Antidepressant Discontinuation Symptoms Not Clinically Significant

A systematic review and meta-analysis indicate that while antidepressant discontinuation is associated with a mild increase in physical symptoms, the average symptom burden does not reach the threshold for clinically significant discontinuation syndrome. Researchers examined symptoms using standardized measures such as the Discontinuation-Emergent Signs and Symptoms (DESS) scale and tracked the incidence of individual symptoms. The study included randomized clinical trials (RCTs) that reported discontinuation symptoms using standardized scales or individual adverse events, and incorporated unpublished data from 11 RCTs. Data from 50 studies involving 17,828 participants (66.9% female, mean age 44 years) were analyzed, with 49 studies included in the meta-analyses. Follow-up ranged from 1 day to 52 weeks. The DESS meta-analysis showed a modest but significant increase in discontinuation symptoms one week after stopping antidepressants (standardized mean difference 0.31), equivalent to one additional symptom on the DESS. Compared to placebo or continued antidepressant use, discontinuation was associated with increased odds of dizziness (OR 5.52), nausea (OR 3.16), vertigo (OR 6.40), and nervousness (OR 3.15), with dizziness being the most common symptom (risk difference 6.24%). However, discontinuation was not linked to worsening depression symptoms, even among individuals with major depressive disorder. Mood worsening is more likely to reflect depression relapse rather than a discontinuation effect. Source: https://jamanetwork.com/