Antidepressants and Discontinuation Syndrome

For someone dealing with major depression, an antidepressant truly can be a lifesaver, both figuratively and literally, but there may come a time when you're feeling better and you're ready to try life without it.

If this describes you, be sure to talk to your doctor first. Why? Because in addition to needing to monitor for any recurrence of your symptoms, antidepressants can cause symptoms of discontinuation syndrome if there are major fluctuations in the amount of drug in your system or if you suddenly stop taking them completely.

While these symptoms are not life-threatening, they can be quite uncomfortable. Your doctor can create a schedule for you to gradually taper off of your medication in order to help minimize or avoid developing discontinuation syndrome.

Causes

By some estimates, antidepressant discontinuation syndrome occurs in about 20% of people who have regularly taken an antidepressant for at least a month and suddenly stop taking it or who drastically reduce their dose. Some types of antidepressants seem to be more likely to cause discontinuation syndrome than others, but you can develop it from any type.

When you're addicted to a substance like drugs or alcohol, it causes changes in your brain that lead to cravings, the need for an increased amount of the substance, and a strong desire to use the substance even though it often causes negative outcomes. Antidepressants don't cause these long-term brain changes nor do they lead to cravings or addiction.

Symptoms

Symptoms of antidepressant discontinuation syndrome tend to be mild. They usually start within two to four days, and last just a week or two. Symptoms include:

• Flu-like symptoms: such as fatigue, sweating, achiness, headache, and feeling sluggish
• Insomnia: which may be accompanied by nightmares or vivid dreams
• Nausea: feeling sick and potentially vomiting
• Balance issues: such as dizziness, feeling lightheaded, or vertigo (a spinning or tilting sensation)
• Sensory disturbances: like tingling, burning, or feeling like you're getting shocked
• Emotional issues: like agitation, irritability, and anxiety

Discontinuation vs. Relapse

For some people, discontinuation symptoms can make it feel as though their depression or anxiety is coming back, and indeed, stopping your antidepressant may increase your risk of relapse. Because of this, it's important to distinguish between discontinuation syndrome and relapse.

The biggest difference between the two is that discontinuation symptoms typically begin within a few days after stopping your antidepressant whereas a relapse normally takes longer to occur and the symptoms develop more gradually.

Another difference is that discontinuation syndrome often involves physical symptoms that aren't associated with depression or anxiety, such as dizziness, nausea, or flu-like symptoms.

With discontinuation syndrome, the symptoms eventually go away, usually within one to three weeks. But if you're having a relapse of your depression or anxiety, the symptoms don't go away and may even get worse.

Additionally, if you start an antidepressant again, discontinuation symptoms will resolve quickly, but depression or anxiety will take longer to respond. Here are some tips to help you avoid discontinuation syndrome and get relief if it does happen to you. 

Stick to Your Schedule

Certain antidepressants, such as Effexor (venlafaxine), leave your system quickly and therefore are more likely to cause withdrawal symptoms. This can happen even when you're simply a little late taking your regular dose.

If you happen to forget your antidepressant, it's OK to go ahead and take it as soon as you realize you missed it. The exception is if it's close to your next scheduled dose; in that case, wait until then and get back on track.

Consider a Switch

Let's say you're taking a selective serotonin reuptake inhibitor (SSRI) but it isn't working very well for you, or it's causing side effects that you can't live with. Rather than stopping it cold turkey and potentially causing discontinuation syndrome, talk to your doctor about switching to another medication, especially if you haven't been on it for long.

Prozac (fluoxetine), for example, has a very long half-life, meaning that after you stop taking it, it leaves your body more slowly than most other SSRIs. For this reason, you're unlikely to have extreme withdrawal symptoms with Prozac. Keep this in mind when you and your doctor are discussing which antidepressant you should try or if you're considering switching to another one.

The same is true if you're switching from an SSRI to a selective serotonin-norepinephrine reuptake inhibitor (SNRI), such as Effexor (venlafaxine). In fact, you should be able to easily go straight from Prozac (fluoxetine) to any other antidepressant except for one in the class of monoamine oxidase inhibitors (MAOIs).

These medications have more safety concerns and potentially have more side effects than the newer drugs, so it's unlikely your doctor would put you on one unless trials of other antidepressants have not been adequately effective.

Taper Off Slowly

If you and your doctor have decided it's time for you to stop taking your antidepressant, it's possible to avoid discontinuation syndrome altogether. Even if you're tempted to, the key is to not quit all of a sudden, but instead to taper off your medication.

Tapering means gradually decreasing your dose over an extended period of time. How you'll do this will depend on how long you've been taking the drug, how high your dose is (if you're on a low dose you'll be able to taper off more quickly), and any other factors your doctor may consider.

Consider Prozac

Sometimes, even if you are slow and deliberate when weaning yourself off an antidepressant, you still may experience symptoms of discontinuation syndrome. One possible way to get relief is to take a dose of Prozac (fluoxetine) along with medications like Zoloft (sertraline) and Lexapro (escitalopram) that you are trying to taper.

Your symptoms will likely go away within a few hours. And because of Prozac's long half-life, it will help smooth out the taper. Ask your doctor about this option if your symptoms are bothersome.

If you were on a very high dose of Paxil (paroxetine) or Effexor (venlafaxine), you may need to take repeated doses of Prozac. Benadryl (diphenhydramine) is an over-the-counter allergy medication that has been reported to help with discontinuation symptoms too, though it has a sedating effect.

Schedule a Follow-Up

After you discontinue your antidepressant, you should have a follow-up appointment with your doctor so they can evaluate your mental health and make sure any discontinuation symptoms have gone away.

Be Active

If you haven't been exercising regularly, make it a point to start when you discontinue your antidepressant. This may be difficult as your depression can easily sap your motivation but it is possible, and it will make you feel better.

Start small and slowly and set reasonable expectations. For example, consider committing to a 20-minute walk two days a week. Make it social and enlist a walking buddy to help keep you accountable.

One way exercise boosts your mood is by releasing feel-good endorphins and it gives you an outlet to relieve stress, all of which can help keep your depression at bay as you taper off and eventually stop your antidepressant.