Queensland, almost one in seven Australians takes antidepressant medication. The decision to start is often made in times of crisis, with the thinking that they can help for a while and then will be discontinued. Most people don't start antidepressants thinking they'll be taking them for the rest of their lives.
Clinical guidelines recommend only six to 12 months of antidepressant therapy for an episode of moderate to severe depression.
However, only about half of people taking antidepressants have been using them for more than 12 months.When people attempt to discontinue antidepressant medications they may experience unpleasant withdrawal symptoms, causing them to restart or continue taking antidepressant medications. A recent Lancet systematic review found that six One in seven people experienced withdrawal symptoms when stopping antidepressants. This may be an underestimate, because most of the people in the study had been taking antidepressants for only a few months.
What did the researchers find?
The Lancet review, which included 79 studies and 21,000 people, found that 15% of antidepressant users experienced withdrawal symptoms after stopping taking the drug. Common symptoms include dizziness, headache, nausea, insomnia, and irritability.Withdrawal symptoms are more common in people who have been taking antidepressants for a long time. But the Lancet study mainly included people taking antidepressants for only short periods of time — mostly for about three to six months but sometimes for less than a week.
Therefore the finding that one in six people who stop taking antidepressants experiences withdrawal symptoms is probably an underestimate; This figure only applies to a small group of people who have taken antidepressant medications.
The Lancet review also found that about 3% of people experienced severe withdrawal symptoms, including suicidal thoughts. Again this is likely an underestimate, as it does not include long-term users, who are more likely to experience withdrawal symptoms and experience more severe withdrawal symptoms.Working out what's really causing the symptoms
Some people continue to take antidepressants for long periods of time in the belief that they are treating or preventing anxiety or depressive symptoms, but since many of the symptoms are similar, they may only be treating or preventing withdrawal symptoms. .
Yet long-term use of antidepressants (more than 12 months) is not harmless. Taking antidepressants for more than 12 months can cause: emotional numbness
Sexual dysfunction, which may be long-lasting, including low libido and difficulty achieving orgasm in both men and women
weight gain, lethargy or fatigue
The risk of falling increases in older people.
Low awareness and recognition of withdrawal symptoms can result in both doctors and patients misinterpreting withdrawal symptoms as "relapses" of anxiety or depression and the continued need for medication. The confusion is easy to understand because some of the withdrawal symptoms are anxiety. And/or there are also symptoms of depression.Withdrawal symptoms include nervousness, irritability, insomnia, fatigue, and agitation.
Symptoms of anxiety include "feeling nervous, anxious, or worried" and "getting upset or irritable easily." Symptoms of depression include "trouble falling asleep or staying asleep," "feeling tired or having low energy," and " Being unsteady or restless".
But it is possible to distinguish withdrawal from relapse. In addition to feeling anxious and irritable, people going through withdrawal may also experience:
Dizziness, vertigo (feeling of spinning) or lightheadedness, electric shock sensation (brain blinks)
imbalance
increased sensitivity to light or noise tinnitus
nausea, diarrhea or upset stomach
Muscle cramps or spasmsVivid dreams or nightmares
shocks
Confusion and sweating.How did people get off antidepressants?
Until recently, there was limited information about how to reduce withdrawal symptoms to enable people to safely come off antidepressants. Previous advice was often to halve the dose, then halve again, and then stop; or taking antidepressants on alternate days; Or to switch to a different antidepressant.
But despite good intentions, these methods are likely to result in withdrawal symptoms.
Withdrawal symptoms begin within hours, days, or sometimes weeks of stopping or reducing antidepressant dosage and can last for weeks or longer. So how can I stop safely?
Brain imaging techniques support a slow reduction of the dose of antidepressant medication to provide a steady change in the brain to reduce withdrawal symptoms.“Hyperbolic tapering” uses increasingly small decreases in drug dosage. For example, a tapering schedule of 50mg, 25mg, 15mg, 10mg, 6mg, 4mg, 2mg, 1mg, then 0mg (stop) gives a stable change in the brain. A slow and gradual reduction in the drug dose reduces withdrawal symptoms. This can give the brain time to adjust and safely stop without antidepressant medications.
Updated clinical guidelines now recommend this approach of hyperbolic slow tapering of antidepressants.
At the University of Queensland, we are conducting a randomized controlled trial in general practice to test the effectiveness of an antidepressant medication specific hyperbolic tapering schedule developed to help people safely discontinue antidepressants.The antidepressant mini doses required for tapering are not readily available in Australia. But people can obtain small doses of antidepressants through a compounding chemist (or for some antidepressants, by crushing a tablet and mixing it with water or diluting it to a liquid formulation in consultation with your doctor).
