Antidepressant withdrawal, not relapse, linked to mood changes
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When people stop taking antidepressants, they can feel terrible—their mood can plummet and anxiety can spike. But are these symptoms caused by withdrawal, or are they signs of a relapse?
A new study led by researchers at Adelaide University and in Switzerland has found that, for most people, withdrawal effects are likely responsible for the stronger depression and anxiety symptoms experienced when reducing antidepressant use.
Researchers followed more than 30 Swiss patients as they reduced their antidepressant doses over six months. They found that many participants experienced worsening mood and increased anxiety during antidepressant tapering, with symptoms increasing after medication reductions and settling when the dose was steady.
"This is a pattern that is typical of withdrawal rather than an episode of depression or anxiety," said Dr. Mark Horowitz, associate professor of psychiatry at Adelaide University and senior author of the study.
"Withdrawal symptoms tend to follow a wave pattern, shooting up after a dose reduction and settling when the dose is held steady. Relapse doesn't do that—it tends to get worse and worse.
"Low mood and anxiety are among the most common withdrawal symptoms from these drugs and can even occur in people without prior mental health problems. They can therefore be mistaken for a return of the underlying condition.
"Interestingly, our study found the worsening mood symptoms correlated substantially with physical symptoms like headaches, dizziness and brain zaps. In fact, when we took into account withdrawal effects for the patients, there was no longer any significant change in depression scores.
"This is not what we usually see when a mental health condition such as anxiety or depression returns and is evidence that patients are most likely experiencing medication withdrawal symptoms rather than a relapse."
About one in seven Australians takes an antidepressant each year.
Current Australian guidelines recommend six to 12 months of treatment after an episode of depression or anxiety, but many people remain on them longer.
"Stopping antidepressants can be very difficult. An increase in symptoms can often be interpreted as evidence that long-term treatment is needed," Horowitz said.
"However, it has become increasingly clear that antidepressant withdrawal effects are more common and severe than previously thought.
"Our new research suggests symptoms may reflect withdrawal, and to avoid this, a slower tapering process is needed when stopping or reducing the dose."
The findings have been published in the journal Psychotherapy and Psychosomatics, and Horowitz said the study adds to growing evidence from a number of studies looking into the long-term use of antidepressants.
"In my clinic, I see people who have felt trapped on antidepressants for years because attempts to stop have caused unbearable withdrawal symptoms," Horowitz said.
"Clinicians should recognize that withdrawal is probably more likely than relapse while people are reducing antidepressants.
"An increase in symptoms should prompt a slower, more careful hyperbolic taper, such as outlined in the Maudsley Deprescribing Guidelines, rather than be taken as evidence that the medication must be continued long term.
"For patients considering stopping, my message is: Do not stop abruptly. Speak to a knowledgeable clinician about a gradual, supported taper, using a liquid formulation or compounded capsules where necessary to reach the small doses required."
Publication details
Michael Hengartner et. al., Acute affective symptoms during antidepressant tapering indicate withdrawal reactions rather than relapse: Results from a prospective longitudinal cohort study, Psychotherapy and Psychosomatics (2026). DOI: 10.1159/pps/aemag002
Journal information: Psychotherapy and Psychosomatics
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PsychiatryPsychology & Mental healthClinical pharmacology Provided by University of Adelaide Who's behind this story?
Swati Mestri
Swati Mestri holds a bachelor's degree in Electronics Engineering and has worked as a content editor since 2019. She has experience editing research documents across technology, health care, and materials science, and has a particular interest in technology and space. Full profile →
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