Doctors prescribe antidepressants to help a person cope with depression, improve their mood, and reduce anxiety. If people taking antidepressants stop taking them, they may experience antidepressant withdrawal syndrome.
Antidepressants improve symptoms of depression, and when a person begins to feel better, they can stop taking the medications. However, suddenly stopping or reducing antidepressant use may cause a person to feel like they have the flu or other viral infection. For some people, symptoms may be severe and may include anxious thoughts and psychosis. These symptoms may be caused by stopping antidepressants.
What causes this?
Experts do not fully understand the causes of antidepressant withdrawal syndrome, but there are several theories. One theory is that sudden withdrawal from selective serotonin reuptake inhibitor (SSRI) antidepressants may lead to a decrease in serotonin concentrations. When a person uses SSRIs for a long time, they may experience an increase in serotonin levels. Serotonin is a hormone responsible for stabilizing mood and creating feelings of happiness and well-being. The activity of serotonin receptors is reduced when using SSRIs. When a person stops taking an SSRI, the receptors may remain in this less active state for several days or weeks. Because it affects how the body uses serotonin, a person may experience antidepressant withdrawal syndrome.
Similar effects may also occur when other antidepressants are discontinued, including monoamine oxidase inhibitors and tricyclic antidepressants, potentially leading to antidepressant withdrawal syndrome.
In addition, tricyclic antidepressants affect a part of the nervous system called the cholinergic system. If a person stops taking them, they may experience balance problems and symptoms similar to those of Parkinson's disease.
Monoamine oxidase inhibitors interact with neurotransmitters in the brain and improve communication between them, which can cause agitation and psychosis in a person.
Antidepressant withdrawal syndrome - symptoms
Symptoms of antidepressant withdrawal syndrome overlap with symptoms of other conditions, so doctors will take a medical history and ask about symptoms to make a diagnosis. People may notice changes in both physical and mental health if they stop taking antidepressants because these drugs affect systems throughout the body.
The following symptoms may appear:
- Flu-like symptoms
: These include fatigue, headaches, muscle and joint pain, and sweating. - Insomnia
: The person has difficulty falling asleep and may have vivid dreams or nightmares. - Nausea
: A person may feel nauseated, vomit, or have gastrointestinal symptoms such as diarrhea and cramps. - Imbalance
: The person may feel dizzy. - Sensory disturbances
: Antidepressant withdrawal syndrome can affect any of the senses, causing symptoms such as tingling of the skin, a burning sensation, or an electric shock, especially in the head. - Overarousal
: This abnormal state of hypervigilance makes a person feel on edge. He may feel restless, irritable, aggressive, or manic.
Drugs that are associated with withdrawal symptoms include:
- desvenlafaxine (Pristiq)
- citalopram (Celexa)
- duloxetine (Cymbalta)
- venlafaxine (Effexor)
- escitalopram (Lexapro)
- paroxetine (Paxil)
- fluoxetine (Prozac)
- sertraline (Zoloft)
Consequences of stopping Paxil
Studies were conducted on volunteers, which revealed the presence of consequences of stopping treatment with Paxil in a third of all patients who completed treatment. Most of them experienced symptoms such as dizziness, headache, tinnitus, discomfort in the extremities, similar to electric shock, tremors, nausea, disturbances of consciousness, sleep disturbances, agitation, and aggressiveness.
The listed manifestations were expressed in varying degrees of intensity, appeared and disappeared at different intervals after discontinuation of the drug. Adolescents and young patients may experience suicidal thoughts and suicide attempts when they stop using the medication.
How long does antidepressant withdrawal syndrome last?
Symptoms of antidepressant withdrawal syndrome are usually mild and resolve within 1-2 weeks. In more severe cases involving widespread cognitive impairment or psychosis, the person may require immediate psychiatric intervention.
The duration of symptoms depends on the half-life of the antidepressant. Half-life is a measure of how long it takes for the amount of a drug's active substance in the body to be reduced by half.
Drugs such as Prozac are known to cause withdrawal symptoms. Those with a longer half-life typically experience withdrawal symptoms that are less intense but last longer.
Stopping monoamine oxidase inhibitors can be more problematic because people often have severe symptoms.
Sudden cessation of tricyclic antidepressant use may also lead to antidepressant withdrawal syndrome. Your doctor may recommend reducing your dosage over several weeks or months.
Unpredictability
The above figures are based on studies performed on large groups of patients - these are averages. “But there are no average patients,” says Claudi Bockting.
“Therefore, it may turn out that antidepressants will not help a person with severe depression. On the contrary, someone with mild depression will benefit. And not every patient with mild depression benefits from cognitive behavioral therapy. And sometimes people are able to function well without medication after several episodes of depression. That is, each patient needs to select the best treatment option for him.”
