Antidepressant Discontinuation: Safe Ways To Navigate SSRI Withdrawals
Selective serotonin reuptake inhibitors (SSRIs) are a class of medication used to treat many different types of mental illnesses like depression, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, and even some kinds of eating disorders. Many people will only be on SSRIs for a period of time rather than for life, which is why it’s important to understand the mechanics of stopping a medication like this.
Starting, stopping, or changing your dose of any medication—particularly SSRIs—should only be done under the supervision of a licensed healthcare provider. This is because experiencing discontinuation symptoms and side effects—some potentially serious and even life-threatening—after you stop taking this type of antidepressant is possible. Being fully aware of the symptoms and risks of no longer taking selective serotonin reuptake inhibitors can be important, as it can help you know what to expect and do so safely.
Reasons someone may want to discontinue SSRI medication use
There are many reasons that an individual might decide they want to stop taking their dose of SSRIs. You may believe your symptoms have resolved, although it could simply be that the medication is doing its job. You may also decide that the side effects have begun to outweigh the benefits, or you might become pregnant and need to stop taking them for the safety of the baby. Or, you may not have the means to refill your prescription. Whatever your reason for wanting or needing to discontinue SSRI medication, it’s crucial to not do so abruptly, as you may experience potentially severe withdrawal symptoms.
Why gradual discontinuation of SSRIs is important
Whenever possible, SSRIs should be discontinued gradually to help prevent SSRI discontinuation syndrome. This is especially important if you are taking high doses of an SSRI. You can work with your doctor or psychiatrist and pharmacist to obtain different strengths of the medication so you can decrease the dose gradually according to your healthcare provider’s instructions.
Note that one of the potential symptoms of abrupt SSRI discontinuation is suicidal thoughts and/or behaviors, which is a key reason that going about this process in the proper way can be so important.
Wean off SSRIs slowly
Depending on your current dosage of the SSRI, weaning off of it safely may take several weeks. That means your healthcare provider could decrease your dose week by week until you’re no longer taking the medication. If you do experience antidepressant discontinuation symptoms during this process, they may begin within the first week of decreased dosage, or they may not occur until you are completely off the medication.
Frequent and careful monitoring during the process
It’s important that you and your doctor carefully monitor your health and mood while you go through the discontinuation process. They may watch for withdrawal symptoms—especially serious or severe ones—and any signs that the original symptoms for which you were prescribed the medication could be returning. Relapse within the first two weeks of decreasing or stopping an SSRI is common. This is because an SSRI may help control symptoms of depression and anxiety so well that the illness appears to be in remission. However, stopping the medication sometimes brings these conditions back swiftly and severely.
Journal your moods
It can be helpful to keep a journal to record your moods and any discontinuation symptoms along the way. Some may be felt physically, while others could affect your mood or mental health. This journal could help your doctor track your progress and make appropriate recommendations for your treatment going forward. Note that it can be beneficial to visit your doctor multiple times throughout the process of discontinuation, especially if you experience any problems.
Physical symptoms of SSRI withdrawal syndrome
There are various symptoms that can be associated with antidepressant discontinuation syndrome. Those who experience withdrawal will typically experience at least two or more. Some may also notice the rapid return of the symptoms the medication was originally treating. Again, as noted above, it’s important to only discontinue SSRI use gradually and under a doctor's supervision. Stopping them abruptly can increase your risk of experiencing symptoms.
Common symptoms after discontinuing antidepressant use
The most common physical symptoms of SSRI withdrawal are:
- Dizziness
- Lightheadedness
- Vertigo
- Electric shock sensations
- Diarrhea
- Fatigue
- Gait instability
- Headache
- Nausea
- Tremors
- Visual disturbances
Symptoms related to mental health
It is also common during withdrawal to experience symptoms related to mental health, such as anxiety, insomnia, and irritability. As mentioned above, abrupt discontinuation could also result in suicidal thoughts or behaviors.
The duration of SSRI withdrawal syndrome symptoms
Antidepressant withdrawal syndrome or discontinuation syndrome is common, regardless of which SSRI is taken or how long medication therapy has been utilized. Antidepressant discontinuation syndrome can also occur with serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs) and other medications used for antidepressant therapy. Note that certain medications carry a higher risk than others of experiencing withdrawal symptoms.
Duration depends on several factors
Studies suggest that around one in five people who discontinue SSRI use too quickly will experience at least some symptoms of discontinuation syndrome. The duration of these symptoms is dependent on several factors, such as how long the medication was used, which medication was used, what the dosage was, how quickly the individual stopped taking it, and the state of the person’s health otherwise. Symptoms tend to begin within a week of discontinuing use and may last for one to three weeks.
Managing physical withdrawal symptoms
There are some steps you can take to manage the flu-like symptoms that may occur from SSRI withdrawal syndrome. Nausea, diarrhea, and headache can all be treated with over-the-counter (OTC) medications designed for those purposes. However, keep in mind that over-the-counter medications may not resolve the symptoms completely. Avoid taking too many OTC medications and use them only as directed.
Treat yourself gently
It can also be important that you treat yourself gently during this process. Make sure that you are getting plenty of rest and staying hydrated. Eat what you can, even if you’re only able to tolerate soup, broth, or crackers at first. Practice good sleep hygiene if experiencing insomnia or other sleep issues. In general, you might treat yourself as you would if you had the flu.
Managing psychological SSRI withdrawal symptoms
Managing the psychological symptoms of selective serotonin reuptake inhibitor discontinuation can be more difficult than managing the physical symptoms. That’s why it can be helpful to visit a therapist before, during, and after stopping an SSRI. A therapist can support you in developing coping mechanisms for dealing with any psychological withdrawal symptoms and can be another line of defense against relapsing into severe depression or anxiety.
