Antidepressant Withdrawal: Going Off Antidepressants
The use of antidepressants has increased dramatically in recent years. Between 2015 and 2018, 13.2% of American adults used an antidepressant in the past 30 days. That number continues to rise. This may be due to a variety of factors, including feelings of isolation, increased pressure from family obligations, work demands, higher cost of living and many other individual circumstances.
There are several methods of dealing with depression without medication, like behavioral and talk therapy, learning coping skills and meditation. While taking antidepressant medications is necessary for some, it is important to note that taking antidepressants is associated with serious side effects and stopping these medications without proper guidance can lead to severe withdrawal symptoms.
What Happens When You Stop Taking Antidepressants?
Some health care professionals will prescribe antidepressants indefinitely to prevent relapse into a depressive episode. However, many experts agree that antidepressant therapy should be given for up to nine months after symptoms have resolved. There are certain instances when longer therapy may be required.
Individuals who have been taking antidepressants for long periods of time may experience antidepressant withdrawal symptoms after they stop. Dizziness and flu-like symptoms including nausea, vomiting, diarrhea and decreased appetite can occur. The severity and length of withdrawal effects depend on how long someone has been taking these medications and the dose prescribed. These unpleasant effects can begin immediately after stopping, and they can last for several weeks. Depression and anxiety may occur long term after stopping and last for months. In some cases, the effects may be evident for years.
How Long Do Antidepressants Stay in Your System?
- Paxil (paroxetine)
- Zoloft (sertraline)
- Lexapro (escitalopram)
- Celexa (citalopram)
- Prozac (fluoxetine)
With the exception of Prozac, the half-life, or the time it takes for a drug to reduce to half its amount in the blood, of these SSRIs ranges from 24 to 36 hours. They are usually eliminated from the body completely in four to eight days. Prozac has a much longer half-life and may take up to 25 days to be removed from the body.
Another group of antidepressants, SNRIs, or serotonin and norepinephrine inhibitors, include:
- Effexor (venlafaxine)
- Cymbalta (duloxetine)
- Pristiq (desvenlafaxine)
Many people assume that if withdrawal symptoms occur from a drug, it is because that drug is addicting. People struggling with drug addiction have a compulsion to seek that drug out. They often also require higher doses of the drug to obtain the same effect, called tolerance. That is not the case with antidepressants. These medications increase substances called serotonin or norepinephrine in the brain. When someone stops using these drugs, they may experience physical and emotional symptoms because there is a decrease or lack of these substances in the body.
Many symptoms felt from stopping antidepressants are actually the same symptoms of depression and anxiety these drugs are used to treat, which may lead the prescriber and patient to believe the individual is relapsing. Therefore, it is important to recognize what antidepressant withdrawal symptoms are and how quickly they start and last.
Antidepressant Withdrawal Symptoms
Antidepressant withdrawal symptoms can include:
- Decreased appetite
- Unsteadiness when walking
- Difficulty sleeping
- Excessive sweating
- Difficulty speaking
- Tremors and shakiness
- Mood swings
- Ringing in the ears
- Sensation of electrical zaps in the brain
How Long Does Antidepressant Withdrawal Last?
In general, antidepressant withdrawal symptoms occur within the first week after the last dose of the medication, with an average onset of two days. Dizziness and flu-like symptoms are common immediate effects of stopping antidepressants, and they can last for up to three weeks.
In some cases, withdrawal symptoms can last for months and even years. This is known as protracted withdrawal syndrome (PWS). This long-term withdrawal often involves anxiety, depression, agitation and suicidal ideation. The person may also experience effects associated with short-term, acute withdrawal, like diarrhea, nausea and brain zaps. Sleep disturbances are less likely, but still possible.
Antidepressant Discontinuation Syndrome
Antidepressant discontinuation syndrome is a group of symptoms someone experiences after abruptly stopping an SSRI or SNRI. They may happen because the patient does not see an improvement in their depressive symptoms or because they struggle with the side effects.