How to survive antidepressant withdrawal syndrome?
A person who wants to stop taking antidepressants should talk to a psychiatrist or psychologist to avoid the syndrome. Experts may advise switching to another drug or reducing your medication intake.
The following recommendations may help avoid or minimize antidepressant withdrawal syndrome:
- Slow withdrawal
: Doctors usually recommend using antidepressants for 6 to 9 months before stopping their use. People who have had relapses of depression or are at higher risk of returning symptoms should use the drugs for 2 years. - Stopping at the right time
: A person should stop taking antidepressants only under the guidance of a doctor when their life circumstances are stable and they feel well. A person should not stop taking antidepressants during periods of significant stress. - Planning
: Tapering or stopping antidepressants should occur over several weeks. The doctor will take into account the specific antidepressant, its dosage, and how long the person has been taking it. - Psychotherapy
: Only 20% of people taking antidepressants receive psychotherapy, which can help people recover from depression and avoid recurrence. - Activity
: A person can maintain their well-being by eating a balanced diet, exercising regularly, practicing stress reduction techniques, and getting enough sleep. Exercise releases feel-good endorphins, which improve your mood and reduce anxiety and depression.
Gradually reducing the antidepressant dose over a long period may reduce or eliminate side effects.
How to stop taking sleeping pills and sedatives
Brenninkmeijer gives the following tips:
(1) Ask for help
»Many people want to stop taking benzodiazepines, but few of them seek professional help. In the Netherlands there are special assistance programs, for example www.benzodebaas.nl. 65% of patients following this program can be pill-free after four months. Among those who try to stop taking medications on their own, only 25% succeed.”
(2) Do not stop taking medications abruptly
“If you still do this, then take into account the possibility of unpleasant withdrawal symptoms: headache, trembling limbs, sweating, speech difficulties, feeling of suffocation, muscle pain... If you “get off” the drug gradually with our support, then withdrawal symptoms will be softer, or there won’t be any at all.”
(3) Learn to cope with your insomnia and anxiety
“In our program, you can learn to cope with your problems with the help of relaxation exercises, sleep techniques and tips for dealing with obsessive thoughts at night.”
(4) Deal with your mental problems
“Sometimes when you stop taking medications, some people have deep-seated fears or frustrations that come to the surface. Often these mental problems underlie the decision to start taking sleeping pills or anti-anxiety medications. Seek professional help because otherwise it will be much more difficult for you to stop using medications.”
When to see a doctor
People considering stopping antidepressants should consult with their doctor to create a personalized plan. Factors that will determine the most appropriate approach include:
- type of antidepressant
- length of time the person took the drug
- any other medications he is taking
If a person has symptoms after abruptly stopping antidepressants, they should consult a doctor. A doctor can help manage severe symptoms, such as psychosis, which may require psychiatric intervention.
Duration of taking antidepressants
According to numerous studies, the duration of taking antidepressants is at least 6 months after the patient begins to notice improvement.
Patients who stop taking medications for up to 8 months may experience a return of symptoms. For patients who have had one or more relapses of depression, the duration of taking antidepressants is about 24 months. And those patients who experience frequent relapses of depression require long-term treatment, which can last several years.
To correctly select the dose of the drug and determine the duration of treatment, the Yusupov Hospital employs psychiatrists of the highest category with a scientific degree. Each patient is given close attention. Patients who seek medical help at the clinic are constantly under the supervision of a specialist throughout the entire treatment. Psychiatrists can be consulted about rehabilitation after treatment, which makes it possible to reduce the incidence of recurrent symptoms of depression.
Independent and uncontrolled use of antidepressants entails the development of unwanted side effects, which in turn leads to early drug withdrawal and ineffective treatment.
Expert opinion
Author:
Elena Mikhailovna Bunina
Psychiatrist, doctor of the highest category
Statistics show that 5% of the population suffers from symptoms of depression. In most cases, psychiatrists decide to prescribe antidepressants. The drugs are included in the list of complex therapy used for depressive disorder.
Antidepressants work by restoring normal levels of chemicals responsible for regulating sadness and anxiety. Numerous clinical studies have proven that drugs of this pharmacological group are not addictive. However, one in five experience withdrawal symptoms. They are associated with abrupt cessation of taking prescribed medications. It is impossible to predict the development of withdrawal symptoms in advance.
Psychiatrists at the Yusupov Hospital select an individual treatment plan for each patient. It includes complex therapy using antidepressants that have undergone quality and safety control. The medications have proven effectiveness and are included in the list of world standards for the treatment of depression. Doctors do not recommend stopping the prescribed course on your own or abruptly. This can worsen the situation and lead to the development of unwanted symptoms.
