What Does Antidepressant Withdrawal Mean?
MELISSA FULGIERI: My name
is Melissa Fulgieri.
I'm a social worker by trade.
The first time I knew that this
was a field I wanted to go into
was my Psych 101 class
as a senior in high school.
I think I was just totally
fascinated by the variety
of the profession
that you could just keep
learning and learning
and still never even scratch
the surface.
I don't know a human that isn't
struggling with something.
So I would say therapy is
for anyone and everyone that
wants to just know themselves
a little bit better.
I like working with folks who
have
high-functioning depression.
Once you start to motivate
people in slightly
a different way, not only can
you change a family
but you can change generations
to come.
What I love
about the current climate,
people are getting a lot more
comfortable with the concept
of therapy.
The more people can be really
honest about the fact
that they go to therapy, that's
one thing that I see as really
a motivator for people,
is knowing other people
in their circle that
go to therapy, knowing
that-- being able to see
mental health as the same thing
as health.
That's an ever-evolving process
that we always have to keep
in mind.
I feel like right now,
we have the most informed
consumers of therapy.
And that people will call me,
looking for therapy and be like,
"OK, I know I have
an anxious avoidant attachment
style, and I know that I was
raised by a narcissist."
People are becoming much more
knowledgeable about what's
happening in their own world.
But I also think we have
a long way to go.
There are a lot of people
out there struggling.
But there is a struggle on top
of that struggle, which is not
allowing yourself to get
the help you need.
So if you can work
on that first struggle
by reaching out for help,
you'll be able to work
on whatever you're struggling
with.
It's never too late
to do the work.
You can be in your 70s
and you can really change
the way you see the world.
So you want to really listen
to yourself and you want
to think about what's the work
that you want to do.
There's so much more to learn
no matter how many years I do
it.
But I think the main thing
that I love is how you can plant
seeds that you don't even know
what they'll grow into.
And so it's
an incredible experience
to be able to know
that the reward is not always
obvious but I know it's there.
If you've taken an antidepressant for at least 6 weeks and stop taking it suddenly, you may develop symptoms, such as nausea, flu-like symptoms, or insomnia. This is known as antidepressant withdrawal or antidepressant discontinuation syndrome. These symptoms may last as long as several months after you stop taking your medicine.
Antidepressant withdrawal is not usually physically harmful, but the symptoms can be very uncomfortable. And you may have a relapse of whatever condition you were taking the antidepressant for. Read on to find out more about the symptoms, possible complications, and how to manage them while you transition off your medicine.
Antidepressant Withdrawal Causes
Antidepressants help boost your levels of naturally occurring, mood-regulating substances in your brain, called neurotransmitters, including serotonin and norepinephrine. Researchers don't know exactly what causes the symptoms of antidepressant withdrawal. But they think it may be because serotonin drops quickly when you stop taking a selective serotonin reuptake inhibitor (SSRI) or serotonin and norepinephrine reuptake inhibitor (SNRI). This drop in serotonin causes certain physical and mood-related symptoms.
About 27%-86% of people who try to stop taking an antidepressant have symptoms, especially when they suddenly stop taking their medicine. If you're thinking about stopping your antidepressant, talk to your doctor. They can help you taper your doses down to help you avoid or minimize symptoms. You may still have some symptoms, but they won't be as uncomfortable if you taper your dose gradually.
There's no way to predict if you will have discontinuation symptoms after quitting an antidepressant. Scientists are not exactly sure why some people develop antidepressant discontinuation syndrome, while others do not.
Are antidepressants addictive?
The symptoms you develop from antidepressant withdrawal are not technically the same thing as physical "withdrawal" from an addictive drug. Physiological withdrawal often leads to craving and drug-seeking behavior. Antidepressants are not addictive or habit-forming. Unlike drug withdrawal, symptoms from antidepressant withdrawal aren't related to addiction but are a result of your body trying to return to a balanced state after you stop taking the medicine.
Antidepressant Withdrawal Risk Factors
Doctors think you may be more likely to have antidepressant withdrawal if you:
- Stop taking it suddenly (compared to tapering your dose slowly down)
- Have taken your medicine for a long time, generally years
- Take a high dose of the medicine (depending on the type of antidepressant)
- Have had withdrawal symptoms if you missed a dose
Antidepressant Withdrawal Symptoms
Symptoms of antidepressant withdrawal most often start about 2-4 days after you stop taking your medicine. Symptoms are usually mild but they can be moderate or severe in some cases. The symptoms may include:
- Flu-like symptoms, such as fatigue, headache, muscle aches, and sweating
- Fatigue
- Flushing
- Heart racing
- Trouble sleeping
- Vivid dreams or nightmares
- Nausea, diarrhea, and possibly vomiting
- Loss of appetite
- Dizziness, lightheadedness, feeling unsteady on your feet
- Burning, tingling, or shock-like sensations
- Mood changes, such as anxiety, irritability, agitation, and aggression
- Brain zaps, which are brief shock-like feelings in your brain, short periods of blacking out, or a shock-like feeling with a buzzing sound
Which Drugs Are Most Likely to Cause Antidepressant Withdrawal?
All anti-depressants can potentially lead to withdrawal symptoms, but some are more likely to do so than others. Drugs that your body breaks down (metabolizes) quickly are more likely to cause antidepressant withdrawal symptoms than others.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are the most likely antidepressants to cause withdrawal symptoms. Listed according to their risk of causing withdrawal, they include:
With a high risk of withdrawal:
- Desvenlafaxine (Khedezla, Pristiq)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil, Pexeva)
- Venlafaxine (Effexor)
With a medium risk of withdrawal:
- Citalopram (Celexa)
- Duloxetine (Cymbalta, Drizalma)
- Escitalopram (Lexapro)
- Sertraline (Zoloft)
With a low risk of withdrawal:
- Fluoxetine (Prozac)
- Levomilnacipran (Fetzima)
- Milnacipran (Savella)
Antidepressants such as monamine oxidase inhibitors (MAOIs) and tricyclic and tetracyclic antidepressants also have a high risk of causing antidepressant withdrawal symptoms.
