for more than two years, the picture was very different. Nearly 96% reported withdrawal symptoms. About 25% said these were severe, and over 30% said the symptoms lasted more than three months. A striking 79% of long-term users were unable to stop the medication despite trying.

One of the most consistent findings was that longer use predicted greater difficulty coming off the drug. Compared to people who had taken antidepressants for less than six months, those who had used them for more than two years were over 10 times more likely to report a withdrawal syndrome, over five times more likely to report severe symptoms, and more than 27 times more likely to say they were unable to stop.

Horowitz was surprised “how strong the relationship between duration of use and effects of withdrawal were. I thought it would be there but was quite shocked by its strength. This also explains why guidelines based on short term studies are so misleading to clinicians and so out of touch for what people go through.”

Symptoms ranged from emotional issues like anxiety, agitation, and tearfulness to physical problems like dizziness, fatigue, and “brain zaps”—a sensation often described as electric shocks in the head. Importantly, over 40% of participants met the most stringent definition of withdrawal syndrome, involving at least four “non-emotional” symptoms, which are less likely to be confused with a return of depression or anxiety.

Overall, 79% of participants said they experienced some level of withdrawal, and nearly 20% said the symptoms lasted more than three months. About 10% reported symptoms that persisted for over a year.

“Withdrawal effects from antidepressants are very common – at least half of people get them and perhaps as many as 80%,” Horowitz told PsyPost. “They can also be severe in their impact and last for months or years. They can be so severe that people are unable to stop their drugs. And most importantly, the longer you use antidepressants the more severe and long-lasting the withdrawal effects and the harder they are to stop because of these effects.”

“This is predictable – the longer you use a drug the more your brain and body get accustomed to it, so the harder it is to stop – but this is the first time that a study has shown this so clearly for antidepressants.”

While previous studies have suggested that gradual tapering of antidepressants can reduce the risk of withdrawal, this study did not find a clear link between tapering duration and withdrawal outcomes. However, most participants in this study tapered over relatively short periods—often just a few weeks—which may not have been long enough to make a difference. Only a small number of people used tapering strategies that spanned several months or more.

In fact, 38% of participants stopped the medication abruptly, and nearly half used less controlled methods like skipping doses. These practices are common, and often reflect the limited tapering guidance given in clinical settings. Skipping doses, in particular, was linked with greater odds of being unable to stop, compared to other methods.

“The main message is that antidepressants should only be used for the minimum period of time necessary because the longer you use them, the harder they will be to stop,” Horowitz said. “The other thing for readers to be aware of is that withdrawal effects are very common, much more common than a return of an underlying condition like anxiety and depression (called a relapse).”

“But clinicians and patients will often mistake these withdrawal effects for a return of their condition and falsely conclude that this indicates that the patient needs to continue taking their drug. This is because withdrawal effects can include low mood, anxiety, panic attacks, suicidality, obsessional thinking, and crying — which can lead people to jump to the conclusion that this is a return of a mental illness.”

“We know that these effects occur even in people without a mental health condition who are coming off these drugs. Clinicians and patients need to be aware of this so that misdiagnosis does not occur. What is needed to avoid these effects is simply to come off theses drugs more carefully (over a longer period, in a hyperbolic pattern – according to the latest research) rather than stay on them lifelong. Guidelines need to be updated to reflect this new information so that patients are provided with adequate informed consent.”

Hyperbolic tapering is a method for coming off antidepressants that involves making smaller and smaller reductions in dose over time. Unlike traditional linear tapering, which reduces the dose by the same amount at each step, hyperbolic tapering takes into account the way antidepressants affect the brain: at lower doses, each milligram has a stronger effect. Because of this, reducing the dose too quickly at the end of treatment can lead to disproportionately strong withdrawal symptoms. Hyperbolic tapering avoids this by slowing the taper as the dose gets lower, giving the brain more time to adjust.

As with all research, there are some limitations to keep in mind. The survey had a relatively low response rate (18%), which raises the possibility that people who had particularly difficult withdrawal experiences were more likely to participate. However, the sample’s demographics and medication histories were broadly similar to the larger population of therapy service users and antidepressant users in England.

Another limitation is the retrospective nature of the data. Participants were asked to recall symptoms they had experienced in the past, which can introduce inaccuracies. Still, the pattern of findings was strong, consistent, and supported by statistical controls for potential confounding factors like age, diagnosis, and severity of depression or anxiety. The results were also broadly in line with other studies of long-term antidepressant users.

“We need urgently to provide more help to people stopping antidepressants to prevent the sort of life-altering consequences that people can experience,” Horowitz said. “This means as much clinician training and help for people who want to stop these drugs as currently exists for people who want to start the drugs. Patients also need to be informed about these risks – that they may not be able to stop the drugs, that if they try to the consequences may be life-altering – when they are considering starting them. There needs to be a plan on when and how to stop when these drugs are started to avoid the open-ended prescribing that is so widespread.”

The study, “Antidepressants withdrawal effects and duration of use: a survey of patients enrolled in primary care psychotherapy services,” was authored by Mark A. Horowitz, Joshua E.J. Buckman, Rob Saunders, Elisa Aguirre, James Davies, and Joanna Moncrieff.