A recent review in JAMA Psychiatry has reignited debate among mental health professionals about withdrawal risks for people who discontinue antidepressants, especially after extended use. This discussion is timely for Thailand, where more patients rely on long‑term therapy and guidelines continue to adapt to evolving evidence.
Antidepressant withdrawal involves a spectrum of physical and psychological symptoms that can occur when reducing or stopping medication. Earlier guidelines, including NICE in the UK, described withdrawal as brief and mild. Newer research paints a more nuanced picture, particularly for long‑term users. The JAMA Psychiatry review analyzed eleven trials, most of which examined short‑term use, and found slightly more withdrawal symptoms in those stopping antidepressants than in placebo groups. The authors attributed much of this to the nocebo effect—the power of negative expectations to trigger symptoms—rather than withdrawal itself.
Top experts in psychiatry and pharmacology caution that these findings may understate the experiences of people who have used antidepressants for years. In the UK NHS, a survey‑based study showed that individuals using antidepressants for more than two years were far more likely to report withdrawal symptoms than those using them for under six months. They were ten times more likely to experience any withdrawal, five times more likely to have severe symptoms, and 18 times more likely to have symptoms lasting beyond three months. This has particular relevance for Thailand, where depression rates are rising and long‑term pharmacotherapy is increasingly common in urban centers. Thai treatment guidelines are often modeled on international recommendations, but they do not consistently address withdrawal risks from prolonged use. In practice, Thai patients who experience persistent symptoms after stopping may face skepticism or misdiagnosis in primary care, reflecting broader gaps in understanding.
Distinguishing withdrawal from relapse is essential. Symptoms such as dizziness, headaches, or sensory changes can mimic a return of depression, potentially leading to ongoing medication use. Some critics of the JAMA Psychiatry interpretation argue that relying on self‑reported data and selected samples may obscure real withdrawal experiences. Elsewhere, a U.S. study following eleven months of antidepressant use found that more than half of participants reported meaningful withdrawal symptoms, suggesting higher real‑world risk than short trials indicate.
Methodological choices in recent reviews matter. Subtracting placebo or continuation group symptoms from stopping symptoms can dampen perceived withdrawal effects. Yet, withdrawal symptoms often differ in intensity and duration from placebo‑associated symptoms and can require medical attention.
In Thailand, the issue is not theoretical. Data from the Ministry of Public Health show rising antidepressant prescriptions over the past decade, with urban centers like Bangkok and Chiang Mai reporting longer durations of use among working‑age adults and older individuals seeking mental health support amid social and economic changes. Widespread misunderstandings about withdrawal can lead to unnecessary suffering, downward spirals of stigma, and reluctance to seek help.
Thai psychiatrists and health educators stress better public awareness of long‑term antidepressant risks and tapering strategies. A representative from a leading Bangkok hospital noted that many patients are unaware of gradual tapering and may abruptly stop, precipitating intense symptoms. Thai cultural context—mindfulness, resilience, and acceptance—can influence how patients perceive and report symptoms, underscoring the need for sensitive clinician‑patient conversations and clear guidance. Current Thai guidelines advise gradual dose reduction but lack detailed instructions for identifying and managing withdrawal, especially for long‑term users.
International momentum to address withdrawal is growing. The UK has acknowledged antidepressant withdrawal as a public health concern, while advocacy groups in the United States call for guideline reevaluation based on new data. Thailand is encouraged to adapt policies to recognize withdrawal risks among Thai patients and to tailor support accordingly.
Emerging research presents both opportunities and challenges. Greater data transparency, the inclusion of long‑term users in trials, and culturally appropriate education for clinicians and patients are essential to improve outcomes. The JAMA Psychiatry findings remind Thai health authorities to weigh the full spectrum of evidence when shaping policy.
For readers considering starting or stopping antidepressants in Thailand, the emphasis is on collaboration with healthcare providers. Do not discontinue abruptly. Seek guidance on tapering plans that fit individual needs. Access to Thai‑language resources, support groups, and hotlines can empower patients to navigate decisions with confidence and compassion.