Antidepressant Withdrawal: What to Know

More than one in 10 people in the United States take an antidepressant, according to the Cleveland Clinic website.

“Even before the emergence of Covid, 1 in 8 American adults was taking an antidepressant drug. According to one estimate, that number rose by 18.6 percent during 2020,” according to an article in The New York Times (NYT). “Zoloft is now the 12^th most commonly prescribed medication in the United States.”

Yet, for some patients, antidepressants may not work as they had hoped. For some, they may have little to no symptom relief. For others, side effects can be uncomfortable or unmanageable. These issues may lead some to stop taking them – often against doctor’s orders.

Those who’ve taken an antidepressant (usually for more than four to six weeks) and suddenly stop may experience uncomfortable symptoms, known as antidepressant withdrawal.

“The drugs have helped millions of people ease depression and anxiety, and are widely regarded as milestones in psychiatric treatment. Many, perhaps most, people stop the medications without significant trouble,” according to the NYT. “But the rise in longtime use is also the result of an unanticipated and growing problem: Many who try to quit say they cannot because of withdrawal symptoms they were never warned about.”

Antidepressant withdrawal: What is it?

The term antidepressant withdrawal refers to symptoms a person may experience after abruptly stopping an antidepressant medication, either by going “cold turkey” and stopping completely, or by reducing the dosage amount of medication they take too quickly.

“Antidepressant withdrawal is possible if you abruptly stop taking an antidepressant, particularly if you’ve been taking it longer than four to six weeks. Symptoms of antidepressant withdrawal […] typically last for a few weeks. Certain antidepressants are more likely to cause withdrawal symptoms than others,” according to the Mayo Clinic website.

Symptoms of antidepressant withdrawal

Antidepressant withdrawal can include unpleasant symptoms that may feel intense.

“The phenomenon often referred to as ‘antidepressant withdrawal’ is actually medically known as antidepressant discontinuation syndrome (ADS). Approximately 20 percent of patients who have taken antidepressants daily for at least a month will experience ADS if they stop these meds too abruptly,” according to SELF.

The mnemonic FINISH was first published in 1998 in the Journal of Clinical Psychiatry and is used to identify the symptoms of antidepressant withdrawal:

• “Flu-like symptoms
• Insomnia
• Nausea
• Imbalance
• Sensory disturbances
• Hyperarousal (anxiety/agitation)”

Some people who experience antidepressant discontinuation symptoms say the negative effects interfere with their daily activities.

Victoria Tonline of Tacoma, Wash. told NYT that it took her nine months to stop taking Zoloft, by gradually reducing the size of her dosage. She “would hunch over the kitchen table, steady her hands and draw a bead of liquid from a vial with a small dropper. It was a delicate operation that had become a daily routine — extracting ever tinier doses of the antidepressant she had taken for three years, on and off, and was desperately trying to quit.”

“Basically that’s all I have been doing — dealing with the dizziness, the confusion, the fatigue, all the symptoms of withdrawal,” Toline told NYT. “I couldn’t finish my college degree. Only now am I feeling well enough to try to re-enter society and go back to work.”

If you suspect you are experiencing antidepressant withdrawal, talk to your healthcare provider about your symptoms.

Relapse depression or withdrawal?

Since antidepressant discontinuation symptoms may feel like depression symptoms, it can be hard to tell if a person who feels them after stopping medication is experiencing withdrawal or, in fact, the return of their depression. In some cases, a person’s doctor may recommend continuing to take antidepressant drugs for a period of time.

“Discontinuation symptoms can include anxiety and depression. Since these may be the reason you were prescribed antidepressants in the first place, their reappearance may suggest that you’re having a relapse and need ongoing treatment,” according to a blog post on the Harvard Health Publishing website.

While it can be hard to determine if you are experiencing withdrawal or depression relapse, here are some common characteristics of discontinuation symptoms:

• “…Emerge within days to weeks of stopping the medication or lowering the dose, whereas relapse symptoms develop later and more gradually.
• …Often include physical complaints that aren’t commonly found in depression, such as dizziness, flulike symptoms, and abnormal sensations.
• …Disappear quickly if you take a dose of the antidepressant, while drug treatment of depression itself takes weeks to work.
• …Resolve as the body readjusts, while recurrent depression continues and may get worse.”