- Loss of balance
- Difficulty sleeping
- Zapping sensation in the brain
Risk of Depression Relapse
The risk of having a relapse after stopping antidepressants depends on several factors. Co-occurring conditions, the antidepressant dose, and how long a person has been taking an antidepressant can all contribute to an individual’s risk for relapse. Data from British research shows that 56% of people who stopped their medication experienced a relapse. However, it is important to note that 39% of those who stayed on the antidepressant still had a relapse.
Relapses can be mistaken for withdrawal or discontinuation symptoms. Deciding which it is depends on when and how symptoms occur. If a person is truly having a relapse, the symptoms generally develop after several days or a few weeks, and they occur gradually, not quickly. Also, a person having a relapse does not usually develop physical symptoms associated with discontinuation or withdrawal, including dizziness and flu-like symptoms.
Benefits of Getting Off Antidepressants
The decision to stop taking antidepressants should always be made in consultation with your doctor. SSRIs and SNRIs can have uncomfortable side effects. SSRIs can cause weight gain, and both can lead to sexual dysfunction. Reasons a person may stop taking antidepressants include:
- Problematic side effects
- Medication shows little to no effectiveness
- Pregnancy or trying to conceive
- Decreased risk of having withdrawal symptoms if antidepressants are taken for a shorter period of time
Which Antidepressants are the Hardest to Come Off Of?
Antidepressants that have a shorter half-life and are removed from the body rapidly have stronger withdrawal symptoms. These drugs include:
Which Antidepressants are the Easiest to Come Off Of?
Antidepressants that have a longer half-life and stay in the body for an extended period of time are less likely to cause withdrawal symptoms; if they do, those symptoms are milder. Prozac, which has a long half-life, is the least likely to cause withdrawal symptoms.
Going Off Antidepressants Safely
The prescriber should always be involved when stopping antidepressants. Many people believe that once depressive symptoms resolve, it is fine to stop the medication. However, this is usually not the case. If effective, a person should generally take antidepressants for at least six months to ensure a relapse will not occur. Depending on the dosage and how long an individual has been taking the medication, the drug may have to be decreased gradually over time to prevent any withdrawal or discontinuation symptoms.
It is also sensible to consider psychotherapy, which is a wonderful tool to help manage or prevent depressive symptoms and to develop general coping skills. Improving your quality of life is another way to safeguard against any risks when stopping antidepressants. This involves proper nutrition, incorporating exercise into your schedule and developing healthy sleep habits.
Natural Remedies for Antidepressant Withdrawal
Antidepressant withdrawal can be difficult and uncomfortable. Fortunately, there are an array of natural solutions an individual dealing with antidepressant withdrawal can use to assist with withdrawal symptoms. These natural remedies include:
- Meditation and deep breathing
- Vitamins and supplements
- Omega – 3 fatty acids
- Vitamin B complex
- Vitamin C
- St. John’s wort
The Nobu app is a valuable resource to assist anyone who has stopped using antidepressants. The app includes features like mindfulness training, which provides meditation and breathing exercises. It also has a selection of soothing sounds that can help with sleeping. Clinical assessments are available to evaluate mental health status, with features to set individualized goals and track your progress. For an additional fee, Nobu can also connect you with a licensed therapist for online therapy sessions. Download the app in the App Store or Google Play store today to get started.
Edited by – Melissa Carmona
As the content manager at Advanced Recovery Systems, Melissa Carmona puts years of writing and editing experience to work helping people understand substance abuse, addiction and mental health disorders. Melissa is a Florida State University graduate… Read more.
Written by – Michelle Giordano Pharm.D.
Michelle Giordano has been a licensed pharmacist in New York State for nearly two decades. She received her doctorate in pharmacology from St. John’s University, where she earned an academic merit scholarship throughout the course of her studies… Read more.
Medically Reviewed by – Dr. Angela Phillips
Angela is a licensed therapist and clinical researcher, and has worked in public, private, government, and not-for-profit organizations, across clinical and research-oriented roles. Angela’s clinical and research experience has included suicide prevention, cognitive behavioral… Read more.
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