Coming Off Antidepressants: Why We Must Do It Slowly

Antidepressants have changed the face of modern psychiatry. For many people, these medications are an important and necessary part of their therapy. But whether reducing intake to move to another medication, or to try a different therapy, to eliminate a drug-interaction, or some other reason, sometimes, we have to cut ties with an existing antidepressant. And in this case, doing so slowly is not only imperative but to do otherwise may be dangerous. Here’s why.

Physical Withdrawals from Antidepressants

The physical withdrawal symptoms that can come with stopping just about any antidepressant can be extremely uncomfortable. According to the Addiction Center, symptoms can begin as early as 1 to 3 days after stopping antidepressants even with tapering. Withdrawal intensity typically increases for 1 to 3 weeks, during which time the patient may experience:

• Headache
• Fever
• Dizziness
• Nausea
• Diarrhea
• Coordination issues
• Confusion
• Insomnia

Another common withdrawal symptom, “brain zaps,” which literally feels like shocks of electricity rushing through the brain, can be especially distressing. The severity of withdrawal symptoms can vary depending on the medication, dose and how long the person was on it. But ultimately, the primary reason to taper off rather than to just quit is that people who attempt to quit antidepressants “cold turkey” are more likely to experience severe symptoms.

SSRI Specific Withdrawal

Selective serotonin reuptake inhibitor (SSRI) withdrawals can sometimes lead to problems, but serotonin- and noradrenaline-reuptake inhibitors (SNRIs) may cause additional issues. They affect noradrenaline in addition to serotonin levels, and withdrawal can cause severe discomfort that may include sweating, vomiting and vertigo.

Stopping selective serotonin- and norepinephrine inhibitors (SNRIs) can cause extreme agitation, anxiety, restlessness and hypomania. Withdrawals from antidepressants that affect dopamine receptors, such as tricyclic antidepressants and MAOIs, may include hallucinations. 

Emotional Effects of Antidepressant Withdrawal

The emotional effects of quitting an antidepressant can feel just as overwhelming as the physical symptoms, or even more so. Some people experience a rebound of depression, which can be severe enough to cause suicidal ideation. Researchers believe this could be due to a temporary serotonin deficit in the brain, particularly in SSRIs. Some people may also experience a clinical relapse, and this is why anyone considering stopping antidepressants should speak to their care providers at length before committing to any action toward that end. They should talk, at minimum, about the risks and benefits of continued antidepressant intervention versus post-intervention needs.

Coping During Withdrawal

Withdrawal from this type of medication can be distressing and physically taxing, and getting through them can feel like a near-impossible feat. Tapering slowly may very well reduce the severity, but symptoms can still be notable. If you’re withdrawing from antidepressants and suffering, talk to a doctor about trying a low dose of Benadryl to help with anxiety, nausea and insomnia. Some people find shifting temporarily to the SSRI fluoxetine, which is one of the easier antidepressants to stop taking, may help if symptoms are too severe.

No matter what route is taken, it's important to be under care both professionally and at home. This isn't something to attempt without having the support of experienced medical professionals and friends or family to help.

People choose to come off antidepressants for a number of reasons, and it can be a difficult choice. Mental health care is important; sometimes people need to take a chance on an antidepressant, and sometimes they need to take a chance on coming off of one. A slow taper can make it easier, but as we said, it’s important to do it under a doctor’s guidance. No matter what, we wish you the best of luck and good health.

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