Understanding Antidepressant Withdrawal: Research and Implications

In early 2023, Liana Shatova, a 40-year-old business development manager from the Greater Boston area, began taking low doses of the antidepressant sertraline, known by its brand name Zoloft, to alleviate symptoms of a premenstrual disorder characterized by mood swings, anxiety, and depression.

Although she initially experienced a boost in energy, after 18 months, Shatova felt emotionally numb and decided to stop the medication. Upon consulting her doctor, who assured her that tapering off the lowest prescribed dose would be simple, she encountered severe withdrawal symptoms, including chronic insomnia, panic attacks, night sweats, muscle and joint pain, and debilitating mood swings.

Her doctor attributed these symptoms to a relapse of her premenstrual dysphoric disorder and suggested another antidepressant, which Shatova declined. Research indicates that withdrawal symptoms from antidepressants, particularly SSRIs, are more common than previously recognized.

A large analysis published in The Lancet in November 2023, conducted by researchers at King's College London, examined data from 151 clinical trials and FDA reports involving approximately 30 antidepressants.

The study found that physical side effects, such as rapid weight gain and elevated heart rate, were more prevalent than once thought. Notably, a small U.K. study revealed that 63% of participants who had been on antidepressants for over two years reported moderate to severe withdrawal effects.

Symptoms ranged from insomnia and confusion to electric sensations, muscle cramps, and mood alterations. Dr. Mark Horowitz of University College London, who led the withdrawal study, highlighted that research shows about 25% of patients may experience severe symptoms upon abrupt cessation of antidepressants.

The report underscores that withdrawal symptoms can also arise even during tapering. Dr. Joseph Goldberg from the Icahn School of Medicine at Mount Sinai noted that antidepressants are known to cause discontinuation symptoms, mainly nausea and dizziness.

However, he expressed skepticism regarding the attribution of severe withdrawal experiences to the medications themselves. He emphasized the importance of not dismissing patients' experiences and called for further testing for those undergoing withdrawal.

The American Society of Clinical Psychopharmacology is developing new guidelines on deprescribing to better inform patients about what to expect when discontinuing psychiatric medications. Dr. Jonathan Alpert from Albert Einstein College of Medicine mentioned that many patients do not report prolonged withdrawal symptoms.

There is a need for more extensive, unbiased research on this topic, particularly as funding cuts to the National Institutes of Health could hinder the investigation into antidepressant withdrawal. David Cohen from UCLA called for large, non-industry-funded trials to thoroughly examine the effects of stopping antidepressants.

As Liana Shatova continues her careful tapering process, now at 0.835 milligrams of Zoloft, she still experiences symptoms triggered by stress and hormonal fluctuations. The urgency for more comprehensive studies on antidepressant withdrawal remains critical.