Withdrawal, dependence and adverse events of antidepressants: lessons from patients and data

Tolerability, withdrawal effects and dependence on prescription medication is an important topic of current scientific and clinical debate, as highlighted by the recent report published on September 2019 by Public Health England (https://www.gov.uk/government/publications/prescribed-medicines-review-report).1 This was a mixed methods public health review of available evidence in adults focusing on specific issues of dependence and withdrawal associated with five groups of medications: (1) benzodiazepines, (2) z-drugs, (3) gabapentin and pregabalin, (4) opioids and (5) antidepressants. The evidence included in the review consisted of: General practitioner (GP) patient data (real-world data), community prescription data in England reported during 2015–2018, longer-term prescription cost analysis data from 2008 in England, and a rapid evidence assessment of published and unpublished literature, including randomised and observational studies. The grey literature was used mainly as a source of information on patients’ experiences. Retrieved information was carefully appraised and the review findings were given a level of confidence using the GRADE-CERQual framework (https://www.cerqual.org/). In the report, three different inter-related entities were considered: dependence was defined as ‘an adaptation to repeated exposure to some drugs or medicines usually characterised by tolerance and withdrawal….’ (p8), tolerance as ‘neuroadaptation arising from repeatedly taking some drugs and medicines, in which higher doses are required to achieve a desired effect’ (p8) and withdrawal as ‘physiological reactions when a drug or medicine that has been taken repeatedly is removed’ (p8). Results about antidepressants …