New Delhi: After years of doctors dismissing or downplaying withdrawal symptoms that people trying to quit antidepressants experience, new research has suggested a new regimen to help ease the symptoms. The paper says that patients should be tapered off medication over months or years, instead of the current practice of four weeks.
Patients trying to quit antidepressants experience several withdrawal symptoms like insomnia, anxiety and even sensations of electric shock in the brain. These claims have been brushed aside by doctors, who said underlying mood problems resulted in these symptoms.
The new study, published in the journal Lancet Psychiatry on March 5, says that a “responsible withdrawal regimen” should have the patient tapering off medication over months or years. Existing practices suggest that patients quit medication over four weeks.
Mark Horowitz, one of the paper’s authors and a clinical research fellow at the UK National Health Service, told the New York Times that he knew people who stop suddenly and get no side effects, but many people do.
Horowitz, who is also a fellow with the University College London, said many people “have to pull apart their capsules and reduce the dosage bead by bead. We provided the science to back up what they’re already doing.”
Other researchers also said the paper reinforces what was observed in clinical practice in many patients. “It’s almost identical to the tapering regimen I use,” Dee Mangin, the chair of family medicine at McMaster University in Canada, told the Times.
Horowitz and his co-author, Dr David Taylor, a professor of psychopharmacology at King’s College London, also experienced withdrawal symptoms, which was part of the reason why they decide to address the topic.
Two previous studies cited in the new research also found that a large number of people suffered severe withdrawal symptoms while trying to taper off antidepressants. A 2010 Japanese study found that 78% experienced severe withdrawal symptoms. When they were tapered off over an average of nine months and for as long as four years, only 6% of subjects experienced withdrawal.
A 2018 Dutch study found that reducing the dosage by increments to 1/40th the original helped 70% of people to safely quit their prescriptions of antidepressants Paxil or Effexor. The new paper also recommends this regimen.
The authors, using brain-imaging evidence, claim to have found that antidepressants like Paxil, Zoloft and Effexor work, among other ways, by blocking the serotonin transporter. This is a molecule that flushes serotonin, a neurotransmitter in the body that imparts a sense of well-being, out from between nerve cells. When an antidepressant enters the picture, it blocks the transporter and prolongs and enhances serotonin’s effects.
However, the brain-imaging studies claim to have found that the transporter levels increase strongly under a dose of antidepressants.
With reduction in dose, the levels also drop the same way, instead of falling in a more gentle curve. And they argue that halving the dosage – which has been standard medical practice – to end medication entirely after four weeks does not take this into account.
Antidepressants in India
India is behind the curve in dealing with problems related to antidepressants. A study published in 2015 found that eight in ten antidepressants in India do not have proper approval. As The Wire had reported:
While there are rigorous regulations for combination drugs used to treat tuberculosis and HIV/AIDS, and for contraception, the researchers found 73% of NSAIDs and 81% of antidepressant combination drugs don’t have CDSCO approval. They also found that 20% of metformin and 70% of antipsychotics are unapproved.
A previous study raised the concern that data is largely available only on acute treatment.
Some major limitations of the research have been that almost all the data available in relation to treatment of depression pertains to acute phase treatment and rarely studies have evaluated the continuation phase treatment.
There is also lack of data with regard to the efficacy and effectiveness in the maintenance phase treatment.