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Stopping Antidepressants

 
Weir (2020) in the Monitor on Psychology  has reviewed the most current information about stopping antidepressants. I will offer here a summary of what I regard as some important points.

The common wisdom has been that those who are stopping antidepressants should wean off them in a few weeks with only mild side effects, if any. However, anecdotally, many patients are said to have complained of very worrisome mental and physical side effects, lasting months or even years. Current research supports those anecdotal reports and finds that a few weeks are a real underestimate. Some of the more distressing physical side effects can include dizziness, headaches, sleep problems, fatigue, and flu-like symptoms. Emotional side effects can be irritability, aggression, anxiety, mood changes, and panic attacks.

Antidepressants have been shown to be effective for major depressive episodes and have traditionally been often used as the first-line treatment . When so used, the expectation is that they will be used for for four to nine months, during the acute phase, before being tapered off. Yet the most recent data from the U.S. National Center for Health Statistics show that more than two-thirds of people on antidepressants have taken them for at least two years and one-fourth for more than ten years.

Unfortunately, we still don't understand how these medications work. Moreover, there have been no well-designed studies of people on them for long periods of time. Also we know that with each new episode using antidepressants, there is a 25% lessening of the chances of going into remission.

Some finding have suggested that antidepressants may work better when combined with psychotherapy. It may be speculated that psychotherapy, at least with mild to moderate depressions, might be the better first-line option. This conclusion will be especially relevant if more research supports the progressive resistance to antidepressant's effectiveness over repeated episodes. The increasing recognition of their potentially troublesome side effects also supports this conclusion.

The role of psychologists is to help their patients make informed decisions based on current data as well as their goals and values, to help them monitor their side effects, to give support if their withdrawal is difficult, and to collaborate with their prescribers.

REFERENCE

Weir, K. (2020). How hard is it to stop antidepressants? Monitor on Psychology, 51(3), 58-64.

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