Antidepressant adverse effects and withdrawal symptoms can continue after quitting, including sexual dysfunction, authors of a new review say.

A new review of antidepressants advised doctors to curb prescribing the drugs, given their questionable efficacy and the risks of harmful side effects during use and discontinuation that can be severe and long-lasting.

Addressing a concern over the steadily growing number of antidepressant users, British researchers Mark Horowitz, Ph.D., of the Division of Psychiatry at University College London, and Michael Wilcock, pharmaceutical researcher at Royal Cornwall Hospitals NHS Trust, reviewed meta-analyses of studies of the newer generation SSRI and SNRI antidepressants. 

Writing in The BMJ’s Drug and Therapeutics Bulletin, they found no clinically significant difference in measures of depression symptoms between adults treated with antidepressants and those taking placebos, whether over a shorter or longer timeframe and regardless of the depression severity of the study participants. 

They further concluded that findings in studies of antidepressant efficacy in adolescents and children “are even less convincing.”  They found that published accounts of clinical studies involving adolescents exaggerated benefits by various means, such as reporting different outcomes than the ones specified for investigation in the initial study proposal.  The researchers also asserted that risks were under-reported in the studies, such as by coding suicide attempts by study participants taking antidepressants as “emotional lability” [mood swings].

Turning to the side effects of antidepressants, the researchers referenced a study of patients who had taken an SSRI antidepressant for one year, which found nearly two-thirds of them (64%) had at least one adverse effect, while one-third of them (31%) had three or more, including sleepiness, weight gain, restlessness, muscle spasms or twitching, nausea, constipation, diarrhea and dizziness.  One in four patients reported sexual problems.

Side effects were reported at a higher rate by longer-term users.  In a survey of patients taking antidepressants for longer than three years, 71% reported emotional numbness, 70% felt “foggy or detached,” 66% had sexual problems, and 63% reported drowsiness.

“There is no guarantee that patients will avoid consequences [of discontinuing antidepressants] such as long-lasting sexual side effects or persistent withdrawal symptoms even with a cautious taper.”
— Mark Horowitz, Ph.D., and Michael Wilcock, pharmaceutical researcher

These adverse effects might not go away when the antidepressant is discontinued.  “There is evidence that some adverse effects can persist after cessation, including sexual dysfuntion,” the researchers wrote.  The medical term “post-SSRI sexual dysfunction” is used for the inability to resume a normal sexual experience after the discontinuation of SSRI and SNRI antidepressants and some tricyclic antidepressants.

Of special note by the researchers were the adverse effects experienced when users attempted to stop taking antidepressants, even when doing so gradually over time.  These are the side effects of antidepressants most reported to the FDA.  Depending on the drug and the length of time taken, the withdrawal effects may include high blood pressure, electrical shock-like “brain zaps,” seizures, stroke-like symptoms, amnesia, fear, anger, aggressive behavior, hallucinations, and suicidal thoughts.

“There is increasing recognition that withdrawal symptoms from antidepressants are common and that these symptoms can be severe and long-lasting in some patients,” the researchers wrote. 

“There is no guarantee that patients will avoid consequences such as long-lasting sexual side effects or persistent withdrawal symptoms even with a cautious taper,” they added.

Numerous other research studies have found harms associated with antidepressants.  A search for the term “antidepressant” in the Citizens Commission on Human Rights (CCHR) psychiatric drugs side effects database currently returns 283 drug studies and 155 international drug regulatory agency warnings concerning the adverse effects of antidepressants, including the increased risk of suicide and violence.

Among them is a 2016 study by Nordic Cochrane Centre researchers led by Andreas Bielefeldt, who conducted an extensive and systematic analysis of clinical trials in which SSRI and SNRI antidepressants were given to healthy adult volunteers with no signs of depression.  The conclusion, published in the British Journal of the Royal Society of Medicine in 2016, was that “antidepressants double the risk of suicidality and violence.”  

The severity and duration of symptoms from antidepressant withdrawal was the subject of a study published in Addictive Behaviors in 2019, in which researchers James Davies, Ph.D., co-founder of the U.K.-based Council for Evidence-based Psychiatry, and John Read, Ph.D., a professor of clinical psychology at the University of East London, analyzed 23 earlier peer-reviewed studies.  They found that more than half (56%) of people who attempt to come off antidepressants experience withdrawal effects, with nearly half (46%) of them describing those effects as severe, and that the symptoms can persist for months. 

WARNING:  Anyone wishing to discontinue or change the dose of an antidepressant or other psychiatric drug is cautioned to do so only under the supervision of a physician because of potentially dangerous withdrawal symptoms.  The Citizens Commission on Human Rights continues to make consumers aware of the serious adverse effects of antidepressants and other psychiatric drugs so they can make fully informed decisions before starting or quitting the drugs.  CCHR also continues to press government mental health and drug agencies to issue further warnings about these risks.