Discontinuing use of antidepressants can trigger some uncomfortable withdrawal symptoms. These symptoms can include a return of depression, and this can be dangerous if not managed correctly.
Doctors generally recommend gradually weaning off antidepressants on a tapering schedule instead of suddenly stopping them. This can help manage any potential danger associated with a return of depressive symptoms.
Can Withdrawal From Antidepressants Happen?
Yes, antidepressant withdrawal does happen if the medication is suddenly stopped.
Antidepressants are designed to regulate moods, often by manipulating brain chemistry. Several types of antidepressants interact differently with the chemical messengers in the brain.
The changes to brain chemistry can become ingrained with regular use of an antidepressant, which can mean that drug dependence can set in. When the drug processes out of the body, the brain may struggle to restore balance. Often, some uncomfortable withdrawal symptoms may kick in.
Antidepressant withdrawal can include a return, or even worsening, of depression and depressive symptoms. These can potentially lead to suicidal thoughts and ideations.
Withdrawal symptoms can be both emotional and physical. They can range from mild to significant, depending on the exact medication taken, how long it was taken for, the way it was taken, and the dosage.
Antidepressant withdrawal generally lasts for a few weeks, but it can last several months or even up to a year in rare cases. Specific methods are usually needed to manage symptoms.
How Withdrawal Works in the Brain
Antidepressants are some of the most widely prescribed medications in the United States, as nearly 13 percent of adults (aged 12 and older) take them. These medications work to stabilize moods. They do so by helping to regulate brain chemistry.
Many people who take antidepressants do so for an extended time. Long-term use of these medications can cause changes to the way the brain regulates its chemical makeup, which can make it more difficult to do so on its own right away. This is called drug dependence, and it can result in withdrawal symptoms.
Antidepressants work on levels of serotonin, norepinephrine, and dopamine. These are some of the brain’s neurotransmitters, or chemical messengers, that serve to regulate stress and emotions. Dopamine and serotonin are often classified as “pleasure-inducing,” as high levels of these neurotransmitters produce “feel good” effects. Antidepressants block the reuptake of these chemical messengers or increase their production to enhance moods.
With regular interaction of these medications on the neurotransmitters, your brain relies on the medicine and does not produce, transmit, or absorb the neurotransmitters in the same way. This can lead to a drop in serotonin and/or dopamine when antidepressants are not active in the bloodstream. As these drugs process out, withdrawal symptoms may begin, which can be both physically and emotionally challenging.
When to Taper Off Antidepressants
It can be dangerous to stop taking an antidepressant cold turkey, or suddenly. Stopping one of these medications abruptly can lead to withdrawal symptoms as much as 80 percent of the time. Withdrawal symptoms can range in severity and duration, depending on how long you’ve been taking them, how you’ve been taking them, the type of medication, and how much you have been taking at a time (dosage).
If you have been taking an antidepressant for a long time in high doses, you are likely to struggle with more intense withdrawal symptoms. Things like co-occurring medical or mental health issues, biology and genetics, and even manner of use can make a difference too. Abuse of antidepressants, including snorting, smoking, or injecting a medication that is meant to be ingested, can increase the severity of withdrawal.
Timeline and Effects of Withdrawal
Withdrawal symptoms can include both physical and emotional side effects.
Physical effects can include the following:
- Nausea and vomiting
- Stomach cramps and pain
- Loss of appetite
- Flushing and sweating
- Feeling lightheaded
- Trouble with balance and coordination
- Sensitivity to pain
- Brain “zaps” like electric shocks
- Ringing in the ears
- Muscle aches
Emotional withdrawal symptoms include the following:
- Increased depression
- Suicidal thoughts and actions
- Panic and paranoia
- Trouble concentrating
- Disturbed and vivid dreams
- Changes in personality
- Significant mood swings
If you have been taking an antidepressant for a month to six weeks, you may experience any or all of these symptoms when you stop taking it. Generally, withdrawal symptoms can begin within a day or up to a week after stopping the medication and last for a few weeks. Withdrawal symptoms can persist for up to a year, however, and they often appear like a return of depression.
Slowly tapering off an antidepressant allows the brain time to regain a safe and stable balance more easily. A very slow taper over a period of months may be ideal in discontinuing an antidepressant to control potential withdrawal symptoms.
There are different types of antidepressant drugs, so one may be switched out for another medication that may have fewer side effects.
Types of Antidepressants and Their Withdrawal Impact
There are several different kinds of antidepressant medications, and the type can have an impact on withdrawal. For instance, drugs with a shorter half-life, which means they wear off more quickly, can have a higher incidence of more intense withdrawal symptoms.
- Selective serotonin reuptake inhibitors (SSRIs): Prozac (fluoxetine), Paxil, Pexeva (paroxetine), Celexa (citalopram), Zoloft (sertraline), and Lexapro (escitalopram)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs): Effexor XR (venlafaxine), Cymbalta (duloxetine), Fetzima (levomilnacipran), Pristiq and Khedezla (desvenlafaxine)
- Monoamine oxidase inhibitors (MAOIs): Marplan (isocarboxazid), Parnate (tranylcypromine), and Nardil (phenelzine)
- Tricyclic antidepressants: Norpramin (desipramine), Tofranil (imipramine), Pamelor (nortriptyline), and Elavil (amitriptyline)
- Atypical antidepressants: Wellbutrin, Forfivo XL, Aplenzin (bupropion), Remeron (mirtazapine), trazodone, Trintellix (vortioxetine), and Viibryd (vilazodone)
Typically, antidepressants that interact with serotonin levels in the brain, such as SSRIs and SNRIs, tend to have more significant withdrawal symptoms, while atypical antidepressants may have fewer symptoms.
Tricyclic antidepressants often have more general side effects, and they are only used if other medications are not working the way they are intended. Atypical antidepressants may have some of the lowest rates of withdrawal symptoms, while SSRIs have the most.
Drugs with a shorter half-life, such as Effexor, tend to have more intense withdrawal symptoms than those with longer half-lives like Prozac.
All antidepressants, or medications that manipulate brain chemistry to impact moods, can have withdrawal symptoms and should be stopped carefully. A medical detox program and slow tapering approach help in managing antidepressant withdrawal.