Citizens Committee on Human Rights

The Mental Health Watchdog

Australian National Office

Withdrawal Effects of Psychiatric Drugs

Many people who have taken psychiatric drugs have found that the withdrawal effects of these drugs can persist for months, even years after they stop taking them. Patients are frequently not warned about this, and are often told that it is simply symptoms of their ‘mental disorder’ returning – yet studies confirm that after patient’s stop taking certain psychiatric drugs, the withdrawal effects may last several months to years afterwards.1

It is extremely important that no one stops taking any psychiatric drug without the advice and assistance of a competent medical doctor. Patients, family members and others are too often not warned about this at time of prescribing.

One Australian study found that just over half of inpatients surveyed and one third of community-based patients reported that they did not receive any information about the psychiatric drug prescribed and carers were even less likely to receive information or be included in discussions and decisions about psychiatric drugs prescribed to those they are caring for.2

In 2018, researchers from the University of Auckland and University of London published their report after surveying more than 1,829 antidepressant users in New Zealand. They found:

  • Only 1% recalled being informed of the potential for withdrawal effects when prescribed antidepressants
  • 55% said they experienced withdrawal effects
  • Withdrawal effects rose to 70% amongst those who had taken antidepressants for more than 3 years
  • 25% said withdrawal effects were severe
  • One in three said they believed they were addicted after 3 years on antidepressants.3

Australian Government Psychiatric Drug Warnings for Withdrawal Effects

Withdrawal effects can be worsening of existing symptoms or new not previously experienced symptoms. They can occur when someone stops a psychiatric drug, decreases the dose or switches from one psychiatric drug to another.

Government drug regulatory agencies from around the world, including Australia’s Therapeutic Goods Administration (TGA) have issued psychiatric drug warnings to warn of withdrawal syndrome.

Australian warnings for withdrawal effects issued by the TGA include:

  • June 2018: The TGA issued a Medicine Safety Update to remind prescribers of psychiatric drugs of the importance of educating patients and their carers about discontinuing, discontinuing symptoms and not suddenly stopping a psychiatric drug, especially when taking an antidepressant. This also includes the “ADHD” drug atomoxetine (Strattera, antidepressant) and the antidepressant Zyban used in smoking cessation.4
  • 2016 December: The TGA warned that antidepressants should never be stopped suddenly and should be reduced gradually [always under a doctor’s supervision] to avoid potential discontinuation symptoms such as nausea, sleep problems, dizziness, irritability, anxiety, numbness and “electric shock-like” symptoms. The TGA advised that it is important for carers and patients to be educated about this.5
  • 2011 November: The TGA issued a safety advisory to warn that suddenly stopping citalopram (Cipramil, Celepram, Talum, Citobell, Celica and others with “citalopram” in their name) can cause withdrawal symptoms including anxiety, insomnia, emotional instability, headache, diarrhoea, vomiting and heart palpitations.6
  • 2011 August: The TGA issued a warning that newborn infants exposed to antipsychotics during the third trimester of pregnancy may be at risk of withdrawal syndrome at birth.7
  • 2005 August: The TGA issued a warning that SSRI’s (class of antidepressant) are not registered for use in children under 18 for depression and that SSRIs had been linked to new onset suicidality (suicidal thoughts and behaviour) in both adults and children. “Similar symptoms can follow withdrawal of the SSRI,” the TGA stated.8
  • 2005 September: Suddenly stopping the antidepressant paroxetine (Aropax, Oxetine, Paxtine, Loxamine and other brand names) can cause withdrawal effects that can be severe or life-threatening, the TGA warned in an information sheet to health professionals.9
  • 2007 November: In an Adverse Drug Reaction Bulletin, the TGA warned that babies born to mothers who had taken SSRI antidepressants throughout pregnancy can experience withdrawal reactions. Reactions reported included jitteriness, fever, anorexia, rapid breathing and irritability.10
  • 2003 August: The TGA warned that SSRI antidepressant use during pregnancy and breast feeding can cause withdrawal effects in the baby such as agitation, jitteriness, poor feeding, gastrointestinal symptoms and hypotonia (deficient muscle tone or tension). In adults, withdrawal effects can occur as with other SSRIs.11

To read a fact sheet with all the Australian drug warnings issued click here.

