Withdrawal from antidepressants

Emily had gone through trauma due to the loss of her family member. She felt very lonely and depressed for a long time and spent most of her time sleeping. The doctor prescribed trazodone (Desyrel) for relieving symptoms of depression. Trazodone is one of the SSRI antidepressants. She was well for quite some time and felt like she had recovered from the symptoms that bothered her before. She had been on trazodone for over 8 weeks and started thinking maybe she doesn’t need to use the medication any more and besides it was an extra expense on her list. Some reasons why other people consider stopping taking antidepressants are either they are pregnant or expecting to become pregnant or if their doctor has advised them to stop taking antidepressants. 

What to expect when you stop taking antidepressants?

When people stop taking antidepressants, they start to feel sick, the condition is sometimes called “antidepressant withdrawal” or “SSRI discontinuation syndrome”. There is science behind withdrawal! Antidepressants interfere with the brain chemistry and the body adjusts to these changes, so stopping suddenly can cause unwanted reactions in the form of withdrawal. Antidepressant withdrawal symptoms last for a few weeks or even months. Symptoms may appear within 2-5 days and persist for up to several weeks according to the American Psychological Association (APA).

People may experience symptoms like nausea, vomiting, stomach cramps, loss of appetite, increased gastric motility, lightheadedness, fatigue, excessive sweating, uncoordinated movements, and mood swings due to which they get anxious and have trouble falling asleep. Some people might also experience strange sensations which they refer to as “brain shivers”. Brain shivers occur when people suffer from pain, they become very sensitive to sounds and it appears as an electric shock to their head.

Results from 14 studies have indicated that after discontinuation of antidepressants, 56 % of people experienced withdrawal symptoms. Amongst these, four studies assessed the severity of withdrawal symptoms and found that 46 % of people experienced severe symptoms and some people mentioned the withdrawal symptoms lasted for several weeks to months.

What affects the severity and duration of symptoms from withdrawal?

There are two main factors that influence the symptoms of withdrawal; half life of medication and length of medication use.

• Half life of antidepressant medication: The half life of a medication is the time it takes to reduce the amount of active drug by half in the body. The medications with a shorter half life cause more withdrawal symptoms compared to those with longer half life. Antidepressants with a short half-life include venlafaxine (Effexor) and trazodone (Desyrel) whereas Fluoxetine (Prozac) and citalopram (Celexa) have a long half-life. Half life of some antidepressants is: Bupropion (Wellbutrin) 21 hr, Citalopram (Celexa) 36 hr, Desvenlafaxine (Pristiq) 12 hr, Duloxetine (Cymbalta) 8-17 hr, Escitalopram (Lexapro) 30 hr, Fluoxetine (Prozac) 96-144 hr, Paroxetine (Paxil) 24 hr, Sertraline (Zoloft) 22-36 hr and Venlafaxine (Effexor) 4-7 hr. Antidepressants with a short half life need to be tapered down for a longer period of time.

• Length of antidepressant therapy: Generally, all antidepressants cause withdrawal symptoms if stopped abruptly or rapidly reduced the dose after taking it for more than 6 weeks. The longer the duration of taking the antidepressant medication, the more likely it is to develop withdrawal symptoms.

How to minimize withdrawal symptoms?

Withdrawal symptoms can be avoided by a thoughtful strategy laid out with the help of a healthcare professional. Some important things to consider before discontinuing antidepressants:

• Taper off slowly: The key strategy to minimize withdrawal symptoms is to reduce the dose of antidepressants gradually. The time of tapering usually depends on the half life and for how long the antidepressant was taken. Doctors usually suggest reducing the dose to minimum or half-minimum doses over 2-4 weeks (short tapers) or longer before completely stopping the medication.

• Switching to another antidepressant with a longer half-life is also helpful to minimize withdrawal symptoms.

• Manage symptoms of withdrawal like gastric upset, sleep issues, and others with respective medications prescribed by healthcare professionals.

• Psychotherapy or cognitive behavioural therapy also offers greater benefits and can help people discontinue antidepressants without increasing the risk of relapse or recurrence.

• Regular checkups with healthcare professionals. Healthcare professionals are trained and experienced in identifying your condition and whether it’s improving or if there is a relapse. Seek support from family, friends, and health professionals when necessary.

• Healthy lifestyle: Positive thinking, healthy life choices and physical activity on a regular basis will help to overcome the symptoms of withdrawal. Studies have shown the positive effects of exercise on serotonin, a chemical in the brain which is a desired target of antidepressant drugs in order to treat depression.