How Do You Know When You No Longer Need an Antidepressant

Coming off your medication can cause antidepressant withdrawal – and could set up you up for a relapse of depression

Can going off your medication cause antidepressant withdrawal symptoms (antidepressant discontinuation syndrome)? About 10% of women ages xviii and over accept antidepressants. Every bit many of usa know, these medications can be a godsend when low has robbed life of its joy and made it hard to muster the free energy and concentration to complete everyday tasks. But equally yous begin to feel better and want to move on, how long should you keep taking the pills?

If you're doing well on antidepressants and non complaining of as well many side effects, many physicians will renew the prescription indefinitely — figuring that it offers a hedge against a relapse of depression. But side furnishings that y'all may have been willing to put up with initially — sexual side effects (decreased desire and difficulty having an orgasm), headache, insomnia, drowsiness, brilliant dreaming, or just not feeling like yourself — can become less acceptable over time, especially if you call up you no longer need the pills.

The decision to go off antidepressants should exist considered thoughtfully and made with the back up of your physician or therapist to make certain you're not stopping prematurely, risking a recurrence of low. Once you decide to quit, you and your dr. should take steps to minimize or avoid the discontinuation symptoms that can occur if such medications are withdrawn too quickly.

Why antidepressant withdrawal?

Antidepressants piece of work past altering the levels of neurotransmitters — chemical messengers that attach to receptors on neurons (nerve cells) throughout the torso and influence their action. Neurons somewhen adapt to the electric 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 exist uncomfortable.

Among the newer antidepressants, those that influence the serotonin organisation — selective serotonin reuptake inhibitors (SSRIs, now commonly known every bit SRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) — are associated with a number of withdrawal symptoms, often chosen antidepressant or SRI discontinuation syndrome. Stopping antidepressants such equally bupropion (Wellbutrin) that practise not touch on serotonin systems — dopamine and norepinephrine reuptake inhibitors — seems less troublesome over all, although some patients develop farthermost irritability.

Having discontinuation symptoms doesn't mean you lot'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 peckish or feel a need to increment the dose. (Sometimes an SRI will stop working — a phenomenon chosen "Prozac poop-out" — which may necessitate increasing the dose or adding another drug.)

Antidepressant withdrawal can await like low

Discontinuation symptoms can include anxiety and depression. Since these may exist the reason yous were prescribed antidepressants in the first identify, their reappearance may suggest that you lot'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 than gradually.

• Discontinuation symptoms often include concrete 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 handling of low itself takes weeks to work.

• Discontinuation symptoms resolve equally the body readjusts, while recurrent depression continues and may become worse.

If symptoms last more than a month and are worsening, it's worth because whether yous're having a relapse of depression.

Antidepressant withdrawal symptoms

Neurotransmitters act throughout the body, and you may experience physical equally well as mental effects when you stop taking antidepressants or lower the dose too fast. Mutual complaints include the following:

• Digestive. Yous may have nausea, airsickness, cramps, diarrhea, or loss of appetite.
• Blood vessel command. Yous may sweat excessively, flush, or observe hot atmospheric condition difficult to tolerate.
• Sleep changes. You may accept trouble sleeping and unusual dreams or nightmares.
• Balance. You lot may become dizzy or lightheaded or feel like you don't quite have your "bounding main legs" when walking.
• Command of movements. Y'all may experience tremors, restless legs, uneven gait, and difficulty coordinating speech and chewing movements.
• Unwanted feelings. You may take mood swings or feel agitated, broken-hearted, manic, depressed, irritable, or confused — even paranoid or suicidal.
• Strange sensations. You lot may accept pain or numbness; you may go hypersensitive to audio or sense a ringing in your ears; y'all may feel "brain-zaps" — a feeling that resembles an electrical shock to your head — or a awareness that some people depict equally "brain shivers."

Equally dire as some of these symptoms may audio, you shouldn't let them discourage you if you want to get off your antidepressant. Many of the symptoms of SRI discontinuation syndrome can exist minimized or prevented by gradually lowering, or tapering, the dose over weeks to months, sometimes substituting longer-acting drugs such every bit fluoxetine (Prozac) for shorter-interim medications. The antidepressants most likely to cause troublesome symptoms are those that have a short half-life — that is, they break downward and leave the torso chop-chop. (Encounter the chart "Antidepressant drugs and their one-half-lives.") Examples include venlafaxine (Effexor), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa). Extended-release versions of these drugs enter the body more slowly merely get out information technology just every bit fast. Antidepressants with a longer half-life, importantly fluoxetine, cause fewer problems on discontinuation.

Also easing the transition, tapering the dose decreases the chance that depression will recur. 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 apace (over one to seven days) were more than likely to relapse within a few months than those who reduced the dose gradually over two or more weeks.

