What to Expect From Antidepressant Withdrawal

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Before you quit taking anti-depressant medication, consider why you are quitting. Remember, depression is a serious and potentially life-threatening illness if it is not properly treated. It's important to consider all of your options and work with your healthcare provider to make the best choice for you.

Why Am I Quitting?

This question could be important if you need further treatment during withdrawal, or afterward.

 Do you feel you are over your depression? Do you dislike the side effects of the medication? Or are you unable to maintain the cost of your medication?

These are all very different reasons, that have important implications for what your experience of withdrawal will be like. It is best not to change your dosages, including quitting anti-depressant medication, without talking to your doctor or prescribing medical professional first.

Some people don't respond well to medication but do feel better after psychotherapy or lifestyle changes. Other antidepressants don't work well or can be harmful if you are self-medicating with other substances, such as alcohol or other psychoactive drugs.

Some people feel better emotionally on antidepressants but dislike the side effects. All of these possibilities are best discussed with a psychiatrist, family doctor, or psychologist, who will help figure out a treatment plan that works for you.

Types of Antidepressant Medication

There are several different types of antidepressant medication that work differently in the brain, have different side effects, and that tend to create different withdrawal experiences for the people who take them. These include tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and atypical antidepressants.

If you don't like how your medication makes you feel, it is possible that you have been misdiagnosed (for example, you may have been diagnosed with major depression when you actually have bipolar disorder, which requires a different type of medication), or that your symptoms will respond more positively to a different medication from the one you were originally prescribed.

There are different approaches that can be taken to treating people with depression who do not respond well to their prescribed antidepressants. Suddenly quitting can cause a range of unpleasant withdrawal symptoms, in addition to feeling more depressed, which vary from one medication to another.

How Long to Take Antidepressants

Guidelines typically recommend that people with major depression take antidepressants for 4–9 months after the first time depression is treated, and longer for later episodes of depression. However, studies of people with depression have produced inconclusive and contradictory results, so it is more important to consider how you feel once the medication has had time to take effect (normally at least 4-6 weeks), than to follow a one-size-fits-all approach.

Responses to antidepressants are very individual, so talk to your doctor about how the medication you have been prescribed is affecting you, and be open to non-medication approach to treatment, particularly if medications don't seem to be helping.

It is possible that taking SSRIs and SNRIs for a long time can affect the body's production of serotonin, one of the natural chemicals, known as neurotransmitters, produced in the body, that are involved in managing depression, which may worsen feelings of depression after the medications have been stopped.

Antidepressant Withdrawal Symptoms

Some of the symptoms that have been reported include the following (although you probably won't experience them all, and may not experience any):

  • Flu-like symptoms, such as dizziness, headache, nausea, weakness, lack of energy
  • Difficulty sleeping
  • Agitation, anxiety or restlessness
  • Paresthesias or feelings of tingling or "pins and needles"
  • Tachycardia or increased heart rate
  • Hypertension or increased blood pressure 
  • Sweating
  • Tremors or unintentional trembling or shaking
  • Nausea, vomiting, or abdominal cramping
  • Muscle spasms
  • Feeling like you suddenly need to urinate

Relapse Prevention

Although a diagnosis of depression is by no means a life sentence, it is important to consider your long-term well-being when thinking about your medication. Over half of the people who experience depression will experience it again at some point in their lives, often more than once. Experiencing depression a second or subsequent time is often called a "relapse," even if it occurs years later, and is triggered by different events.

Research looking into what makes relapse likely for adults with the main diagnosis of major depressive disorder, show that antidepressants help during the acute stages of depression, and reduce the chances of relapse, but studies of people who felt better after taking antidepressants have indicated that there are no established, validated markers of individual relapse risk after stopping taking antidepressants.

Some people even relapse while on antidepressant medication. Therefore, it is especially important to work with your doctor to figure out what is the best course of treatment for you.

Studies looking at the history of people's depression, including the age of people when they first experience depression, how severe their depression was, how long they have had depression, and how many episodes of depression they have had shown that none of these factors can reliably predict how they will respond to antidepressants, or how they will respond to coming off antidepressants. However, people who have had depression before do seem to be more vulnerable to further relapses.

Demographic Factors

Studies looking at whether age or gender influence people's response to antidepressant treatment have shown that neither factor is significant. Therefore, it doesn't make any difference what gender or age you are. Neither of these demographic factors can predict how you will respond to taking or withdrawing from antidepressant medication.

A study comparing caucasian with minority groups showed that caucasians with depression had a significant risk of relapsing if they stopped taking medication, but there were not enough people from minority groups to evaluate whether or not this also affects people from minority groups with depression.

