Section - Quick Takes

01. Antidepressant Reappraisal: Have the Risks Been Underestimated?

Published on November 1, 2020 Expired on April 1, 2023

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

Should one even prescribe antidepressants anymore? Do the benefits outweigh the risks if one takes into account the risk of severe withdrawal symptoms? Because benefits are relatively small relative to placebo (mean effect size 0.3), risks must be relatively small. Therefore, the advisability of antidepressants hinges on the assessment of withdrawal risk, which new data and opinion suggest is larger than previously recognized, perhaps too large to justify long-term use of antidepressants.

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Text version

Wegdan Rashad, M.D.: This is a special Quick Take from the Psychopharmacology Institute. Dr. Jim Phelps and I review some interesting literature on antidepressant withdrawal. We are familiar with some antidepressants that are notorious for their withdrawal effects, like paroxetine and venlafaxine. The story is much bigger, in any case. When clinicians prescribe antidepressants, they have decided the benefits outweigh the risks. However, how significant is that benefit? Or how small is that risk? We delve deeper into the risk of severe withdrawal symptoms when the patient tries to stop an antidepressant.

Jim Phelps, M.D.: I proposed this special Quick Take to echo a message from the Royal College of Physicians. They recently said, “there should be greater recognition of the potential in some people for severe and long-lasting withdrawal symptoms” regarding antidepressant discontinuation. I suggested starting with a big picture view of antidepressant benefits and then comparing the risks.

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Learning Objectives:

After completing this activity, the learner will be able to:

Assess the quality of evidence regarding the frequency, severity, and duration of severe withdrawal symptoms following antidepressant discontinuation.

Original Release Date: November 1, 2020

Review and Re-release Date: March 1, 2023

Expiration Date: April 1, 2023

Relevant Financial Disclosures:

James Phelps declares the following interests:

- McGraw-Hill: book on bipolar disorder

- W.W. Norton & Co.: book on bipolar disorder

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

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Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.