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Do withdrawal symptoms predict depression relapse after antidepressant cessation?
Constantin Volkmann1, Subati Abulikemu2, Isabel M Berwian3
1Department of Psychiatry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Campus Mitte, 10117, Berlin, Germany. constantin.volkmann@charite.de.
European Archives of Psychiatry and Clinical Neuroscience
|April 23, 2025
Summary
Discontinuing antidepressants can cause withdrawal symptoms, which are more common in women and may increase the risk of major depressive disorder relapse. Differentiating these symptoms from relapse is possible.
Area of Science:
- Psychiatry
- Clinical Psychology
- Pharmacology
Background:
- Discontinuing antidepressants after remission carries risks of withdrawal symptoms and relapse.
- Differentiating withdrawal from relapse is crucial for patient management.
Purpose of the Study:
- To differentiate antidepressant withdrawal symptoms from relapse.
- To identify risk factors for withdrawal.
- To examine the association between withdrawal and relapse.
- To optimize antidepressant discontinuation.
Main Methods:
- 103 patients with remitted major depressive disorder were randomized to continue or discontinue antidepressants.
- Withdrawal symptoms assessed using the Discontinuation Emergent Signs and Symptoms (DESS) scale.
- Statistical analyses included linear regressions, logistic regression, and Cox proportional hazards models.
Main Results:
- Withdrawal syndrome occurred in 29% of patients, with women reporting more symptoms than men.
- Ten symptoms were exclusive to the discontinuation group, aiding differentiation.
- Withdrawal symptoms and early depressive symptoms were associated with increased relapse risk.
- Tapering duration did not impact withdrawal or relapse rates.
Conclusions:
- Antidepressant withdrawal symptoms are common, particularly in women, and may elevate relapse risk.
- Withdrawal symptoms can be distinguished from relapse.
- Further research is needed to optimize discontinuation strategies.
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