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Publication type: Article in scientific journal
Type of review: Peer review (publication)
Title: Estimating risk of antidepressant withdrawal from a review of published data
Authors: Horowitz, Mark Abie
Framer, Adele
Hengartner, Michael P.
Sørensen, Anders
Taylor, David
et. al: No
DOI: 10.1007/s40263-022-00960-y
Published in: CNS Drugs
Volume(Issue): 37
Issue: 2
Page(s): 143
Pages to: 157
Issue Date: 14-Dec-2022
Publisher / Ed. Institution: Springer
ISSN: 1172-7047
Language: English
Subject (DDC): 615: Pharmacology and therapeutics
616.8: Neurology, diseases of nervous system
Abstract: Adaptation of the brain to the presence of a drug predicts withdrawal on cessation. The outcome of adaptation is often referred to as 'physical dependence' in pharmacology, as distinct from addiction, although these terms have unfortunately become conflated in some diagnostic guides. Physical dependence to antidepressants may occur in some patients, consistent with the fact that some patients experience withdrawal effects from these medications. It is thought that longer duration of use, higher dose and specific antidepressants affect the risk of antidepressant withdrawal effects as they might cause greater adaptation of the brain. We searched PubMed for relevant systematic reviews and other relevant analyses to summarise existing data on determinants of antidepressant withdrawal incidence, severity and duration. Overall, data were limited. From survey data, increased duration of use was associated with an increased incidence and severity of withdrawal effects, consistent with some evidence from data provided by drug manufacturers. Duration of use may be related to duration of withdrawal effects but data are heterogenous and sparse. Serotonin and noradrenaline reuptake inhibitors and paroxetine are associated with higher risks than other antidepressants, though data for some antidepressants are lacking. Higher doses of antidepressant has some weak association with an increased risk of withdrawal, with some ceiling effects, perhaps reflecting receptor occupancy relationships. Past experience of withdrawal effects is known to predict future risk. Based on these data, we outline a preliminary rubric for determining the risk of withdrawal symptoms for a particular patient, which may have relevance for determining tapering rates. Given the limited scope of the current research, future research should aim to clarify prediction of antidepressant withdrawal risk, especially by examining the risk of withdrawal in long-term users of medication, as well as the severity and duration of effects, to improve the preliminary tool for predictive purposes. Further research into the precise adaptations in long-term antidepressant use may improve the ability to predict withdrawal effects for a particular patient.
Fulltext version: Published version
License (according to publishing contract): CC BY-NC 4.0: Attribution - Non commercial 4.0 International
Departement: Applied Psychology
Organisational Unit: Psychological Institute (PI)
Published as part of the ZHAW project: Antidepressiva Entzug bei Hausarzt-PatientInnen
Appears in collections:Publikationen Angewandte Psychologie

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Horowitz, M. A., Framer, A., Hengartner, M. P., Sørensen, A., & Taylor, D. (2022). Estimating risk of antidepressant withdrawal from a review of published data. CNS Drugs, 37(2), 143–157.
Horowitz, M.A. et al. (2022) ‘Estimating risk of antidepressant withdrawal from a review of published data’, CNS Drugs, 37(2), pp. 143–157. Available at:
M. A. Horowitz, A. Framer, M. P. Hengartner, A. Sørensen, and D. Taylor, “Estimating risk of antidepressant withdrawal from a review of published data,” CNS Drugs, vol. 37, no. 2, pp. 143–157, Dec. 2022, doi: 10.1007/s40263-022-00960-y.
HOROWITZ, Mark Abie, Adele FRAMER, Michael P. HENGARTNER, Anders SØRENSEN und David TAYLOR, 2022. Estimating risk of antidepressant withdrawal from a review of published data. CNS Drugs. 14 Dezember 2022. Bd. 37, Nr. 2, S. 143–157. DOI 10.1007/s40263-022-00960-y
Horowitz, Mark Abie, Adele Framer, Michael P. Hengartner, Anders Sørensen, and David Taylor. 2022. “Estimating Risk of Antidepressant Withdrawal from a Review of Published Data.” CNS Drugs 37 (2): 143–57.
Horowitz, Mark Abie, et al. “Estimating Risk of Antidepressant Withdrawal from a Review of Published Data.” CNS Drugs, vol. 37, no. 2, Dec. 2022, pp. 143–57,

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