Commonly used SNRIs may cause dependence and withdrawal when stopped

The difficulties that people have in discontinuing antidepressant medications has been in the news recently. An analysis published in the current issue of Psychotherapy and Psychosomatics on the effects of discontinuing commonly used antidepressant drugs like venlafaxine and duloxetine indicates that these drugs may cause dependence and withdrawal syndromes when they are stopped.

The Authors conducted a systematic review examining electronic databases including PubMed, the Cochrane Library, Web of Science, and MEDLINE from the inception of each database to June 2017. Sixty-one studies met the criteria for inclusion. There were 22 double-blind randomized controlled trials, 6 studies where patients were treated in an open fashion and then randomized to a double-blind controlled phase, 8 open trials, 1 prospective naturalistic study, 1 retrospective study, and 23 case reports. Results showed that withdrawal symptoms occurred after discontinuation of any type of serotonin-noradrenalin reuptake inhibitor (SNRI). The prevalence of withdrawal symptoms varied across reports and appeared to be higher with venlafaxine. Symptoms typically ensued within a few days from discontinuation and lasted a few weeks, also with gradual tapering. Late onset and/or a longer persistence of disturbances occurred as well.

These findings highlight the need for clinicians to add SNRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with other types of psychotropic drugs. The leading author of the study, Giovanni A. Fava, MD (University of Bologna and University at Buffalo) comments: "this type of antidepressant drugs is widely used with the wrong assumption that they do not cause dependence and problems upon discontinuation. We should be more cautious in prescribing them and be aware of the problems that ensue when you stop them."