Section - Quick Takes

04. Distinguishing Relapse From Antidepressant Withdrawal: Clinical Practice and Antidepressant Discontinuation Studies

Published on July 1, 2023 Certification expiration date: July 1, 2026

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

Amid the intense debate about the incidence of severe withdrawal symptoms among patients discontinuing antidepressants, here is a calm and systematic review of available evidence.
Features distinguishing withdrawal from relapse include: Timing of onset, response to reinstatement, concurrent physical symptoms, and pattern over time (viz. worsening then resolution following each decrement).
The incidence of withdrawal cannot be given in a single number. It depends on definition of withdrawal, antidepressant type, taper rate, duration of use prior to discontinuing, and (more tentatively) dose before taper.

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In the last Quick Take, we looked at the average benefit of antidepressants in the treatment of major depression. And now, let’s look more closely at the risk side. New data suggest that we may have been underestimating the frequency of severe withdrawal symptoms, but there’s so much emotion on both sides of the debate about this that we need a calm, level-headed assessment from a good team of scientists. Here are 2 articles, I think, that meet that description.

Hi! Jim Phelps here for the Psychopharmacology Institute. First, let’s look at a 2022 article by Dr. Mark Horowitz and colleagues. Their search for data on antidepressant withdrawal conducted by standard means led to 330 articles, of which only 9 met their criteria for detailed examination, which illustrates the first problem the authors would like to call to our attention—that the literature on withdrawal is scant. For years, patients’ symptoms

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05. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 Guidelines for the Management of Patients with Bipolar Disorder

Learning Objectives:

Discuss the importance of nonmanic markers in assessing bipolar features among patients.
Consider the implications of a dimensional approach to the diagnosis of depressive disorders with mixed features and its impact on treatment options.
Evaluate the benefit–risk ratio of antidepressants in light of the results of 8 large meta-analyses.
Reassess the incidence of severe withdrawal symptoms when antidepressants are discontinued and clinical features which distinguish withdrawal from relapse.
Compare the first- and second-line treatment options for bipolar depression in 2 recent treatment guidelines.

Original Release Date: July 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: July 1, 2026

Expert: James Phelps, M.D.

Medical Editor: Melissa Mariano, M.D.

Relevant Financial Disclosures:

James Phelps declares the following interests:

- McGraw-Hill Publishing Company: Royalties
- W.W. Norton & Co. Publishing Company: royalties

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

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