#Pharmacoepidemiology

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.