If you're thinking about getting off antidepressants, talk to your doctor, who can support and monitor you through the process of stopping safely.(Conversation)
RUP
Clinical guidelines recommend only six to 12 months of antidepressant therapy for an episode of moderate to severe depression.
However, only about half of people taking antidepressants have been using them for more than 12 months.When people attempt to discontinue antidepressant medications they may experience unpleasant withdrawal symptoms, causing them to restart or continue taking antidepressant medications. A recent Lancet systematic review found that six One in seven people experienced withdrawal symptoms when stopping antidepressants. This may be an underestimate, because most of the people in the study had been taking antidepressants for only a few months.
What did the researchers find?
The Lancet review, which included 79 studies and 21,000 people, found that 15% of antidepressant users experienced withdrawal symptoms after stopping taking the drug. Common symptoms include dizziness, headache, nausea, insomnia, and irritability.Withdrawal symptoms are more common in people who have been taking antidepressants for a long time. But the Lancet study mainly included people taking antidepressants for only short periods of time — mostly for about three to six months but sometimes for less than a week.
Therefore the finding that one in six people who stop taking antidepressants experiences withdrawal symptoms is probably an underestimate; This figure only applies to a small group of people who have taken antidepressant medications.
The Lancet review also found that about 3% of people experienced severe withdrawal symptoms, including suicidal thoughts. Again this is likely an underestimate, as it does not include long-term users, who are more likely to experience withdrawal symptoms and experience more severe withdrawal symptoms.Working out what's really causing the symptoms
Some people continue to take antidepressants for long periods of time in the belief that they are treating or preventing anxiety or depressive symptoms, but since many of the symptoms are similar, they may only be treating or preventing withdrawal symptoms. .
Yet long-term use of antidepressants (more than 12 months) is not harmless. Taking antidepressants for more than 12 months can cause: emotional numbness
Sexual dysfunction, which may be long-lasting, including low libido and difficulty achieving orgasm in both men and women
weight gain, lethargy or fatigue
The risk of falling increases in older people.
Low awareness and recognition of withdrawal symptoms can result in both doctors and patients misinterpreting withdrawal symptoms as "relapses" of anxiety or depression and the continued need for medication. The confusion is easy to understand because some of the withdrawal symptoms are anxiety. And/or there are also symptoms of depression.Withdrawal symptoms include nervousness, irritability, insomnia, fatigue, and agitation.
Symptoms of anxiety include "feeling nervous, anxious, or worried" and "getting upset or irritable easily." Symptoms of depression include "trouble falling asleep or staying asleep," "feeling tired or having low energy," and " Being unsteady or restless".
But it is possible to distinguish withdrawal from relapse. In addition to feeling anxious and irritable, people going through withdrawal may also experience:
Dizziness, vertigo (feeling of spinning) or lightheadedness, electric shock sensation (brain blinks)
imbalance
increased sensitivity to light or noise tinnitus
nausea, diarrhea or upset stomach
Muscle cramps or spasmsVivid dreams or nightmares
shocks
Confusion and sweating.How did people get off antidepressants?
Until recently, there was limited information about how to reduce withdrawal symptoms to enable people to safely come off antidepressants. Previous advice was often to halve the dose, then halve again, and then stop; or taking antidepressants on alternate days; Or to switch to a different antidepressant.
But despite good intentions, these methods are likely to result in withdrawal symptoms.
Withdrawal symptoms begin within hours, days, or sometimes weeks of stopping or reducing antidepressant dosage and can last for weeks or longer. So how can I stop safely?
Brain imaging techniques support a slow reduction of the dose of antidepressant medication to provide a steady change in the brain to reduce withdrawal symptoms.“Hyperbolic tapering” uses increasingly small decreases in drug dosage. For example, a tapering schedule of 50mg, 25mg, 15mg, 10mg, 6mg, 4mg, 2mg, 1mg, then 0mg (stop) gives a stable change in the brain. A slow and gradual reduction in the drug dose reduces withdrawal symptoms. This can give the brain time to adjust and safely stop without antidepressant medications.
Updated clinical guidelines now recommend this approach of hyperbolic slow tapering of antidepressants.
At the University of Queensland, we are conducting a randomized controlled trial in general practice to test the effectiveness of an antidepressant medication specific hyperbolic tapering schedule developed to help people safely discontinue antidepressants.The antidepressant mini doses required for tapering are not readily available in Australia. But people can obtain small doses of antidepressants through a compounding chemist (or for some antidepressants, by crushing a tablet and mixing it with water or diluting it to a liquid formulation in consultation with your doctor).
If you're thinking about getting off antidepressants, talk to your doctor, who can support and monitor you through the process of stopping safely.(Conversation)
RUP