Psychiatric Drug Withdrawal Can Last Years

The journal Psychotherapy and Psychosomatics published a report in September 2012 about persistent post-withdrawal effects which began six weeks after cessation of taking SSRI antidepressants. Researchers reviewed self-reported adverse events between February and September 2010 and found post-withdrawal symptoms “may last several months to years.” Symptoms included disturbed mood, persistent insomnia, irritability, depression, impaired concentration and memory, poor stress tolerance and emotional liability (exaggerated mood changes with strong emotions or feeling such as uncontrollable crying or laughing or heightened irritability or temper).12

Dr. Stuart Shipko, a California psychiatrist who has published reports on SSRI antidepressant withdrawal, said his “clinical observation is that long-lasting symptoms occur even in patients who taper very slowly, not just those who stop quickly and that there is no guarantee that these symptoms will go away no matter how long the patient waits.”13

In 2014, the Council for Evidence-based Psychiatry in the United Kingdom determined: “Withdrawal from psychiatric drugs can be disabling and can cause a range of severe physical and psychological effects which often last for months and sometimes years….”14

British psychiatrist Joanna Moncrieff and others reported in The Journal of Psychoactive Drugs: “It is now accepted that all major classes of psychiatric medication produce distinctive withdrawal effects which mostly reflect their pharmacological activity.” Further the researchers reported, “Just like the various substances that are used recreationally, each type of psychiatric medication induces a distinctive altered mental and physical state….”

“Furthermore,” they said, “Discontinuation of most psychoactive substances after chronic use produces mental and physical changes. Withdrawal from psychiatric medications, including antidepressants and antipsychotics, is associated with distinctive withdrawal or discontinuation syndromes, which are suppressed by resumption of the drug. These affects are significant, they said, “because they may be─and probably often are─ mistaken for signs of relapse,” and their prescribers may wrongly believe that the patient cannot manage without it.15

An Australian literature review of antipsychotic discontinuation effects found that withdrawal effects for antipsychotics include:

  • Vomiting, nausea/and or diarrhoea
  • Difficulty sleeping, restlessness, anxiety, and/or agitation
  • Dizziness
  • Problems with muscle movement including involuntary muscle contractions, inability to stay still and/or uncontrollable movements 16

Benzodiazepines are tranquilisers such as Valium, Serepax, Normison and Mogadon. Australia’s drug regulatory agency’s Product Information used by doctors to prescribe, lists the following as withdrawal effects for alprazolam a very common benzodiazepine also commonly known as Xanax.

  • Insomnia
  • Anxiety
  • Vomiting
  • Tremor
  • Muscle and abdominal cramps
  • Delusional beliefs
  • Heart palpitations
  • Loss of short term memory
  • Convulsions
  • Psychosis 17

The Western Australian Department of Health advises people taking benzodiazepines that they can easily become addicted, and when they stop taking them, they will experience withdrawal symptoms. They also advise, “Abrupt withdrawal symptoms can last from weeks to months” and it is dangerous to suddenly stop.18

Withdrawal Effects Reported to Australia’s Drug Regulatory Agency

As of 3 January 2019, the Therapeutic Goods Administration had received 938 reports of withdrawal syndrome for antidepressants and a further 165 reports of withdrawal syndrome for antipsychotics. As experts say that only between 1 and 10% of side effects are reported, the number can only be much higher.19

Video

Watch a video of US attorney Karen Beth Menzies on antidepressants ─addiction and withdrawal click on this link: https://www.youtube.com/watch?v=Mpex0n0DXuc


