As a psychiatrist, patients naturally ask me a ton of questions about medication. (I’m glad—it’s what I’m there for!) When it comes to antidepressants, a lot of people are particularly concerned about “antidepressant withdrawal,” a colloquial term often used to describe what’s medically known as antidepressant discontinuation syndrome (ADS).
A lot of times, this question seems to come from a patient’s fear of staying on medication forever. Since I work on a college campus, I see a lot of people who are worried about starting to take something when they’re 18 or 19 that they might need for the rest of their lives. (While there’s absolutely nothing wrong with taking medication for your mental health, I know the stigma around it persists all the same.) So they want to talk about if, when, and how they can stop the medication in the future. But I also get this question from patients who have been on antidepressants for some time, are interested in getting off of them, and have heard some pretty…intimidating stories about that process.
The truth is that some people do benefit from staying on antidepressants for their entire lives. This can be life-saving, life-enriching, or both. But other people don’t need to stay on mental health meds forever, which means at some point, they’ll need to stop taking them as safely as possible. There are a lot of misconceptions around coming off of antidepressants, so here’s how I talk about it with my patients. Hopefully this can shed some insight if you have similar questions, but remember that talking to your doctor is always the best way to receive answers tailored to your situation.
Here are some things to keep in mind before you start antidepressants.
There are many types of antidepressants, including the ones we often recommend first because they tend to cause the fewest side effects: selective-serotonin reuptake inhibitors (SSRIs). These medications block the brain’s reabsorption of serotonin, a neurotransmitter (chemical signaling molecule) related to your mood. This increases serotonin, which can improve mood. Obviously, this can help with depression, but we can also use SSRIs to treat anxiety, post-traumatic stress disorder, obsessive-compulsive disorder, phobias, and panic disorder, among other conditions.
After explaining how antidepressants work, I talk about how I decide how long someone might need to remain on a medication. This decision typically comes down to their previous mental health symptoms and treatment, though it’s a very imperfect science. For example, psychiatric guidelines generally suggest that someone having their very first experience of major depression (meaning the symptoms last at least two weeks) may benefit from six to nine months of treatment before slowly decreasing and eventually coming off of medication. Those who have had more than one episode of major depression might require longer treatment, but again, this isn’t a hard-and-fast rule. In general, though, the more persistent and severe your depression, the longer you are likely to need medication.
“If a person has a history of repeated relapses into depression following a previous response to antidepressants, they probably need to stay on an antidepressant indefinitely,” Charles Conway, M.D., professor of Psychiatry and director of the Center for the Advancement of Research in Resistant Mood and Affective Disorders (CARRMA) at Washington University in St. Louis, tells SELF. Many doctors consider at least three major episodes of depression enough reason to recommend permanently staying on antidepressants, he adds.
Whether or not it’s recommended that someone stay on antidepressants indefinitely, there are a few common reasons people want to stop taking them. A few I hear pretty often: The patient is doing better (and their medical history doesn’t point to a need for staying on them forever), they’re fed up with side effects, the medication isn’t working well enough, or they want to see if they “really need it.”
Whatever the reason, stopping medication is always ultimately a patient’s choice. I’m there to offer my professional opinion on the benefits and drawbacks of doing so, and if they decide to stop, try to make sure it happens safely. To that end, coming off of antidepressants should always be done with the help of a physician. I would love to say this is all about good doctor-patient communication, which does definitely factor in. But it’s actually mainly to prevent you from feeling terrible or even possibly endangering yourself while coming off of antidepressants.
These are the symptoms of “antidepressant withdrawal” and how to avoid them.
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. One way to identify ADS symptoms is with the pneumonic FINISH:
- F: Flu-like symptoms (fatigue, headache, joint aches, sweating)
- I: Insomnia (often with nightmares or vivid dreams)
- N: Nausea (potentially accompanied by vomiting)
- I: Imbalance (dizziness, lightheadedness)
- S: Sensory disturbances (feelings of burning, tingling, and shock-like sensations that are often called “brain zaps”)
- H: Hyperarousal (anxiety, irritability, aggression, mania, physical jerkiness)
These symptoms typically appear within a few days of stopping the medication, the Mayo Clinic explains, and they usually last for a couple of weeks. (With that said, I’ve seen people who mention having ADS symptoms when they forget even one pill. That’s definitely possible and, if it happens to you, it probably means you need to be extra diligent about not forgetting a dose.)
