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Neurons eventually adapt to the current level of neurotransmitters, and symptoms that range from mild to distressing may arise if the level changes too much too fast — for example, because you've suddenly stopped taking your antidepressant.
They're generally not medically dangerous but may be uncomfortable. Among the newer antidepressants, those that influence the serotonin system — selective serotonin reuptake inhibitors SSRIs, now commonly known as SRIs and serotonin-norepinephrine reuptake inhibitors SNRIs — are associated with a number of withdrawal symptoms, often called antidepressant or SRI discontinuation syndrome. Stopping antidepressants such as bupropion Wellbutrin that do not affect serotonin systems — dopamine and norepinephrine reuptake inhibitors — seems less troublesome over all, although some patients develop extreme irritability.
Having discontinuation symptoms doesn't mean you're addicted to your antidepressant. A person who is addicted craves the drug and often needs increasingly higher doses. Few people who take antidepressants develop a craving or feel a need to increase the dose. Sometimes an SRI will stop working — a phenomenon called "Prozac poop-out" — which may necessitate increasing the dose or adding another drug. 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.
Here's how to distinguish discontinuation symptoms from relapse:. Discontinuation symptoms emerge within days to weeks of stopping the medication or lowering the dose, whereas relapse symptoms develop later and more gradually. Discontinuation symptoms often include physical complaints that aren't commonly found in depression, such as dizziness, flulike symptoms, and abnormal sensations.
Discontinuation symptoms disappear quickly if you take a dose of the antidepressant, while drug treatment of depression itself takes weeks to work. Discontinuation symptoms resolve as the body readjusts, while recurrent depression continues and may get worse. If symptoms last more than a month and are worsening, it's worth considering whether you're having a relapse of depression.
Neurotransmitters act throughout the body, and you may experience physical as well as mental effects when you stop taking antidepressants or lower the dose too fast. Common complaints include the following:. As dire as some of these symptoms may sound, you shouldn't let them discourage you if you want to go off your antidepressant. Many of the symptoms of SRI discontinuation syndrome can be minimized or prevented by gradually lowering, or tapering, the dose over weeks to months, sometimes substituting longer-acting drugs such as fluoxetine Prozac for shorter-acting medications.
The antidepressants most likely to cause troublesome symptoms are those that have a short half-life — that is, they break down and leave the body quickly. See the chart "Antidepressant drugs and their half-lives.
Extended-release versions of these drugs enter the body more slowly but leave it just as fast. Antidepressants with a longer half-life, chiefly fluoxetine, cause fewer problems on discontinuation. Besides easing the transition, tapering the dose decreases the risk that depression will recur. In a Harvard Medical School study, nearly 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. Source: Adapted from Joseph Glenmullen, M. If you're thinking about stopping antidepressants, you should go step-by-step, and consider the following:. Take your time. You may be tempted to stop taking antidepressants as soon as your symptoms ease, but depression can return if you quit too soon.
Clinicians generally recommend staying on the medication for six to nine months before considering going off antidepressants. If you've had three or more recurrences of depression, make that at least two years. Talk to your clinician about the benefits and risks of antidepressants in your particular situation, and work with her or him in deciding whether and when to stop using them. Consider psychotherapy. 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.
Stay active. Bolster your internal resources with good nutrition, stress-reduction techniques, regular sleep — and especially physical activity.
Exercise has a powerful antidepressant effect. Exercise makes serotonin more available for binding to receptor sites on nerve cells, so it can compensate for changes in serotonin levels as you taper off SRIs and other medications that target the serotonin system. Seek support. 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.
A short course of a non-antidepressant medication such as an antihistamine, anti-anxiety medication, or sleeping aid can sometimes ease these symptoms. If symptoms are severe, you might need to go back to a previous dose and reduce the levels more slowly.
You may want to involve a relative or close friend in your planning. A close friend or family member may also be able to recognize signs of recurring depression that you might not perceive. Complete the taper. By the time you stop taking the medication, your dose will be tiny. You may already have been cutting your pills in half or using a liquid formula to achieve progressively smaller doses.
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