Withdrawal symptoms are common after stopping antidepressants

A new study published in Molecular Psychiatry estimates that about 43% of people who stop taking antidepressants experience withdrawal symptoms. These symptoms typically appear within two weeks of stopping the medication and can range from mild to severe. The findings suggest that withdrawal effects are widespread and highlight the need for better guidance on how to discontinue antidepressants safely.

Antidepressants are some of the most widely prescribed medications for mental health conditions such as depression and anxiety. While they can be effective, many people remain on them for extended periods. In the United States, nearly half of antidepressant users have been taking them for over five years. In the United Kingdom, the majority have used them for more than two years. Despite this long-term use, withdrawal symptoms that can follow discontinuation are not fully understood. Previous reports have varied widely in estimating how common these symptoms are—ranging from as low as 3% to as high as 77%.

To address this uncertainty, researchers led by Mi-Mi Zhang and colleagues at Peking University conducted the most comprehensive analysis to date on antidepressant withdrawal symptoms. Their goal was to estimate how often these symptoms occur, what they typically look like, and what factors increase the risk of experiencing them. They also aimed to provide clearer evidence to guide clinicians and patients when it comes to tapering off these medications.

The researchers systematically reviewed six major medical databases and included 35 studies in their final analysis. These studies included randomized controlled trials, as well as observational and cross-sectional research. In total, the analysis covered data from tens of thousands of individuals who had stopped taking antidepressants. Some studies tracked patients in clinical settings, while others relied on self-reports from online surveys. Across these different types of studies, the researchers consistently found that withdrawal symptoms were common.

The pooled incidence of antidepressant withdrawal symptoms across all studies was 42.9%. Among randomized controlled trials, the rate was slightly higher at 44.4%. Symptoms typically emerged within two weeks after stopping the medication and were generally measured for less than four weeks. However, some long-term users reported that symptoms lasted for months or even years. For example, one online survey found that “brain zaps”—a sudden electrical shock-like sensation in the head—could persist for decades.

The severity of symptoms also varied. Most people experienced mild to moderate symptoms, especially after short-term use of 8 to 12 weeks. However, a significant minority reported severe or even very severe symptoms, especially those who had been on antidepressants for a longer time. In one study, nearly half of the participants who discontinued venlafaxine after 8 weeks experienced moderate or severe symptoms.

The types of withdrawal symptoms also depended somewhat on the class of antidepressant. For selective serotonin reuptake inhibitors (SSRIs), the most commonly reported symptoms included dizziness, increased dreaming or nightmares, irritability, and anxiety. For serotonin-norepinephrine reuptake inhibitors (SNRIs), neurological symptoms like dizziness were more common. Tricyclic antidepressants had the highest estimated withdrawal rate (around 60%), but were less frequently studied.

Although the study found that tapering the dose over time was associated with a lower incidence of withdrawal symptoms compared to abruptly stopping the medication (34.5% vs. 42.5%), the difference was not statistically significant. This may be due to the relatively short tapering periods used in most studies—typically just 2 to 4 weeks. Some experts argue that much longer tapering schedules may be needed, especially for people who have been on antidepressants for years.

Several risk factors were associated with an increased likelihood of experiencing withdrawal symptoms. These included being female, younger age, experiencing early side effects during treatment, higher doses, longer treatment durations, and abrupt cessation. There is also some evidence that genetic differences, such as variation in a serotonin receptor gene, may play a role.

Interestingly, the researchers found that psychological factors—such as expecting to feel worse after stopping the medication—were not the main drivers of withdrawal symptoms. In randomized controlled trials, the group that actually stopped taking the medication had much higher rates of symptoms than those who continued treatment, suggesting that the symptoms were not just caused by expectations.

Despite the robust findings, the study does have limitations. Most of the included studies followed patients for only a few weeks after discontinuation, which may underestimate the true duration and severity of symptoms. There was also substantial variation in how withdrawal symptoms were measured and defined, which may affect the accuracy of the estimates. The authors also noted the possibility of publication bias, meaning studies with higher rates of withdrawal symptoms might have been more likely to be published.

Another key limitation is that most of the studies focused on people who had taken antidepressants for relatively short periods—often less than three months. This is not representative of typical long-term users, who may be more prone to withdrawal symptoms and whose experiences may differ in important ways. The researchers emphasize the need for future studies that track withdrawal in long-term users over extended follow-up periods.

Despite these limitations, the study provides strong evidence that withdrawal symptoms are a common experience for people discontinuing antidepressants. The findings challenge the notion that stopping these medications is usually straightforward and stress the importance of patient education and individualized discontinuation plans.

The authors recommend that clinicians inform patients of the possibility of withdrawal symptoms when starting an antidepressant and monitor them closely during and after discontinuation. They also call for better research into long-term use and more refined tapering strategies, which could help reduce the risks associated with stopping antidepressants.

The study, “Incidence and risk factors of antidepressant withdrawal symptoms: a meta-analysis and systematic review,” was authored by Mi-Mi Zhang, Xuan Tan, Yong-Bo Zheng, Na Zeng, Zhe Li, Mark Abie Horowitz, Xue-Zhu Feng, Ke Wang, Zi-Yi Li, Wei-Li Zhu, Xinyu Zhou, Peng Xie, Xiujun Zhang, Yumei Wang, Jie Shi, Yan-Ping Bao, Lin Lu, and Su-Xia Li.