A newly published review in JAMA Psychiatry has sparked controversy among mental health experts, raising concerns that it significantly underestimates the risks faced by long-term users of antidepressants when they attempt to discontinue their medication. The debate centers on the review’s focus on short-term, industry-funded studies and has important implications for millions worldwide, including a growing cohort of patients in Thailand who rely on antidepressant therapy.
Antidepressant withdrawal — the range of physical and psychological symptoms experienced when stopping or reducing dosage — has come under increased scrutiny as more people use these medications for extended periods. While previous medical guidelines, such as those from the UK’s National Institute for Health and Care Excellence (NICE), described withdrawal as “brief and mild,” recent scrutiny has revealed a more complex picture, particularly for long-term users. The new JAMA Psychiatry review, authored in part by academics with ties to pharmaceutical companies, concludes that withdrawal symptoms from antidepressants are generally not clinically significant for most users, especially those on the medication for only eight to twelve weeks. Its analysis, based on eleven trials — the vast majority of which involved short-term use — found slightly more withdrawal symptoms in those stopping antidepressants than in placebo groups, but the authors attribute much of this to the “nocebo effect” (the power of negative expectations to trigger adverse symptoms) rather than to withdrawal itself.
However, leading experts in psychiatry and pharmacology argue that these findings risk minimizing the experiences of those who have taken antidepressants for years. According to a recent survey-based study conducted within the UK National Health Service (NHS), the duration of antidepressant use is strongly correlated with both the likelihood and the severity of withdrawal. Individuals who had used antidepressants for over two years were found to be ten times more likely to suffer from withdrawal effects than those who used them for less than six months, five times more likely to have severe symptoms, and 18 times more likely to experience symptoms lasting over three months. For Thailand, where the incidence of depression is rising and long-term drug therapy is becoming more common in urban centers, this research is particularly relevant. Current Thai treatment guidelines, modeled on international recommendations, do not fully address the withdrawal risks posed by long-term antidepressant use. Patients in Thailand who struggle with persistent symptoms after stopping these medications often encounter skepticism or misdiagnosis at primary care facilities, likely reflecting the same gaps in clinical understanding noted in global studies.
The distinction between drug withdrawal and relapse of depression is critically important for both patients and clinicians. As pointed out by psychiatric researchers, ongoing withdrawal symptoms such as dizziness, headaches, or sensory disturbances may be mistaken for a return of depressive illness, leading to unnecessary or prolonged medication use. The debated review suggests that depression symptoms following discontinuation are simply the return of the underlying disorder, since similar rates were found in placebo groups. However, this assumption has been criticized for relying on unprompted participant self-reporting and a small, potentially unrepresentative sample. Other well-designed pharmaceutical studies, notably one in the United States examining patients after eleven months of antidepressant use, found that more than 60% experienced significant withdrawal symptoms. This figure suggests that real-world withdrawal risk is far higher than indicated by short-duration, industry-funded trials that dominate the research landscape.
From an expert perspective, the problem lies in the methodologies used in recent reviews. By subtracting symptoms reported by placebo groups or users continuing antidepressants from those stopping the drug, reviewers may downplay withdrawal effects, assuming that overlap with common ailments means these symptoms are not caused by withdrawal. Yet, as summarized in alternative medical reviews, symptoms experienced after discontinuing placebos tend to be milder and less prolonged than those suffered by patients stopping actual antidepressant medications, sometimes necessitating emergency care.
In the context of Thailand, the debate is far from theoretical. Over the past decade, the Thai Ministry of Public Health has reported a steady increase in antidepressant prescriptions, paralleling trends in the United States and Europe. A recent BBC investigation reports that in England alone, two million people have been on antidepressants for over five years, with the US figure at least 25 million. While comparable data in Thailand are limited, hospital pharmacies in Bangkok, Chiang Mai, and Khon Kaen report similar increases in long-term use, especially among working-age adults and elderly Thais seeking to maintain mental health amid changing social and economic conditions. Yet widespread misunderstanding around withdrawal means Thai patients may face unnecessary suffering, sometimes attributing withdrawal effects to personal weakness or spiritual disharmony, deepening stigma and discouraging open dialogue about mental health.
Thai psychiatrists and mental health educators emphasize the need for better public awareness regarding the risks of long-term antidepressant use and withdrawal. An officer from a leading psychiatric hospital in Bangkok highlighted that, “Patients are often unaware of tapering strategies and may abruptly stop medication, precipitating intense symptoms.” Thai cultural attitudes toward suffering — including Buddhist notions of impermanence and mind-over-matter — can also compound risks by encouraging patients to silently endure symptoms rather than consult healthcare professionals. At present, most withdrawal guidelines in Thailand recommend gradual dose reduction but lack detail on symptom identification or management, especially for those with prolonged use.
Internationally, growing recognition of the problem is driving change. In recent years, the UK government has acknowledged antidepressant withdrawal as a public health concern, and advocacy groups in the US are calling for reevaluation of treatment guidelines based on new research. The hope is that Thailand will follow suit, updating clinical protocols to recognize and manage withdrawal risks tailored to the needs and cultural background of Thai patients.
Looking ahead, the flood of new research on antidepressant withdrawal brings both opportunities and challenges. Increased data transparency, inclusion of long-term users in clinical trials, and culturally appropriate educational programmes for both clinicians and patients are critical for improving outcomes. The controversial JAMA Psychiatry review demonstrates the influence of research funding and study design on medical guidelines — a reminder to Thai authorities to carefully consider the full spectrum of available data before shaping policy.
For Thai readers considering starting or stopping antidepressant therapy, experts recommend open communication with healthcare providers: “Never discontinue antidepressants abruptly. Always consult with a trained mental health professional, and ask about gradual dose reductions tailored to your individual case.” Support groups, online forums, and mental health hotlines can also provide valuable information in Thai language, empowering patients to make informed, compassionate choices.
For more on this topic, see the original article at The Conversation, and further background from BBC, NHS, and the Royal College of Psychiatrists.