Antidepressant drugs and their half-lives*
Drug	Half out of torso in	99% out of body in
Serotonin reuptake inhibitors
paroxetine (Paxil)	24 hours	4.4 days
sertraline (Zoloft)	26 hours	v.4 days
escitalopram (Lexapro)	27 to 32 hours	6.one days
citalopram (Celexa)	36 hours	seven.three days
fluoxetine (Prozac)	Four to six days	25 days
Serotonin and norepinephrine reuptake inhibitors
venlafaxine (Effexor)	5 hours	1 solar day
duloxetine (Cymbalta)	12 hours	2.5 days
desvenlafaxine (Pristiq)	12 hours	2.5 days
Dopamine and norepinephrine reuptake inhibitor
bupropion (Wellbutrin)	21 hours	four.4 days
*Discontinuation symptoms typically start when 90% or more of the drug has left your system. Source: Adjusted from Joseph Glenmullen, Grand.D., The Antidepressant Solution: A Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and "Addiction" (Free Press, 2006).

How to get off antidepressants

If y'all're thinking near stopping antidepressants, you should go footstep-by-footstep, and consider the following:

Have your time. Y'all may exist tempted to stop taking antidepressants every bit soon as your symptoms ease, but low can return if you quit besides soon. Clinicians generally recommend staying on the medication for 6 to nine months before considering going off antidepressants. If you've had 3 or more recurrences of depression, make that at least two years.

Talk to your clinician almost the benefits and risks of antidepressants in your particular situation, and work with her or him in deciding whether (and when) to cease using them. Earlier discontinuing, yous should feel confident that you're functioning well, that your life circumstances are stable, and that y'all can cope with whatever negative thoughts that might emerge. Don't endeavour to quit while you're under stress or undergoing a significant change in your life, such every bit a new job or an affliction.

Brand a programme. Going off an antidepressant usually involves reducing your dose in increments, allowing ii to half-dozen weeks between dose reductions. Your clinician tin can instruct you lot in tapering your dose and prescribe the appropriate dosage pills for making the modify. The schedule will depend on which antidepressant you're taking, how long yous've been on it, your electric current dose, and any symptoms you had during previous medication changes. It's besides a proficient idea to keep a "mood calendar" on which you record your mood (on a calibration of one to 10) on a daily ground.

Consider psychotherapy. Fewer than 20% of people on antidepressants undergo psychotherapy, although it's oft of import in recovering from depression and avoiding recurrence. 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 probable to accept a relapse.

Stay agile. Bolster your internal resources with good nutrition, stress-reduction techniques, regular sleep — and specially concrete activity. Exercise has a powerful antidepressant effect. Information technology'south been shown that people are far less likely to relapse after recovering from depression if they exercise three times a week or more than. Exercise makes serotonin more than available for binding to receptor sites on nerve cells, and so information technology can recoup for changes in serotonin levels as you taper off SRIs and other medications that target the serotonin system.

Seek back up. Stay in touch with your clinician equally you go through the process. Let her or him know well-nigh any concrete or emotional symptoms that could be related to discontinuation. If the symptoms are mild, yous'll probably exist reassured that they're just temporary, the result of the medication clearing your system. (A brusk course of a not-antidepressant medication such as an antihistamine, anti-anxiety medication, or sleeping aid can sometimes ease these symptoms.) If symptoms are astringent, you might need to go back to a previous dose and reduce the levels more slowly. If y'all're taking an SRI with a brusk one-half-life, switching to a longer-acting drug like fluoxetine may help.

You may want to involve a relative or close friend in your planning. If people effectually you realize that yous're discontinuing antidepressants and may occasionally be irritable or tearful, they'll be less likely to accept it personally. A close friend or family member may also be able to recognize signs of recurring low that yous might not perceive.

Complete the taper. By the time you lot stop taking the medication, your dose will exist tiny. (Y'all may already have been cutting your pills in half or using a liquid formula to attain progressively smaller doses.) Some psychiatrists prescribe a single twenty-milligram tablet of fluoxetine the day after the last dose of a shorter-acting antidepressant in order to ease its terminal washout from the trunk, although this approach hasn't been tested in a clinical trial.

Check in with your clinician one month subsequently y'all've stopped the medication altogether. At this follow-upward appointment, she or he volition check to make sure discontinuation symptoms have eased and there are no signs of returning low. Ongoing monthly check-ins may be advised.

Epitome: AlinaTraut/Getty Images

To learn what yous can exercise to become the sleep y'all demand for optimal health, safety, and well-existence, but the Harvard Special Health Report Improving Sleep: A guide to a skillful nighttime's balance.

Every bit a service to our readers, Harvard Health Publishing provides admission to our library of archived content. Delight note the date of last review or update on all articles. No content on this site, regardless of engagement, should ever be used as a substitute for direct medical advice from your doc or other qualified clinician.

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Source: https://www.health.harvard.edu/diseases-and-conditions/going-off-antidepressants

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