Bipolar Disorder Treatment Medications SSRI Withdrawal Symptoms Understanding SSRI Discontinuation Syndrome By Paula Connell Medically reviewed by Medically reviewed by Steven Gans, MD on July 14, 2019 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Review Board Steven Gans, MD Updated on March 24, 2020 Print Selective serotonin reuptake inhibitors (SSRIs) are a class of drug commonly used to treat depression. The drugs help normalize brain function in people with certain mood disorders by increasing the amount of serotonin in the brain. While beneficial, one of the downsides is that some people may experience a form of withdrawal called SSRI discontinuation syndrome when treatment is stopped. This most commonly occurs when treatment is stopped abruptly and can manifest with symptoms that seem very much like the depression and anxiety SSRIs were being taken to treat. People experiencing SSRI discontinuation syndrome often believe that they are having a relapse and request to be placed back on SSRIs. Illustration by Emily Roberts, Verywell Why SSRI Withdrawal Symptoms Occur Serotonin is a type of chemical, called a neurotransmitter, whose purpose is to deliver messages to and from brain cells. By modifying this process, the chemistry in the brain can be regulated in a way that typically improves depression or anxiety. The assorted SSRI drugs used to treat mood disorders have similar mechanisms of action, but varying degrees of drug half-life. This term describes how long an active drug molecule stays in the bloodstream before being expelled from the body. If a drug has a short half-life, it will require frequent dosing to maintain the ideal concentration in the blood (and, therefore, the desired effect). If it has a long half-life, it will remain in a steady state for longer and be less prone to ups and downs. Most SSRIs have short half-lives. Common SSRI medications used to treat depression include: Prozac (fluoxetine)Celexa (citalopram)Lexapro (escitalopram)Paxil (paroxetine)Zoloft (sertraline) Of these, Prozac has a very long half-life and, when stopped, will gradually clear from the bloodstream. The others, by contrast, have a short half-life and, when stopped, will drop off abruptly. When this happens, the person taking them may experience disconcerting or even profound symptoms of withdrawal. Changes in the Brain Drug half-life is only part of the reason for SSRI discontinuation syndrome symptoms. When used over a period of time, SSRIs can effect changes in the brain that result in alterations in serotonin receptors. When this happens, the brain will "down-regulate" the number of receptors in response to the increased volume of serotonin. It's a physiological balancing act meant to prevent the overstimulation of brain cells. When treatment is eventually stopped, there will be fewer receptors than before and a short-term deficiency of serotonin activity. The body will typically correct this, but there will be a period of adjustment until the system normalizes. What People Experience The most common symptoms of SSRI discontinuation syndrome are described as either being flu-like, or feeling like a sudden return of anxiety or depression. They include: DizzinessVertigoLightheadednessDifficulty walkingNausea/vomitingFatigueIrritabilityHeadachesInsomniaDiarrheaChillsShock-like sensationsParesthesia (burning, prickly, or skin-crawling sensations)Visual disturbancesImpaired concentrationVivid dreamsDepersonalization (a detached, out-of-body experience)Suicidal thoughtsPsychosisCatatonia (a state of unresponsiveness)Muscle pain (rare) While these symptoms can be uncomfortable, they are rarely severe. Most people only experience mild to moderate forms of SSRI discontinuation syndrome. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see our National Helpline Database. Prevention of SSRI Discontinuation Syndrome Around 20% of people on Paxil, Zoloft, Celexa, or Lexapro will experience some degree of withdrawal following termination of treatment, lasting anywhere from one to three weeks. For those who have been on SSRIs for many years, the symptoms may persist for longer. To lower the risk of SSRI withdrawal symptoms, speak with your doctor about weaning you off your drug gradually. Typically, if treatment has lasted less than eight weeks, tapering off over one to two weeks would be reasonable. After six to eight months of treatment, you may need to taper off over the course of six to eight weeks. Don't try to make up your own course of action or stop taking your recommended treatment without your doctor's knowledge. Work with them to do so, as they will better understand the limitations and potential hazards of any drugs you are taking, and help guide you accordingly. Was this page helpful? Thanks for your feedback! Dealing with racing thoughts? Always feeling tired? Our guide offers strategies to help you or your loved one live better with bipolar disorder. Sign up for our newsletter and get it free. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Haddad P. The SSRI discontinuation syndrome. J Psychopharmacol (Oxford). 1998;12(3):305-13. doi:10.1177/026988119801200311 Majeroni BA, Hess A. The pharmacologic treatment of depression. J Am Board Fam Pract. 1998;11(2):127-39. doi:10.1056/NEJM199710303371801 Artigas F. Serotonin receptors involved in antidepressant effects. Pharmacol Ther. 2013;137(1):119-31. doi:10.1056/NEJM199710303371801 Warner CH, Bobo W, Warner C, Reid S, Rachal J. Antidepressant discontinuation syndrome. Am Fam Physician. 2006;74(3):449-56. doi:10.1056/NEJM199710303371801 Additional Reading Fava GA, Gatti A, Belaise C, Guidi J, Offidani E. Withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation: A systematic review. Psychother Psychosom. 2015;84(2):72-81. doi:10.1159/000370338 Harvey BH, Slabbert FN. New insights on the antidepressant discontinuation syndrome. Hum Psychopharmacol. 2014;29(6):503-16. doi:10.1002/hup.2429