Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum

Abstract

Background: Protracted withdrawal syndrome (PWS) after stopping antidepressants (frequently also referred to as post-acute withdrawal syndrome or PAWS) has been described in a few case reports. However, a detailed quantitative analysis of specific symptom manifestations in antidepressant PWS is still lacking.

Methods: We extracted patient narratives from a large English-language internet forum SurvivingAntidepressants.org, a peer support site concerned about withdrawal from antidepressants. PWS was ascertained based on diagnostic criteria proposed by Chouinard and Chouinard, specifically ⩾6 months of continuous antidepressant use, with emergence of new and/or more intense symptoms after discontinuation that last beyond the initial 6 weeks of acute withdrawal. We assessed medication history, outcome of PWS, and the prevalence of specific symptoms.

Results: In total, n = 69 individual reports of protracted withdrawal were selected for analysis. At time of the subjects' most recent reports, duration of PWS ranged from 5 to 166 months, mean = 37 months, median = 26 months. Length of time on the antidepressant causing protracted withdrawal ranged from 6 to 278 months, mean = 96 months, and median = 79 months. Throughout the withdrawal experience, affective symptoms, mostly anxiety, depression, emerging suicidality and agitation, were reported by 81%. Somatic symptoms, mostly headache, fatigue, dizziness, brain zaps, visual changes, muscle aches, tremor, diarrhea, and nausea were reported by 75%. Sleep problems (44%) and cognitive impairments (32%) were mentioned less frequently. These broad symptom domains were largely uncorrelated.

Conclusion: PWS or PAWS from antidepressants can be severe and long-lasting, and its manifestations clinically heterogeneous. Long-term antidepressant exposure may cause multiple body system impairments. Although both somatic and affective symptoms are frequent, they are mostly unrelated in terms of occurrence. Proper recognition and detection of PWS thus requires a comprehensive assessment of medication history, duration of the withdrawal syndrome, and its various somatic, affective, sleep, and cognitive symptoms.

Keywords: PAWS; antidepressant; discontinuation; persistent post-withdrawal disorder; protracted.

Figure 1.

Antidepressants suspected to precipitate PWS. PWS, protracted withdrawal syndrome.

Figure 2.

Recorded duration of PWS among subjects at time of last report. Blue dots indicate the 9 who resolved with reinstatement of the antidepressant precipitating PWS. Blue diamonds indicate the 2 who benefited significantly from other subsequent psychotropic treatment; orange dots the 4 who experienced only some benefit. Green dots indicate the 4 who resolved naturally without subsequent drug treatment; yellow, the 12 who, at last report, were partially recovered; violet, 2 suicides. The gray dots indicate the remaining 36 individuals for whom resolution of PWS has not been reported. PWS, protracted withdrawal syndrome.

Figure 3.

Outcomes for subjects with PWS as recorded at time of last report. PWS, protracted withdrawal syndrome.

Figure 4.

Prevalence rates of protracted withdrawal symptoms. Somatic is a higher-order domain and comprises general, balance, sensory, visual, neuromotor, vasomotor, and gastrointestinal symptoms.