11-07-2025
What are the withdrawal effects of antidepressants? A new review explores the issue
"I was initially quite resistant to any kind of medication, but I got a point a couple of years ago, I got to a point where I was really struggling with suicidal thoughts and just being able to function and do things because of my mood, and all of these horrible feelings and thoughts I was having, and finally got convinced to try Sertraline. And it definitely fairly immediately actually I noticed that I felt quite numb." Kizzy, who is an Allied Health professional is someone who engages with BEING Mental Health Consumers, an organisation advocating for people with lived experience of mental health issues. She says she never wanted to be reliant on anti-depressant medications, and has come off it twice now in the past. "My hope is that I can one day be not require antidepressants and still maintain this level of functioning and mental health I guess, and continue to improve, especially because there are still, for example, because it potentially affects my liver, like this current medication, I can't consume any alcohol, which is a healthy thing." A new review by academics published in JAMA Psychiatry examines antidepressant withdrawal symptoms. The international team of researchers analysed a large amount of data from over 50 studies involving more than 17,000 patients. The review found study participants who discontinued antidepressants experienced more symptoms - compared to those discontinuing placebo or continuing an antidepressant. Dr Ramya Raman is the Vice President and Western Australia Chair at the Royal Australian College of GPs. She says the decision to start and stop anti-depressants is a shared decision-making between patients and health professionals. "We look at how long a patient has been well and how their mood is actually going, what are some of the other factors that might be contributing to their current circumstances? What are their support systems around? Are they seeing a psychologist? Do they have other therapy in place for example with cognitive behavioural therapy or interpersonal skills training with their psychologist? And if they're doing really well with all of those and the patient actually says, I've been on these medications, I'm seeing the psychologist, I'm feeling a lot better, there's improvement, my family's telling me that there is improvement, I feel much better. My work has improved, my physical wellbeing has improved." Antidepressants are some of the most commonly prescribed medications globally and in Australia. Long-term use of the medication - that is longer than 12 months - is rising, and with it the understanding of the greater risk of harm. New resources have been developed to support safely stopping the use of antidepressants over time usually months, through what's called a tapering plan. The review published in JAMA Psychiatry included 38 studies which had an observation period longer than two weeks, the critical time frame during which withdrawal symptoms are expected to occur. The review found withdrawal symptoms - such as dizziness, nausea, vertigo - occur in a minority of cases, but they are on average typically not severe and manageable, especially with proper clinical support. Dr Raman says while there is room for further research on symptoms over a longer time period, the insight is useful for GPs. "In other words a weaning off of the medication and there is a trusted relationship with the GP in a regular follow up with that doctor, the risk of having the discontinuation symptoms are less the concern though when patients actually abruptly stop it. So the symptoms can include brain fogginess, dizziness, nausea, sometimes headache and sleep disturbances and of course mood changes and irritability can occur." Sonya Morrissey is the National GP Advisor at Headspace, a platform supporting the mental health and wellbeing of younger people. She says there is a growing understanding of how to support patients in their tapering plans - as they withdraw from using antidepressants "In the past, we would've not really talked to young people that we were prescribing antidepressants about the possibility of discontinuation symptoms. But it is something that we are, I think, recognising more and there's lots more research being done now, which is great, although there's not a significant amount of research yet in the cohort that we see, which is the 12 to 25 year olds. So that is a bit of a gap." She says antidepressants are not their first line of treatment at Headspace, but will be used occasionally, if needed. "In the cohort that we see at Headspace, which is young people age 12 to 25, antidepressant medication is not considered first-line treatment, for example, for anxiety disorders or for depression because they would be the psychological therapies and other supports. But for some young people who experience symptoms that either don't respond to those therapies or that are severe enough to be really impacting function, we will sometimes use antidepressant medication." Professor Paul Fitzgerald is the Director of the School of Medicine and Psychology at Australian National University, who is also a part of the Royal Australian and New Zealand College of Psychiatrists. He was not involved in the review. He says it is important to be aware of the more severe cases of side effects. "There are some unusual symptoms that patients experience. The most dramatic one the patients find quite disturbing is the phenomena that patients often talk about as Brain Z. They get this very strange sensation of electrical Z in their head or down their spinal cord, and if they haven't been warned about it, it can be quite distressing. It just seems strange." He says it's unclear from this latest review whether the symptoms are from their condition - or from discontinuation of antidepressant medication. "What happens when somebody's stopping a medication and their underlying symptoms of their condition get worse? In other words, start to experience more depression or more anxiety, and it can be really difficult to know under those circumstances. Are those symptoms that they're experiencing some sort of discontinuation or is it really just the symptoms of the illness coming back because the treatment's been withdrawn?" As a young adult in her mid-thirties, Kizzy says it can be challenging navigating the use of antidepressants and the withdrawal process. But she's found a way to use her voice and advocate to people who may be in a similar situation as her. She says what can make a big difference is finding a GP with an interest in mental health.
"I think it's important to find a GP who has a genuine interest in that area rather than just going to your generic GP, finding a regular one who you know can rely on, who can really support you and speak to you in a way that you're going to feel respected and really understood. And I think that's a really important kind of foundation support to have because once you have that, then you will feel safe enough to be checking in with them, sharing all your concerns, talking about coming off or going on or switching medications and still be okay through all of that."
