Linking To And Excerpting From Psychiatry Online’s “Antidepressant Withdrawal”

Today, I review, link to, and excerpt from Psychiatry Online‘s “Antidepressant Withdrawal“. Publication Date: 27 August 2025. Psychiatric News
Volume 60, Number 9 https://doi.org/10.1176/appi.pn.2025.09.9

All that follows is from the above resource.

Even as one in eight adults in the U.S. population is prescribed an antidepressant, there is little formal guidance on how to safely, effectively taper off these medications. Here’s what psychiatrists need to know about withdrawal, including how to avoid it—and what can be done to improve its detection, prevention, and management.

Antidepressant withdrawal, recognized as antidepressant discontinuation syndrome in the DSM-5-TR, is a distressing condition that occurs after the abrupt or rapid discontinuation of antidepressant drugs. Once considered mild and short-lived (Rosenbaum & Zajecka, 1997), it is increasingly recognized as a significant clinical concern often associated with substantial morbidity and functional impairment (Horowitz & Taylor, 2019).

This report highlights the epidemiology and clinical features of antidepressant withdrawal, associated risk factors, principles of safely tapering antidepressants, and current gaps in care resulting from lack of formalized guidance and research.

Epidemiology and Clinical Features

Systematic reviews estimate the overall incidence of antidepressant withdrawal as ranging from 33% to 56% (Henssler, et al., 2024; Davies & Read, 2019). The estimated incidence of severe forms of withdrawal varies considerably. A 2019 meta-analysis reported that severe symptoms occur in 25% of patients, but this finding was likely inflated due to selection bias associated with the inclusion of online surveys (Davies & Read, 2019). A more recent meta-analysis estimated the rate to be as low as roughly 3% of patients, but this analysis included mostly studies that relied on spontaneous reporting of symptoms, and also included many studies of shorter duration: Nearly half of included studies were less than 12 weeks, and the weighted average of all included studies was 25 weeks (Henssler, et al., 2024). Given that the risk of withdrawal appears to increase significantly with longer-term use and that the median duration for antidepressant treatment in the United States is five years (Ward, et al., 2025), the inclusion of studies with such short treatment periods likely led to an underestimation of incidence in typical clinical populations. Thus, incidence—particularly of severe withdrawal—has not yet been definitively characterized and should be a research priority moving forward.

In terms of symptomatology, acute antidepressant withdrawal involves a constellation of cognitive, psychiatric, and somatic symptoms that typically occur within 24 to 48 hours of stopping treatment (Figure 1) (Horowitz & Taylor, 2019). Common symptoms include dizziness, irritability, anxiety, and electric shock–like sensations in the head described as “brain zaps” (Shapiro, et al., 2023). Nearly all clinical studies of antidepressant withdrawal to date have involved treatment with selective serotonin reuptake inhibitors (SSRIs), and antidepressants with little or minimal serotonergic activity may have different characteristic symptoms based on their pharmacologic profile. Somatic and neurologic sensations such as dizziness, brain zaps, and paresthesia can help distinguish acute antidepressant withdrawal from relapse of an underlying psychiatric condition. Acute symptoms typically abate within two to four weeks, although a subset of patients experience protracted withdrawal symptoms that can last several months or longer and may not fully improve with antidepressant reinstatement (Cosci & Chouinard, 2020). Functionally, antidepressant withdrawal has been associated with missed work days, reduced productivity, and increased health care costs resulting from unnecessary medical workup (Rosenbaum & Zajecka, 1997).

Risk Factors

Start here.