Timeline of antidepressant withdrawal

Symptoms of antidepressant withdrawal can start within a day or two of quitting your medication suddenly, according to the Mayo Clinic website. The timeline from there can depend on a number of factors.

“The experience of antidepressant withdrawal can vary greatly from one person to the next. Factors affecting withdrawal – including how long symptoms last – include the type of antidepressant taken, its dosage, and the length of time the drug has been used,” according to a Verywell Mind article. “Antidepressant withdrawal symptoms are usually fairly mild in the first one to three days, potentially intensifying before beginning to subside. It can take several weeks for all symptoms to resolve completely, with some people experiencing effects for months.”

During this timeframe, your brain is adjusting to the reduction in medication, according to psychiatrist Jessica A. Gold, M.D., M.S., in SELF.

“I like to think of coming off medication just as I do about starting them: It’s something to do mindfully and slowly,” according to Dr. Gold. “Gradually lowering your dosage instead of suddenly stopping or even stopping too quickly allows your brain to better adjust to the fluctuating neurotransmitter levels.”

Tapering the use of antidepressants

Your healthcare provider can help you learn how to taper your medication, considering your specific medication and health history.

“I often decrease my patients’ antidepressants over two to four weeks, but some studies recommend even slower tapers over a period of months. What’s right for you will depend on the exact drug you’re taking, how long you’ve been taking it, and other factors,” according to Dr. Gold. “Also, tapering effectively might mean getting lower doses of your medication altogether. The point of tapering is to eventually get you to a dose below what’s considered ‘therapeutic.’”

Tapering slowly may also have other benefits, according to the Harvard Health Publishing blog post.

“Besides easing the transition, tapering the dose decreases the risk that depression will recur,” according to the blog post. “In a Harvard Medical School study, nearly 400 patients (two-thirds of them women) were followed for more than a year after they stopped taking antidepressants prescribed for mood and anxiety disorders. Participants who discontinued rapidly (over one to seven days) were more likely to relapse within a few months than those who reduced the dose gradually over two or more weeks.”

 How antidepressant withdrawal may be treated

You should work closely with a healthcare provider to taper your antidepressant, which may help you reduce or avoid withdrawal symptoms.

“Stay in touch with your clinician as you go through the process. Let her or him know about any physical or emotional symptoms that could be related to discontinuation,” according to the Harvard Health Publishing blog. “If the symptoms are mild, you’ll probably be reassured that they’re just temporary, the result of the medication clearing your system.”

While you’re discontinuing antidepressants, it’s best to go step-by-step, according to the blog:

• “Take your time” and try to avoid quitting during a stressful time in your life.
• “Make a plan” – including tracking any mood changes you experience during your taper.
• “Consider psychotherapy” (talk therapy) – “In a meta-analysis of controlled studies, investigators at Harvard Medical School and other universities found that people who undergo psychotherapy while discontinuing an antidepressant are less likely to have a relapse.”
• Practice healthy habits – eating well, reducing stress, getting enough sleep and exercising
• “Seek support” – such as bringing a close friend or relative in on what you’re going through. It is also important to keep in touch with your clinician as you go through the discontinuation process.
• “Complete the taper” – Follow your clinician’s instructions on the taper and don’t stop taking your medication just because the dose gets tiny.

Your provider may also suggest other ways to treat or prevent antidepressant discontinuation symptoms.

“In some cases, your doctor may prescribe another antidepressant or another type of medication on a short-term basis to help ease symptoms as your body adjusts. If you’re switching from one type of antidepressant to another, your doctor may have you start taking the new one before you completely stop taking the original medication,” according to the Mayo Clinic website.

Have a check-in with your provider about a month after you’ve completely finished your medication, according to the Harvard Health Publishing blog. And don’t hesitate to reach out for help again in the future if you need it.

“At this follow-up appointment, she or he will check to make sure discontinuation symptoms have eased and there are no signs of returning depression. Ongoing monthly check-ins may be advised,” according to the blog.

For more information about this topic, please read:

Antidepressant Withdrawal or Depression Reoccurrence? What Healthcare Providers Should Know

5 Things to Know Before Starting Antidepressants

Depression Disconnect: GeneSight® Mental Health Monitor Shows Misunderstanding of Depression and Treatment