If your symptoms are severe or they last a long time (or both), you might need to go back on medication. This might be on a short-term basis to eventually help you taper off properly, but if your depression returns without treatment, your doctor might recommend continuing to take the meds for a longer amount of time. (It can sometimes be tough to tell the difference between ADS and returning depression, so hopefully your doctor will ask you a lot of thorough questions to figure out what’s going on.)
But it’s important to note that not everyone who stops taking antidepressants experiences ADS. As I mentioned, most people don’t. But there are some risk factors that might make you more likely to experience it. One is taking antidepressants with a shorter half-life (the time it takes for a medication to get to half of its starting dose in your system) because the amount in your body will decrease much faster when you stop the medication. Others include a longer length of treatment and a previous history of ADS. The good thing is that talking about stopping antidepressants with your doctor can reduce your odds of winding up with ADS by helping you taper off slowly enough.
I like to think of coming off medication just as I do about starting them: It’s something to do mindfully and slowly. Gradually lowering your dosage instead of suddenly stopping or even stopping too quickly allows your brain to better adjust to the fluctuating neurotransmitter levels. “The brain does not do well with sudden changes,” Dr. Conway says.
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. 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.” If you take capsules you can’t cut in half, or if your current drug has a short half-life so you need more in-between doses from your doctor, it can be hard to taper effectively on your own. This is why it’s so important to talk to your doctor first.
Remember: Needing antidepressants is not the same as addiction.
After I walk patients through this whole discussion about the safest way to come off of medication like antidepressants, they sometimes wonder if the possibility of “antidepressant withdrawal” means that they can become addicted to the medication. In a word? No.
For starters, addiction is marked by long-lasting changes in how your brain responds to things like pleasure and decision-making. These kinds of changes simply don’t occur with antidepressants, no matter how long you use them. “There is no evidence that being on antidepressants alters the brain in a permanent way,” Dr. Conway says. “In fact, the emergence of ADS symptoms would actually argue for the opposite. Your brain is attempting to return to its pre-antidepressant state, and those adaptations are leading to the symptoms you observe in ADS.”
Caroline DuPont, M.D., vice president of the Institute for Behavior and Health, has a great analogy for differentiating between needing antidepressants and addiction. “The first thing I do every morning is put on my glasses,” she tells SELF. She’s clearly dependent on them, she explains, but that doesn’t translate into being addicted. “I am able to function better in all my life roles with my glasses, [and] my use of them is as prescribed,” she says. “This is very different from an addiction where a person will continue to use at great personal cost and despite many painful consequences to their health and relationships.”
Also, a person using the right dosage of antidepressants typically won’t require more and more medication to keep feeling just as good, whereas people who regularly use drugs like alcohol or cocaine typically need higher amounts to achieve the same feeling. That’s another hallmark of addiction, according to the National Institutes of Health.
Finally: “No one I have met, even those with antidepressant withdrawal, has drug craving or loss of control of their use,” two other addiction symptoms, Michael Ostacher, M.D., M.P.H., MM.Sc., professor of Psychiatry at Stanford and director of the Bipolar and Depression Research Program at the VA Palo Alto, tells SELF.
I don’t point out the difference between addiction and needing antidepressants to stigmatize substance use disorders. But clarifying this misconception is necessary to prevent misunderstanding and minimization of addiction. It’s also necessary to prevent people who could benefit from antidepressants being too scared to try them or deciding suddenly to quit.
“Most people I see agree that mental pain is at least as bad, if not worse, than physical pain,” Dr. DuPont says. “I don’t think medications should be started lightly, but they should not be feared.”