How Long Does Antidepressant Withdrawal Last?
How long your withdrawal symptoms last will depend on several factors such as which medicine you took and how long you took it. Generally, your symptoms will last about 1-2 weeks. Sometimes they last a couple of months. Rarely, some people still have symptoms after 1-3 years.
Antidepressant Withdrawal Complications
Going off your antidepressants can increase your risk of:
- Anxiety or depression coming back
- Suicidal ideation or suicide
- Mania (an unstable and extreme increase in your mood, activity, and energy levels)
- Hyperarousal (anger, irritability)
How to Prevent Antidepressant Withdrawal Symptoms
If you are thinking about stopping your antidepressant therapy, talk to your doctor first so they can help you understand your risks and benefits. Never stop "cold turkey." Here are some things to think about before you stop taking your medicine:
Consider your life situation. Before you stop taking your antidepressant, make sure you feel like you're functioning well, your life circumstances are stable, and you're set up to deal with negative thoughts when they come up. It's generally not a good idea to make a big change like going off your medication when you're under a lot of stress or you're already going through a big change.
Make a plan with your doctor. To go off your antidepressant safely, you will need to reduce your dose over time. You'll generally need to stay on the lesser dose for 2-6 weeks between dose reductions. Your doctor will help you decide on which doses to take and the schedule for the dose reductions. It will depend on which antidepressant you're taking, how long you've been on it, your current dose, and any symptoms you had during previous medication changes. Your doctor may ask you to keep track of your daily mood while you're reducing your dose.
Consider going to therapy if that's an option for you. Research suggests that people who go to therapy while they're reducing their dose have less chance of having a relapse of depression or anxiety.
Keep up a healthy lifestyle and especially stay active. Research shows that people who exercise at least three times per week are less likely to have a relapse. Keeping your lifestyle healthy also helps your body adjust while you transition off your medicine.
Stay in touch with your doctor. If you're having troublesome withdrawal symptoms, they can prescribe medicine in the short term, such as an anti-anxiety medicine or a sleep aid to help ease those symptoms. If you are having severe symptoms, they may need to adjust the schedule and taper your dose more slowly. Or, they may switch you to a longer-acting antidepressant, such as fluoxetine, that may have fewer symptoms as you taper off.
Stick to the tapering schedule you and your doctor agree on. Don't try to go faster or your symptoms may be worse.
Managing Antidepressant Withdrawal
To help yourself get through your antidepressant withdrawal symptoms, try the following:
- Stay aware of your symptoms. If you need to, you can resume taking your antidepressant at your previous dose and then taper again more slowly.
- Make sure your doctor knows the other medicines you're taking. Antidepressants can interfere with your other medicines, so when you go off them, you may need to adjust your doses of any other medicines.
- For headaches, take ibuprofen or acetaminophen. For nausea, try ondansetron (Zofran). For anxiety or insomnia, your doctor may suggest diphenhydramine (Benadryl) or you can ask your doctor about getting a short-term prescription for hydroxyzine (Atarax) or a benzodiazepine.
- Maintain a healthy lifestyle by staying hydrated, eating well, and getting some regular exercise. This can help you feel your best while your body is adjusting to going off of your medicine.
Takeaways
You may get antidepressant withdrawal symptoms after you stop taking your antidepressant, especially if you've been taking them for longer than 6 weeks or you stop taking them suddenly. You're most likely to get symptoms if you take an SSRI such as Paxil or an SNRI such as Effexor. The symptoms aren't usually harmful but they can be unpleasant and include flu-like symptoms, nausea, and anxiety. You can minimize your symptoms by tapering off your dose slowly. If you're considering going off your medicine, talk to your doctor so they can help you come up with a tapering schedule that works for you. They can also help you manage your symptoms and ensure you don't have a relapse as you transition off.
Antidepressant Withdrawal FAQs
How long does it take for brain chemistry to return to normal after antidepressants?
How long it takes for your brain to regulate itself after you go off antidepressants depends on several factors, such as:
- What drug you were taking
- How long you took them
- What your dose was (if your dose was higher, it would take longer)
- How long it takes for your body to metabolize the drug
- Your age (younger people are at a higher risk of having symptoms)
- If you've ever had withdrawal symptoms before when you changed your dose or tried stopping
In general, it can take several months for your brain to regulate itself. Some people have symptoms for longer than a few months. Your best strategy for going off your medicine is to taper your doses down slowly. Your doctor can help you figure out the best tapering schedule for you.
What happens if you come off antidepressants suddenly?
This depends on several factors, such as the drug you were taking, how long you took it, and what your dose was. However, you may run the risk of having withdrawal symptoms if you stop taking your medicine suddenly. These symptoms can be very uncomfortable, and you also run the risk of having a relapse of depression or anxiety. Doctors don't recommend you suddenly stop taking your medicine. If you want to go off, talk to your doctor about tapering your dose down gradually over time.
Do you feel worse after stopping antidepressants?
Yes, you can feel worse for a while after stopping antidepressants. This is because your body needs to adjust to having less of some brain chemicals. Also, you may have a relapse of your condition which can make you feel worse. This feeling may last a few months. Talk to your doctor about it. They can help you come up with a plan that can help minimize your symptoms.
What does discontinuation syndrome feel like?
It can feel a lot like depression or anxiety. Sometimes, it's hard to tell if you are having a relapse. That's why it's best to keep your doctor involved while you go off. They can help you transition off in the most comfortable way you can.
