Eduard Vieta
Professor of Psychiatry at the University of Barcelona, Head of the Psychiatry and Psychology Department at Hospital Clínic in Barcelona, and researcher at the Biomedical Research Centre in Mental Health (CIBERSAM)
This is a high-quality meta-analysis that examines the clinically relevant phenomenon of rebound symptoms and discomfort at the time of discontinuation of antidepressant treatment, which occurs with some frequency (in the study data, in 15% of patients).
The study confirms what we already knew, i.e. that this is a real phenomenon and that it occurs with some frequency with some drugs, but not all.
The methodology is excellent but not free of biases and limitations, mostly derived from those of the studies analysed. Among them, it should be noted that the study has focused on controlled clinical trials, which is a strength as it has a placebo control group, but also a limitation, as the data may not faithfully reflect what happens in clinical samples outside the scope of clinical trials and that the discontinuation phase of treatment is usually open-label (without masking).
The implications of the study are that one in six patients may experience symptoms following discontinuation of antidepressant treatment that may appear to be relapse symptoms, but are actually caused by more or less abrupt discontinuation of the drug, and that venlafaxine, desvenlafaxine, paroxetine and imipramine are the drugs most frequently associated with this phenomenon. Both patients and psychiatrists should avoid abruptly discontinuing these drugs or opt for others that are not associated with this problem.