How therapy can help with SSRI withdrawals
Again, if you have been taking SSRIs and want to stop, it’s important that you don’t do so on your own. Consulting with your prescribing doctor or psychiatrist should be the first step towards stopping these medications safely. In addition, a therapist can help you through the psychological symptoms that may come along with the discontinuation of an SSRI. Research suggests that cognitive behavioral therapy (CBT) may help ease the distress a person might experience when discontinuing SSRI use under doctor supervision.
Online therapy to combat withdrawal symptoms
If you’re looking to meet with a therapist from the comfort of your home instead of traveling to and from appointments, online therapy can represent a viable alternative to in-person sessions. With an online counseling platform like BetterHelp, you can get matched with a therapist with whom you can meet via phone, video call, and/or in-app messaging. Research suggests that online therapy can be as effective as in-person sessions, so this format may be worth exploring if it’s more convenient for you.
Takeaway
What helps with SSRI withdrawals?
Discontinuing a selective serotonin reuptake inhibitor can sometimes cause unpleasant symptoms such as reduced mood, sleep changes, digestive problems, difficulty with movement or coordination and hypersensitivity to light or sound. Discontinuation syndrome can sometimes be unpleasant but rarely a medical emergency. Some common ways to help manage it include:
- Make a plan. It is often easier to manage SSR discontinuation syndrome if you are aware that some adverse effects may occur as you taper off of it. It is often helpful to work with your medical provider to develop a discontinuation schedule to reduce the chances of symptoms appearing.
- Practice self-care. Basic self-care like regular exercise, healthy eating, and getting enough sleep can help reduce the symptoms of antidepressant discontinuation syndrome.
- Communicate with your provider. Let the medical professional managing your SSRI prescription know about any major symptoms that develop or any unplanned changes.
- Taper off the medication completely. Most people discontinue SSRIs gradually, progressively taking a smaller dose until they are no longer taking the medication. It is crucial to finish that tapering process to prevent withdrawal symptoms.
What's the hardest antidepressant to get off of?
Antidepressant withdrawal symptoms are likely to vary from person to person based on unique health factors. The degree to which their mental health condition is managed, their physical well-being, and with discontinuation procedures might all play a role. However, research has revealed a few general trends that may apply to most people. One systematic review of withdrawal effects found that discontinuing paroxetine produced symptoms of antidepressant withdrawal that were more severe than other SSRIs. Citalopram and venlafaxine also produced notable withdrawal effects.
Is SSRI discontinuation syndrome life-threatening?
Selective serotonin reuptake inhibitor discontinuation is not considered a life-threatening condition. The symptoms are usually mild and typically resolve within a couple of weeks. Symptoms may vary based on the type of antidepressant, but regardless of the specific medication, they are typically able to be managed with little medical intervention.
Do you go back to normal after SSRIs?
Determining whether someone goes back to “normal” after discontinuing an SSRI is highly subjective and will vary considerably based on the individual. When stopping an SSRI, some people experience adverse effects associated with antidepressant discontinuation, such as flu-like symptoms or mood dysregulation. Still, those symptoms are typically mild and resolve within a few weeks. Many people also report that side effects they experienced while taking the antidepressant begin to resolve within the same time period.
Do you feel worse after stopping an SSRI?
Some people experience withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation, but those symptoms typically resolve within one to two weeks of stopping the medication completely. Some people do feel worse due to a relapse in their mental health condition. For example, someone who uses an SSRI to manage symptoms of depression may feel worse due to their depression being poorly managed without medication. Management of antidepressant discontinuation syndrome often includes working with professionals to differentiate between withdrawal symptoms and relapse.
Do SSRIs have long-term effects after stopping?
SSRIs are generally considered safe, and few long-term effects have been reported. However, researchers are concerned due to the lack of empirical evidence supporting the conclusion that SSRIs are free from long-term adverse effects. Case studies and limited investigations indicate that SSRIs are unlikely to cause long-term harm. Still, there is a small possibility of problems that continue well after the medication is discontinued. Currently, the most compelling evidence indicates that sexual dysfunction is the most likely long-term concern, in some cases becoming permanent. However, the vast majority of patients do not experience long-term effects after discontinuing SSRIs, although they are likely to experience discontinuation symptoms for 1 to 2 weeks after stopping the medication.
Which SSRI is easiest to withdraw from?
The ease of discontinuation can vary greatly based on the particular SSRI, the physical condition of the person taking the medication, and unique factors like genetics or length of time on the medication. When choosing an antidepressant, your medical provider will discuss the pros and cons of each medication, including potential withdrawal, and help you make an informed choice.
You and your provider will balance your treatment needs alongside the risks of side effects or withdrawal effects, and discontinuation may not be the top priority. For example, some evidence suggests that fluoxetine is unlikely to cause withdrawal symptoms compared to other antidepressants, but fluoxetine may not be the best choice to treat your specific mental health concern. It may be worthwhile to consider a medication with a more severe withdrawal profile if it is likely to be more effective at helping you treat your primary mental health concern.
Am I better off without antidepressants?
Whether you are better off without antidepressants can only be decided by engaging in thorough evaluation and consultation with a medical professional familiar with mental health. Often, medical providers work alongside mental health professionals like therapists or psychologists, all of whom may become involved when deciding if you are better off without antidepressants. It is typically worthwhile to go through this process and communicate with medical and mental health professionals. Regardless of anything else, it is vital that you do not stop taking prescribed medication without consulting a medical provider. Doing so could introduce unpleasant side effects and unknown risks to your mental and physical well-being.
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