References

  1. Benedict Carey, “How to Quit Antidepressants: Very slowly, Doctors Say,” The New York Times, 5 March 2019. https://www.nytimes.com/2019/03/05/health/depression-withdrawal-drugs.html; Mark Abie Horowitz, PhD, Prof. David Taylor, PhD, “Tapering off SSRI treatment to mitigate withdrawal symptoms,” The Lancet, Psychiatry, Volume 6, Issue 6, P538-546, June 01, 2019. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30032-X/fulltext
  2. Department of Health and Ageing Therapeutic Goods Administration, “Medicines associated with a risk of neuropsychiatric adverse events,” Medicines Safety Update, Volume 9, Number 2, June 2018. https://www.tga.gov.au/publication-issue/medicines-safety-update-volume-9-number-2-june-2018 ; Tran N, Castle D, “Outcomes from a regular medication information program for consumers with a mental health illness,: Australasian Psychiatry, 20 April 2012.
  3. John Read PhD, Claire Cartwright PhD, Kerry Gibson PhD, “How many of 1829 antidepressant users report withdrawal effects or addiction?” International Journal of Mental Health Nursing, 5 June 2018. https://onlinelibrary.wiley.com/doi/full/10.1111/inm.12488; “Antidepressant users unprepared for withdrawal symptoms,” Pharmacy News, 7 June 2018. https://www.ausdoc.com.au/news/antidepressant-users-unprepared-withdrawal-symptoms-0
  4. Department of Health and Ageing Therapeutic Goods Administration, “Medicines associated with a risk of neuropsychiatric adverse events,” Medicines Safety Update, Volume 9, Number 2, June 2018. https://www.tga.gov.au/publication-issue/medicines-safety-update-volume-9-number-2-june-2018
  5. Department of Health and Ageing Therapeutic Goods Administration, “Antidepressants – Communicating risks and benefits to patients,” Medicines Safety Update, Volume 7, Number 5, October-December 2016. https://www.tga.gov.au/publication-issue/medicines-safety-update-volume-7-number-5-october-december-2016
  6. Department of Health and Ageing Therapeutic Goods Administration, Safety advisory, “Citalopram and heart problems – changes to recommended doses,” 4th November 2011. https://www.tga.gov.au/alert/citalopram-and-heart-problems-changes-recommended-doses
  7. Department of Health and Ageing Therapeutic Goods Administration, Medicines Safety Update “In utero antipsychotic exposure and neonatal extrapyramidal and withdrawal adverse effects”
    Volume 2, Number 4, August 2011.
  8. “Suicidality with SSRIs: adults and children,” The Australian Therapeutic Goods Administration, Adverse Drug Reactions Bulletin, Vol. 24, No. 4, August 2005. https://www.tga.gov.au/publication-issue/australian-adverse-drug-reactions-bulletin-vol-24-no-4
  9. “General information concerning use of SSRI antidepressants in pregnant women” Australian Government, Department of Health and Ageing September 7, 2005. https://www.tga.gov.au/alert/ssri-antidepressants-information-health-professionals-concerning-use-ssri-antidepressants-pregnant-women
  10. 10 SSRIs and neonatal disorders…” Therapeutic Goods Administration, Australian Adverse Drug Reactions Bulletin Volume 16, Number 4, November 1997. https://www.tga.gov.au/publication-issue/australian-adverse-drug-reactions-bulletin-vol-16-no-4
  11. 11 7 “Maternal SSRI Use and Neonatal Effects,” The Australian Therapeutic Goods Administration, Adverse Drug Reactions Bulletin, Vol 22, No. 4, August, 2003. https://www.tga.gov.au/publication-issue/australian-adverse-drug-reactions-bulletin-vol-22-no-4
  12. “Patient Online Report of Selective Serotonin Reuptake Inhibitor-Induced Persistent Post-withdrawal Anxiety and Mood Disorders,” Psychotherapy and Psychosomatics, 19 Jan, 2012.
  13. Ibid.
  14. “Withdrawal from psychiatric drugs can be disabling and can cause a range of severe Physical and Psychological effects….”Council for Evidence-based Psychiatry, 15 Mar. 2014. https://ravimid.files.wordpress.com/2015/02/psychiatric-drug-withdrawal-can-be-disabling-010314-1.pdf
  15. Joanna Moncrieff, M.B.B.S., David Cohen and Sally Porter,” The psychoactive Effects of Psychiatric Medication: The Elephant in the Room,”Journal of Psychoactive Drugs, Nov. 2013; 45(5): 409-415, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4118946/.
  16. Carmela Solomon, Bridget Elizabeth Hamilton, “Antipsychotic discontinuation syndromes: A Narrative review of the evidence and its integration into Australian mental health nursing textbooks, International Journal of Mental Health Nursing, December 2012.
  17. Product Information Alprax, alprazolam, 5 Feb 2018.
  18. “Benzodiazepine withdrawal,” Healthy Information for Western Australian’s, Department of Health, https://healthywa.wa.gov.au/Articles/A_E/Benzodiazepine-withdrawal
  19. Therapeutic Goods Administration Database of Adverse Event Notifications-Medicines, List of reports generated for each antidepressant & antipsychotic as of 3/01/19 and added manually. https://www.tga.gov.au/database-adverse-event-notifications-daen