Do antidepressants have any withdrawal effects?

Antidepressant discontinuation syndrome

Antidepressants are extremely effective at treating major depressive disorder (MDD) and numerous other mental health conditions. As you begin to feel better and notice your symptoms subsiding, you may feel tempted to lower your dose or stop taking the medication together. This would be unwise and can lead to antidepressant withdrawal, also known as discontinuation syndrome.

Discontinuation syndrome occurs in roughly 50% of people who have taken antidepressants and who suddenly halt treatment or significantly lower their dose. ^[2] It is essential you take antidepressants exactly as prescribed by your healthcare provider to avoid, or minimize, withdrawal effects.

If you are suffering from withdrawal effects, it can feel helpful and reassuring to learn how they are caused, common types of withdrawal effects, and strategies to cope with them.

Types of antidepressant withdrawal effects

Withdrawal effects related to antidepressant discontinuation syndrome can vary from individual to individual. In addition, the intensity and duration of these effects can also differ.

Here are some common examples of withdrawal effects that individuals might experience when discontinuing or reducing their antidepressant medication: ^{[1] [3]}

• Balance issues: You may experience dizziness or lightheadedness or feel jelly legged whilst walking.
  
• Sleep difficulties: You may have trouble sleeping for sustained periods and have unusual dreams or nightmares.
• Digestive: You may experience nausea, vomiting, cramps or diarrhea.
• Sweating: Your blood vessels may behave differently causing you to sweat excessively, flush, or be unable to tolerate hot weather.
• Electric shock sensations in your head: Often described as sudden electrical jolts or "zaps" in the head, these sensations can be uncomfortable and disorienting.
• Movement issues: You may experience tremors, uneven gait, restlessness, speech coordination,and mastication issues.
• Mood swings: You may experience emotional symptoms such as mood swings, low mood, increased irritability, anxiety, and heightened emotional sensitivity.
• Unwanted negative feelings: You may experience an arrayof increased negative feelings, including but not limited to irritability, anger, anxiety, or depression.
• Flu-like symptoms: You may experience flu-like symptoms, including body aches, chills, fatigue,and general malaise.

How do antidepressants withdrawal effects come about?

Antidepressants work by altering the balance of neurotransmitters in the brain, particularly serotonin, but also dopamine, norepinephrine, and others. Over time, the brain adapts to these changes.

SSRIs and SNRIs inhibit the reuptake of serotonin, allowing more of the neurotransmitter to be available in the brain. When the medication is stopped suddenly, there's an abrupt decrease in the availability of serotonin, which can lead to a range of withdrawal effects. ^[3]

Other types of antidepressants, such as tricyclics and MAOIs can also lead to side effects if dosage is altered drastically or sharply.

The longer you have taken antidepressants, the greater the likelihood, duration, and severity of antidepressant withdrawal. ^[4]

How long do withdrawal effects last?

The experience of antidepressant withdrawal varies from individual to individual. Several factors influence the duration of antidepressant withdrawal including the type of antidepressant, the dosage, how long the medication was taken, and the individual’s physiological make up.

The onset of withdrawal symptoms can vary depending on the half-life of the specific antidepressant, typically starting within five days of stopping taking medication. ^[1]

Shorter-acting medications might lead to quicker onset of symptoms after discontinuation, while longer-acting medications might have delayed effects.

Withdrawal effects typically peak within the first week after discontinuation. During this period, symptoms might be the most intense and challenging to manage. ^[1]

After the initial peak, symptoms usually start to gradually improve over the next one to two weeks. However, some individuals might continue to experience severe withdrawal symptoms that last for several months or more. ^[1]

How to cope with withdrawal effects

The primary way to handle withdrawal effects is to prevent their emergence in the first place by taking your antidepressants as prescribed by your healthcare provider. Never abruptly stop or adjust your dose as you see fit, otherwise you’re increasing your likelihood of experiencing withdrawals.

Here are several strategies you can use to help manage, or prevent, the symptoms and make the process more comfortable: ^[3]

Make a plan with your medical provider to taper off slowly

Tapering off gradually is your best bet at minimizing the risk of antidepressant withdrawal. Going off antidepressants typically involves lowering your dose incrementally, allowing for two to six weeks between dose reductions. ^[3]

The schedule will depend on what antidepressant you’re taking, what your dosage is, and your individual circumstances. However, no one taking antidepressants should be dictating how to taper themselves, as this should only be done by a medical professional. Your doctor will provide you with steps to follow when tapering off from antidepressants. ^[3]

Keep a mood book

Noting down details of your mood over the course of your tapering off process can help you understand how your body reacts to different doses of antidepressants. ^[5]

Make a self-care box

When you feel unwell, you typically have less energy and drive to pursue the things you enjoy or to do things that may make you feel better.

As such, prior to stopping antidepressant treatment, it can be helpful to create a box of things that may provide you comfort and happiness if you suffer from antidepressant withdrawal. ^[5] These may include a scented candle, favorite book, notes of encouragement, and well-loved food.

Look after your physical health

• Prioritize sleep: Good sleep is essential for managing withdrawal symptoms and supporting your overall well-being. Establish a consistent sleep schedule, create a relaxing bedtime routine, and create a comfortable sleep environment. ^[5]
• Stay hydrated and eat well: Proper nutrition and hydration can help support your body as it adjusts to changes in medication. Focus on a balanced diet and drink plenty of water. ^[5]
• Stay active: Physical activity can have a positive impact on your mood and energy levels. Engage in regular exercise, even if it's just a gentle walk or yoga.
• Avoid drugs and alcohol: During withdrawal, it might be helpful to avoid or reduce stimulants like caffeine and nicotine, as they can exacerbate anxiety and other symptoms.

Look after your emotional wellbeing

• Engage in relaxation techniques: Relaxation techniques such as deep breathing, meditation, and mindfulness can help reduce stress and anxiety, which are common during withdrawal. ^[5]
• Practice self-care: Engage in activities that bring you joy and relaxation. This could include spending time with loved ones, reading, listening to music, or enjoying a favorite hobby. ^[5]
• Spend time in nature: Being outside in nature can help you feel more grounded and bring you peace.