Vinkers et (2021) helpfully talk about the proof associated to antidepressant withdrawal. As they are saying:
When confronted with the opportunity of discontinuation, sufferers, their members of the family and physicians concern recurrence of the dysfunction, and may additionally concern antidepressant discontinuation signs [see eg. previous post] …. The significance and prevalence of antidepressant discontinuation distinction largely with the restricted scientific proof and medical consideration for this matter. … [D]iscussions … are significantly pushed by opinions or private experiences relatively than proof.
There are methodological issues of antidepressant discontinuation research, not least that blinding methods are sometimes inadequate to correctly tackle placebo and nocebo elements (see eg. earlier submit). The overview notes that antidepressant discontinuation signs even happen in blinded antidepressant arms when antidepressants are continued. Proof is required concerning the underlying mechanisms of antidepressant withdrawal (see eg. earlier submit).
Because the additionally useful NICE draft guideline suggestions clarify:
Dependence is characterised by tolerance (the necessity for rising doses to keep up the identical impact) and withdrawal signs if the dose is decreased or the medication is stopped abruptly. Dependancy additionally options tolerance and withdrawal however has the extra traits of cravings, lack of management, overuse and continued use regardless of hurt. There may be appreciable debate in relation to those definitions, and in observe, the phrases are sometimes used interchangeably.
Antidepressants don’t trigger tolerance in the identical method as alcohol and opioids. Nor ought to individuals who makes use of antidepressants be seen as drug addicts, within the sense of drug abusers, as antidepressants should not stimulants as such and don’t create cravings (see earlier submit). As I’ve stated a number of occasions earlier than, psychological dependence on antidepressants shouldn’t be minimised (see eg. earlier submit). The precise function of any bodily dependence wants additional clarification.
