Discontinuing antidepressant medications in adults. Fava GA, et al. Withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation: A systematic review. Psychotherapy and Psychosomatics. Bhat V, et al. Recognition and management of antidepressant discontinuation syndrome. Journal of Psychiatry and Neuroscience. Definition of addiction.
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Coffee after dinner? Participants who discontinued rapidly over one to seven days were more likely to relapse within a few months than those who reduced the dose gradually over two or more weeks. Source: Adapted from Joseph Glenmullen, M. If you're thinking about stopping antidepressants, you should go step-by-step, and consider the following:. Take your time. You may be tempted to stop taking antidepressants as soon as your symptoms ease, but depression can return if you quit too soon.
Clinicians generally recommend staying on the medication for six to nine months before considering going off antidepressants. If you've had three or more recurrences of depression, make that at least two years. Talk to your clinician about the benefits and risks of antidepressants in your particular situation, and work with her or him in deciding whether and when to stop using them. Before discontinuing, you should feel confident that you're functioning well, that your life circumstances are stable, and that you can cope with any negative thoughts that might emerge.
Don't try to quit while you're under stress or undergoing a significant change in your life, such as a new job or an illness. Make a plan. Going off an antidepressant usually involves reducing your dose in increments, allowing two to six weeks between dose reductions.
Your clinician can instruct you in tapering your dose and prescribe the appropriate dosage pills for making the change. The schedule 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. It's also a good idea to keep a "mood calendar" on which you record your mood on a scale of one to 10 on a daily basis. Consider psychotherapy.
In a meta-analysis of controlled studies, investigators at Harvard Medical School and other universities found that people who undergo psychotherapy while discontinuing an antidepressant are less likely to have a relapse. Stay active. Bolster your internal resources with good nutrition, stress-reduction techniques, regular sleep — and especially physical activity.
Exercise has a powerful antidepressant effect. It's been shown that people are far less likely to relapse after recovering from depression if they exercise three times a week or more.
Exercise makes serotonin more available for binding to receptor sites on nerve cells, so it can compensate for changes in serotonin levels as you taper off SRIs and other medications that target the serotonin system. Seek support. Stay in touch with your clinician as you go through the process.
Let her or him know about any physical or emotional symptoms that could be related to discontinuation. If the symptoms are mild, you'll probably be reassured that they're just temporary, the result of the medication clearing your system.
These symptoms can be physical and mental, although they are different for everyone — and they can be different for individual antidepressants see Appendix 1. This resource aims to help you avoid getting any withdrawal symptoms — or get the fewest possible. Talk this over with your doctor so you can find the best way to stop taking them. The NICE guidelines suggest that for some, withdrawal symptoms can be mild and go away relatively quickly, without the need for any help.
Other people can have more severe symptoms which last much longer sometimes months or more. This is still poorly understood.
Brain chemicals called neurotransmitters such as serotonin and noradrenaline are involved. They allow nerve cells to communicate with each other by acting on nerve endings. Antidepressants increase levels of these chemicals in the space between nerve cells in the brain. Over time, the brain seems to slowly adjust to these increased levels. If an antidepressant is stopped quickly, the brain will need time to adjust back again.
The sudden lowering of neurotransmitter levels seems to produce withdrawal symptoms, while the brain adjusts to the change. The more gradual the changes, the milder and more tolerable symptoms should be — or, indeed, they may not happen at all.
Between a third and half of people who take an antidepressant will experience such symptoms to some extent. We cannot yet predict who will get these symptoms. The risk seems to be greater if you have taken a high dose for a long time, but it can happen if you have taken an antidepressant for just a month.
It can also depend on the type of antidepressant you have been taking. You are more likely to get these symptoms and for them to be worse if you stop taking an antidepressant suddenly or if you reduce the dose quickly. Some withdrawal symptoms can feel like the symptoms you had before you started the antidepressant.
The low mood and difficulty in sleeping of withdrawal can feel like the symptoms of depression. Dizziness is a common symptom of anxiety. In this case, you should carry on taking your antidepressant at the prescribed dose — and talk with your doctor. These are some of the ways you and your doctor can tell whether you are having withdrawal symptoms or whether it is the symptoms of a return of anxiety or depression:.
Withdrawal symptoms normally start soon after your medication is reduced or stopped. This may be one or two days for some antidepressants — or even after missing a single dose.
Usually they take a few days to start, and then get worse. The return of depression or anxiety usually takes longer — typically weeks or months. Some antidepressants, like fluoxetine, take a lot longer to leave the body. An important factor in the duration of withdrawal is how long the person took antidepressants.
Someone who took an antidepressant for six months usually has less intense symptoms than someone who took the medication for two years. Certain antidepressants are more likely to cause negative withdrawal symptoms. People taking Paxil and Effexor often have more intense withdrawal symptoms. These drugs have short half-lives and leave the body faster than drugs with long half-lives.
The faster an antidepressant leaves the body, the worse the withdrawal symptoms. This is because of the sudden imbalance of chemicals in the brain. Antidepressants with longer half-lives, like Prozac and Zoloft, linger in the body for days. Withdrawal from these antidepressants lasts longer than short half-life drugs but are less intense. Learn More. Detoxing from antidepressants is the process of letting the drugs leave the body.
Medical detox can help limit withdrawal symptoms. Antidepressant detox involves gradually stepping down doses until the user can safely stop taking them. So, it can take a month or six weeks or two months. But we just simply step the dose down slowly over time. Some people initially cut their dose in half and then reduce their dose by quarters. Some taper down in as little as a month while others taper down over several months. Detox is the first step to quitting antidepressants. Treatment then can progress to involve therapy and counseling.
Counselors can help users understand and move past the underlying causes of their depression. Polydrug use like this can worsen symptoms of depression and increase the risk of addiction.
If you need help giving up antidepressants or another substance, contact a treatment provider for rehab-related help today. After graduation, he decided to pursue his passion of writing and editing. All of the information on this page has been reviewed and verified by a certified addiction professional. Theresa is also a Certified Professional Life Coach and volunteers at a local mental health facility helping individuals who struggle with homelessness and addiction.
Theresa is a well-rounded clinician with experience working as a Primary Addiction Counselor, Case Manager and Director of Utilization Review in various treatment centers for addiction and mental health in Florida, Minnesota, and Colorado. She also has experience with admissions, marketing, and outreach. As a proud recovering addict herself, Theresa understands first-hand the struggles of addiction.
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