The Risks Associated With Stopping an Antidepressant
Psych Congress cochair Charles Raison, MD, admits there are no easy answers to the questions clinicians face when prescribing antidepressants. But he hopes his talk at the upcoming 32nd annual Psych Congress will give attendees information they need to make informed decisions with their patients
Dr. Raison is the Mary Sue and Mike Shannon Chair for Healthy Minds, Children & Families; Professor, Human Development and Family Studies, School of Human Ecology; and Professor, Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin- Madison. He is also Director of Clinical and Translational Research for the Usona Institute, which conducts research on the therapeutic effects of psilocybin.
Dr. Raison's session, “Faded Love: A Critical Look at the Strengths and Weaknesses of Antidepressants for the Treatment of Major Depression,” will be held from 4:15 p.m. to 5:30 p.m. on Saturday, Oct. 5.
Q: What risks are associated with stopping an antidepressant and with restarting it?
A: In psychiatry, the scientific literature is never 100% consistent, so there's always studies that support your position. But, I think the bulk of the studies suggest that in people who have had a response to an antidepressant, stopping the antidepressant increases the risk for relapse.
There's a large study showing that you're much more likely to get depressed again if you just stop an antidepressant quickly than if you remove it slowly. That's very consistent. That's one of the strongest pieces of evidence for this idea that the brain fights back against the antidepressant by themselves. The brain and antidepressants are pushing on each other, you take away the antidepressant and the push of the brain just pushes over the depression. So if you go slowly, it allows the brain to adjust to the absence of the antidepressant. That's the risk in stopping an antidepressant: your risks of being depressed again go up.
Also, with some antidepressants more than others, there is a fairly regular occurrence of withdrawal syndrome. As a field, we were in denial about this for years. Patients came to us complaining about it and we didn't have the paradigm for it because these are not “addictive” drugs. I mean, nobody parties with their antidepressant, right? Many, many, people have pretty nasty withdrawal symptoms. Sometimes I think it can be confused with relapse into depression. People feel sick and dizzy. It's rough, and there are people who experience this withdrawal for weeks and weeks and weeks. There are case reports of people who have sort of experienced it forever. So that's another risk of going off the antidepressant.
Go to Part 2: The Risks of Long-Term Antidepressant Treatment
In general, there are studies showing that if you go off whatever psychotropic agent you're on, you're less likely to respond to it if you go back on it and you'll also have to be put back on at a higher dose to get the effect.
This is why one of the things about this talk is it provides information, but it doesn't provide easy answers. I just finished saying we might not want to think about keeping people on antidepressants forever, but I'm also now saying that taking people off their antidepressants comes at a risk too. But that's one of the reasons we should be thinking more upfront about can we help the person not get into a situation where they can't make it without their antidepressant.
Go to Part 3: Deciding When to Stop an Antidepressant