How can you safely stop taking antidepressants?

Clinical guidelines recommend only six to 12 months of antidepressant therapy for a single episode of moderate to severe depression.

However, about half of people taking antidepressants have used them for more than 12 months. People may experience unpleasant withdrawal symptoms when they try to stop antidepressants, leading to restarting or continuing antidepressants.

A recent Lancet systematic review found that about one in six to seven people had the experience withdrawal symptoms when stopping antidepressants. This is likely an underestimate, as most of the people in the studies had been taking antidepressants for only a few months.

What did the researchers find?

The Lancet review, which included 79 studies and 21,000 people, found that 15% of antidepressant users experienced withdrawal symptoms after they stopped taking the drug. Common symptoms included dizziness, headache, nausea, insomnia and nervousness.

Withdrawal symptoms are more common in people who have taken antidepressants for a long time. But the Lancet study mostly included people who took the antidepressants for only a short time – mostly for about three to six months, but sometimes as little as a week.

So finding that one in six people stop taking antidepressants experience withdrawal symptoms likely to be underestimated; this figure only applies to a small subset of people who took antidepressants.

The Lancet review also found that around 3% of people experienced severe withdrawal symptoms, including suicidal thoughts. Again this is likely an underestimate, as it does not include long-term users who are more likely to experience withdrawal symptoms and experience more severe withdrawal symptoms.

Working out what is actually causing the symptoms

Some people continue to take antidepressants for a long time in the belief that they are treating or preventing symptoms of anxiety or depression, but since many of the symptoms are similar, they may only treat or prevent withdrawal symptoms, but long-term use ( more than 12 months) antidepressants is not harmless.

Taking antidepressants for more than 12 months can cause:

1. emotional numbness
2. Sexual dysfunction, which may be long-term, including low libido and difficulty reaching orgasm in both men and women
3. Weight gain
4. Lethargy or fatigue
5. The risk of falling increases in the elderly.

Low awareness and recognition of withdrawal symptoms has resulted in both doctors and patients misinterpreting withdrawal symptoms as a “relapse” of anxiety or depression and the continued need for medication.

The confusion is easy to understand as some of the withdrawal symptoms are too symptoms of anxiety and/or depression.

Withdrawal symptoms include irritability, nervousness, insomnia, fatigue and agitation.

Symptoms of anxiety include “feeling nervous, anxious, or in trouble” and “getting upset or irritated easily.”

Symptoms of depression include “trouble falling or staying asleep,” “feeling tired or low on energy,” and “being restless or anxious.”

But it is possible to distinguish withdrawal from relapse. In addition to feeling anxious and nervous, people experiencing withdrawal may also experience:

1. dizziness, vertigo (spinning sensation) or lightheadedness
2. Electric Shock Sensations (Brain Devices)
3. Imbalance
4. Increased sensitivity to light or noise
5. Tinnitus
6. Nausea, diarrhea or stomach upset
7. muscle spasms or cramps
8. vivid dreams or nightmares
9. tremors
10. Turmoil
11. sweating.

Clinical guidelines recommend only six to 12 months of antidepressant therapy for a single episode of moderate to severe depression. (Source: Freepik)

How did people stop antidepressants?

Until recently, information on how to minimize withdrawal symptoms to enable people to safely stop antidepressants has been limited.

Previous advice was often to halve the dose, halve again and then stop; or to take antidepressants on different days; or switch to a different antidepressant.

But while intentional, these methods are likely to result in withdrawal symptoms.

Withdrawal symptoms tend to begin within hours, days, or sometimes weeks of stopping or reducing the dose of the antidepressant and can last for weeks or more.

So how can I safely stop?

Brain imaging techniques support a slow tapering of the antidepressant drug to provide a lasting change in the brain to minimize withdrawal symptoms.

“Hyperbolic tapering” uses progressively smaller decreases in drug doses. For example, a tapering schedule of 50 mg, 25 mg, 15 mg, 10 mg, 6 mg, 4 mg, 2 mg, 1 mg, then 0 mg (stop) gives a lasting change in the brain.

A slow and hyperbolic one reducing the dose of the drug can minimize withdrawal symptomsgiving the brain time to adjust to being off antidepressants and stop safely.

Updated clinical guidelines now recommend this hyperbolic slow-tapering antidepressant approach.
At the University of Queensland, we are conducting a randomized controlled trial in general practice, testing the effectiveness of specific hyperbolic tapering schedules of antidepressants, developed to support people to stop antidepressants safely.

The mini-doses of antidepressants required to taper them off are not readily available in Australia. But people can access mini-doses of antidepressants through a compounding chemist (or for some antidepressants, by crushing a tablet and mixing it with water or diluting a liquid formula, in consultation with your doctor).

If you’re considering coming off antidepressants, talk to your doctor, who can support and monitor you through the safe stopping process.