Why quit, symptoms and more

When people stop taking antidepressants, they may experience withdrawal symptoms or relapse.

According to a study, approximately 20% of people who suddenly stop taking antidepressants will have symptoms, which doctors call antidepressant stopping syndrome. The National Alliance on Mental Illness says the number can reach 80%.

For this reason, experts recommend to consult a doctor before stopping the use of antidepressants. Antidepressants are not addictive, so stopping them does not cause withdrawal. However, it can cause symptoms, which a doctor can help manage.

In this article, we take a look at why it can be difficult to stop taking antidepressants. We also discuss what symptoms may occur, how to relieve them, and tips for safely stopping these medications.

Antidepressants can’t cure depression, but they can help reduce anxiety, bad moods, and thoughts of suicide. They work by changing the way the brain uses chemicals to balance mood or manage stress.

When people start taking antidepressants, it may take several weeks or more for the drugs to work. Antidepressants can also have side effects. Both of these factors can make a person want to stop taking them.

People might also want to stop taking antidepressants because:

  • the drug is too expensive
  • they have the impression of having recovered enough
  • a healthcare professional advised them to stop
  • they are pregnant or planning to become pregnant

It can be difficult to stop taking antidepressants after taking them for a long time.

People should seek medical advice and support when considering stopping these medications. The doctor will help you make a plan which may involve reducing the dosage gradually or switching to another medicine.

Although they do not cause physical dependence, drugs for depression alter chemicals in a person’s brain. The body adapts to these changes, so stopping suddenly can cause a reaction.

Stopping antidepressants can have a mental and physical impact. A person may also fear that symptoms of depression will return.

Six types of symptoms can occur when stopping antidepressants.

They are:

  • Flu-like symptoms: Fatigue, headaches, pain and sweating.
  • Insomnia: Difficulty sleeping and vivid dreams.
  • Nausea: There may also be vomiting.
  • Imbalance: Dizziness, vertigo and lightheadedness.
  • Sensory disturbances: Tingling, burning and shocking sensations.
  • Hyperexcitation: Restlessness, irritability, anxiety, aggressiveness, mania and jerks.

Stopping different antidepressants will cause different symptoms, to some extent depending on the half-life.

Antidepressants with a short half-life may cause more side effects and be more difficult to stop taking. However, people may still experience symptoms when they stop taking a drug with a longer half-life.

Half-life is the time it takes for the level of the substance in the body to drop by half. The half-life varies among drugs, and it can also vary among individuals.

Short-half-life antidepressants include venlafaxine (Effexor) and trazodone (Desyrel). Fluoxetine (Prozac) and citalopram (Celexa) have a long half-life.

Below, we take a look at some types of antidepressants and the different side effects that can occur when stopping them.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs include drugs such as citalopram and fluoxetine. Symptoms of discontinuation include:

  • upset stomach and cramps
  • flu-like symptoms
  • headache
  • lethargy
  • dizziness
  • appetite changes
  • insomnia and nightmares
  • Vertigo
  • ataxia or loss of muscle coordination
  • Blurred vision
  • numbness and tingling
  • sensations of “electric shock”
  • tremor
  • difficulty with movement
  • restlessness, anxiety, aggressiveness and bad mood

Monoamine oxidase inhibitors (MAOIs)

MAOIs include drugs such as phenelzine (Nardil) and isocarboxazid (Marplan). Symptoms of discontinuation include:

  • headache
  • insomnia and nightmares
  • feeling restless or irritable
  • jerky movements or muscle contractions
  • commotion
  • bad mood
  • hallucinations and delusions
  • delirium
  • catatonia, which is when a person is unable to move

Tricyclic antidepressants (TCAs)

TCA drugs include amitriptyline (Elavil) and doxepin (Silenor). Symptoms of discontinuation include:

  • flu-like symptoms
  • headache
  • lethargy
  • abdominal and gastrointestinal complaints, such as nausea, vomiting, cramps and diarrhea
  • insomnia and nightmares
  • dizziness, lightheadedness and vertigo
  • coordination and movement problems
  • tremor
  • feeling agitated or anxious
  • bad mood

Atypical antidepressants

These include venlafaxine (Effexor) and duloxetine (Cymbalta). Symptoms that can occur after stopping include:

  • flu-like symptoms
  • headache
  • lethargy
  • appetite changes
  • nausea and vomiting
  • insomnia and nightmares
  • dizziness and vertigo
  • ‘electric shock’ and tingling sensations
  • anxiety
  • bad mood

Symptoms usually appear a few days after stopping an antidepressant. Knowing what symptoms to expect can help a person prepare.

In some cases, severe symptoms may require time off work.

Choosing an appropriate time to stop taking antidepressants can make the process easier. A person may be at greater risk for relapse into depression during times of stress or emotional difficulties.

Flu-like symptoms

Some people have flu-like symptoms. A doctor may recommend treating them by:

  • drink lots of fluids
  • rest
  • stay warm

Taking pain relievers to relieve any discomfort is generally safe, but it is best to see a doctor first.

Fatigue and sleep disturbances

Symptoms of fatigue, disturbed sleep, and irritation can make daily activities more difficult.

Planning a few quieter days while stopping antidepressants can reduce stress.

Is it a relapse?

Sometimes the symptoms of stopping can resemble a relapse. However, while withdrawal symptoms usually begin within a few days, signs of a relapse take more time – usually 2 to 3 weeks – to appear.

If a person fears a return of depression, they may want to see a doctor. In some cases, a doctor may prescribe medication to relieve withdrawal symptoms.

How long do the symptoms last?

Withdrawal symptoms usually start within a few days. 2017 research indicates they tend to last 1 to 2 weeks, but it may take longer in some cases. Some more recent research has shown that, although it is rare, withdrawal symptoms can last for up to 79 weeks.

According to the American Psychological Association, a person can expect symptoms to last “at least several weeks.”

Having a good support network in place or someone understanding to talk to during this time can be beneficial.

Getting enough rest, eating well, and exercising regularly can reduce symptoms in some people.

Stopping antidepressants is a serious decision that can affect a person’s health. A doctor can provide you with information and advice.

Know your medicine

Being involved in decision making and planning at each stage of treatment can help reduce the risk of an unpleasant experience.

For example, a person can talk to the doctor about:

  • the medicine and how to stop using it, even before you start
  • reasons to quit and a plan to quit, for when they feel ready to quit
  • what effects to expect, how long they are likely to last, and how to distinguish between side effects and a relapse

It can also be helpful for the person to keep a chart to track their progress. They can share this with their doctor.

Gradually stop

A doctor will often advise a person to gradually stop taking antidepressants, which are called declining. A person slowly reduces the dose of the medicine over time until they stop taking it.

The time it takes to gradually stop taking antidepressants will depend on the drug and how long it is used. A doctor can advise you on this process and how best to approach it.

Change drugs

In some cases, a doctor may recommend to change to another drug as a step towards stopping the drug.

They may suggest switching to a drug with a longer half-life and then gradually lowering the dosage.

Seek help

Family and friends can support a person while they stop taking antidepressants. Supportive psychotherapy can also help.

Deciding to stop using antidepressants should be carefully considered. With the right support, many people quit safely, even though they may experience uncomfortable side effects.

A person should always seek the advice of a doctor before stopping and follow the plan he suggests.

Withdrawal symptoms from some medications can lead to suicidal thoughts. If this happens, it is vital to seek urgent support.

People can contact the National Suicide Prevention Lifeline in the United States at 1-800-273-8255 or visit their website for help and information.

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