Antidepressant Withdrawal

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Antidepressants are a class of medications used to treat depression and some anxiety disorders. The most common class of antidepressants is selective serotonin reuptake inhibitors, also known as SSRIs. Other examples of antidepressants include:  

• – Serotonin/Norepinephrine Reuptake inhibitors (SNRIs) 
• – Atypical Antidepressants. 
• – Tricyclic Antidepressants (TCAs) 
• – Monoamine Oxidase Inhibitors (MAOIs) 

Antidepressants take approximately six weeks to affect an individual’s neurochemistry, reducing depressive or anxious symptoms. As a result, healthcare professionals usually advise individuals to stay on antidepressants for at least three months. However, some individuals may choose to stop taking their antidepressants for many reasons, such as unwanted side effects, high medication costs, pregnancy, or easing of symptoms. Regardless of the reason, discontinuing antidepressants suddenly can result in withdrawal or discontinuation syndrome.  

Discontinuation syndrome occurs in approximately 20 percent of individuals taking antidepressants, and some antidepressants are more likely to create withdrawal than others. For example, desvenlafaxine, venlafaxine, paroxetine, citalopram, and escitalopram have the highest risks of antidepressant withdrawal syndrome, whereas fluoxetine has the lowest risk profile. Additionally, risk factors such as higher dosages, abrupt cessation, previous history of discontinuation syndrome, co-occurring anxiety disorder, and long duration of antidepressant use are more likely to result in discontinuation syndrome.  

Why does withdrawal occur? 

Withdrawal from antidepressants occurs because the brain becomes dependent on serotonin (and, depending on the specific medication, other neurotransmitters such as dopamine and norepinephrine). In other words, the brain believes it needs serotonin to function normally. Serotonin is known as the “happy neurotransmitter” as it promotes feelings of well-being and joy and therefore helps curb symptoms associated with depression. When an individual takes a medication pumping their brain and body full of serotonin and then abruptly stops taking this medication, they may experience rebound depression and other withdrawal symptoms as their serotonin reserves become depleted. It is important to keep in mind that dependence differs from addiction. Dependence has to do with the body’s physical symptoms. At the same time, addiction is a clinical term that describes the compulsive misuse of a substance despite the negative side effects it has on the body and mind and the negative consequences this behavior has on your everyday life. Therefore, an individual can have physical dependence but not experience addiction. 

Common symptoms of antidepressant withdrawal: 

• – Rebound depression 
• – Irritability 
• – Anxiety 
• – Headache 
• – Nausea
• – Insomnia 
• – Muscle aches 
• – Lethargy
• – Sweating 

Symptoms associated with discontinuation syndrome usually occur one to two days after abruptly stopping the medication and usually last 1-2 weeks. It is important to note the difference between relapse depression and withdrawal symptoms. The main difference is timing, as symptoms of relapse depression gradually onset, whereas symptoms of antidepressant withdrawal occur within a day or two after stopping the medication. 

Treating and preventing antidepressant withdrawal syndrome 

Antidepressant withdrawal syndrome can best be treated with therapy, exercise, and even switching to another antidepressant. Therapy can help you cope with unwanted side effects as well as the ability to ask your therapist questions about your symptoms. Exercise can help increase serotonin levels to help prevent withdrawal. Finally, switching to a different medication with less likely withdrawal symptoms while discontinuing your current antidepressant could help with unwanted withdrawal symptoms.  

If you want to prevent antidepressant withdrawal syndrome, it is best to do so while under the care of a medical professional. A doctor can help you taper your medication over time to prevent unwanted symptoms. The tapering schedule may depend on which medication you are taking, the duration of use, the dosage, and the half-life.  

Before starting an antidepressant, asking your doctor about discontinuation syndrome can be beneficial as some antidepressants have a higher profile for discontinuation syndrome than others. You may also want to ask how long you should stay on medication before switching to a new one, and if you choose to stop taking an antidepressant, what would this look like regarding the need to taper and the risk of withdrawal symptoms?  

Antidepressants can be life-changing, and the risk of withdrawal should not deter individuals from starting an antidepressant if they are experiencing symptoms of depression; however, it is always important to stay informed and to ask questions about any potential side effects when starting a medication.