Viloxazine shows a strong withdrawal signal
STUDY: Ebina T et al, Psychiatry Clin Neurosci Rep 2026;5:e70337
STUDY TYPE: Pharmacovigilance study (disproportionality analysis)
FUNDING: Japan Society for the Promotion of Science
Background
Most clinicians know to taper ADHD meds gradually to prevent withdrawal symptoms like fatigue from stimulants or blood pressure spikes from alpha-2 agonists like guanfacine and clonidine. But what about atomoxetine (Strattera) and viloxazine (Qelbree)? an cause blood slowly, but guidance on stopping non-stimulants is sparse.
The Study
This study mined nearly 20 million reports from the FDA Adverse Event Reporting System (FAERS) for withdrawal-related adverse effects from FDA-approved ADHD medications. They used reporting odds ratios to flag disproportionate withdrawal signals.
Withdrawal signals emerged for all meds except atomoxetine. Clonidine showed a meaningful signal (reporting odds ratio 3.0), consistent with its known rebound hypertension risk. The surprise was viloxazine, which had the strongest signal by far (reporting odds ratio 8.7) — higher than any stimulant, and may be related to its serotonergic effects (it is a repurposed SNRI, used in Europe for depression since the 1970s).
Limitations: Viloxazine is also newly approved with relatively few total reports. This type of study doesn’t establish causation.
Chart from Difficult to Treat Depression, Chris Aiken, Carlat Publishing: 2025.
Practice Implications
- When in doubt, taper off meds gradually, over at least 2-4 weeks at often longer.
- When it comes to withdrawal, research is thin and we are always in doubt.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