Anxiety and Pain

Research shows that anxiety and pain that can occur alongside depression may increase the risk of relapse to depression, after discontinuing antidepressant medication. Therefore, you should be particularly careful about discontinuing medication if you have problems with anxiety or chronic pain, as you may be more likely to experience depression again if you stop taking medications. Your antidepressant medication may also help with your symptoms of anxiety or pain, which may also feel worse if you stop taking antidepressants.

How Your Doctor Can Change Your Antidepressants

There are several different approaches your doctor can take to changing from one medication to another. The exact approach they use will depend on what you have taken previously, how you responded to it, and the risk of withdrawal symptoms from stopping your current medications. Some of the approaches that can be taken include:

Direct Switch
With the direct switch approach, your doctor will stop your old antidepressant, and start your new antidepressant the next day at the same therapeutic dose as your old antidepressant.

  • Advantages of the direct switch are that there is no washout period required, and you may respond quickly by getting to your the most effective dose of your new antidepressant more quickly than other approaches.
  • Disadvantages of the direct switch approach are that being able to do this is limited to specific drug classes, as it can't be done from and to every type of antidepressant. There is also a risk of drug interactions between your old antidepressant and your new antidepressant, and discontinuing your old antidepressant may bring on withdrawal symptoms from your old antidepressant before your new antidepressant starts working, depending on what you are taking.

Cross Taper
With the cross-taper approach, your doctor will gradually reduce and stop your old antidepressant, and at the same time, start your new antidepressant at a low dose while tapering down your old antidepressant. They will then either titrate your new antidepressant to the dose you need—your therapeutic dose—while the old antidepressant is being tapered, or they will increase your new antidepressant to your therapeutic dose, once your old antidepressant is stopped.

  • Advantages of the cross-taper approach are that it reduces the chances that your depression symptoms will reoccur, it minimizes the withdrawal symptoms you are likely to experience, there is no washout period required, therefore it is a good idea for people who are at higher risk of having depression again.
  • Disadvantages of the cross-taper approach are that there is a risk of drug interactions. It may also take a long time to successfully taper you off the old antidepressant, depending on how quickly the new antidepressant is titrated.

Modified Cross Taper
T
he modified cross-taper approach is used when antidepressant medications interact. First, the doctor will gradually reduce and stop your old antidepressant. You may need a drug-free washout period over 2-4 days (or 2-5 weeks for MAOIs). Then, your doctor will start you on your new antidepressant at the typical starting dose.

  • Advantages of the modified cross-taper approach are that there is a lower risk of drug interactions than there is when you switch directly from one medication to another, or take two medications at the same time, as with a regular cross-taper. This could be important from a physical point of view.
  • Disadvantages of the modified cross-taper approach are that there is an increased risk of withdrawal symptoms, particularly as medications are reduced to nothing for a brief washout period, plus during the additional time it takes for your new antidepressant to start working. This increases the risk of you becoming seriously depressed during this time, so you may need additional support and medical management during this time to ensure you stay safe. It may also take a long time to successfully taper off your old antidepressant

As you can see from the various approaches to switching antidepressant medications, there are important considerations to take into account, so you should stay connected to your doctor, as well as any other people who provide you with emotional support, whether professional or personal.

While you can always get your anti-depressants refilled by attending an emergency room, the medical staff there will only be able to manage your crisis, they won't be able to provide the kind of thoughtful treatment planning that you will get from your psychiatrist or prescribing professional, who has seen you at different times, and in response to different treatments and circumstances.

Extreme Withdrawal Reactions

Although rare, it should be noted that occasionally, people have experienced very severe reactions to discontinuing antidepressant medications. If you or someone you know has had any of the following symptoms in response to reducing or discontinuing antidepressants, seek medical help immediately:

  • Delirium. This can include sudden disorientation in time and place, confusion, restlessness, agitation, and difficulties with working memory (remembering aspects of a current line of thought).
  • Suicidal Feelings. While many people with depression report occasional or frequent suicidal feelings, it is important to seek help immediately if these occur during antidepressant withdrawal.
  • Psychosis. Disconnection from reality, particularly involving delusions and/or hallucinations.

While these extreme reactions can be frightening to the person experiencing them, and to those around them, they are well-recognized medical symptoms that can be treated. Therefore, it is important to get the person experiencing them help as soon as possible.

A Word From Verywell

Although antidepressants can have troubling side effects and don't always help right away, many people are helped by these medications. They aren't a magic pill and don't replace the need for psychological support and therapy, but with patience, you and your doctor may be able the find a medication that provides some relief to your symptoms of depression. Although this sometimes takes perseverance, finding the right medication can vastly improve the quality of life for many people with depression.

However, it is important not to try and manage your medication alone. If it isn't working, or you don't like the side effects, don't just quit on your own. You, your doctor, and your support team can work together to keep you safe and comfortable while you figure out the right approach to treatment. Never hesitate to reach our if you feel in despair, and don't try and self-medicate. Help is just a phone call away. Call 911 if you need to.

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