Discontinuing Antidepressant Medication

---

Have you tried to stop taking antidepressants and found that the withdrawal effects are so unpleasant that you go back to taking the medication? 

You are not alone, in fact over half of all people taking prescribed drugs for depression have difficulties coming off their medication (Davies and Read, 2019). 

The symptoms can be severe and mistakenly confused with symptoms of relapse of anxiety or depression, which often compels people to recommence their medications. 

The average duration of these symptoms is 6 weeks, with some people experiencing withdrawal effects for up to 3 years.

All classes of drugs used to treat depression can cause symptoms which are many and varied and are reported in 8 different categories: 

• Flu-like symptoms, such as headache, lethargy, sweating, chills, tiredness, loss of appetite, muscle pain 
• Sleep disorders, such as poor sleep and nightmares 
• Gastrointestinal symptoms, such as nausea, vomiting, diarrhoea and anorexia 
• Balance problems, such as dizziness and coordination disorders 
• Sensory symptoms, such as sensations of electrical shocks, paraesthesias and palinopsia (abnormal persistence or recurrence of an image in time) 
• Mental complaints, such as anxiety, gloominess and irritability/irritation 
• Extrapyramidal symptoms, such as movement disorders and tremors 
• Other symptoms, such as cognitive alterations and cardiac arrhythmias. 

Antidepressants work by increasing the amount of neurotransmitters such as serotonin and noradrenaline at the nerve endings. 

These natural chemicals pass messages between the nerves and increasing their quantity is thought to help treat the symptoms of anxiety and depression. The nerve endings get used to being exposed to larger quantities of these chemicals and can become less sensitive to them over time. 

When we reduce the quantity of neurotransmitters by stopping the antidepressant, the nerves are not stimulated as much as they have become used to, and symptoms of withdrawal can follow. 

These symptoms can be minimised by withdrawing the antidepressant medication using a gradual and personalised tapering of the dose, with an evidenced based method (Horowitz and Taylor, 2019). 

This method involves reducing the dose by an agreed percentage over time, continuously until a very small dose is taken. 

The saying is “stop slow as you go low,” which means we need to reduce the dose by smaller amounts towards the end of the reduction program. 

The time between reduction varies from 1-4 weeks. The dose should ideally be reduced in accordance with appearance of symptoms, so must be personalised to the experience of the individual.

Studies have shown that patients who had previously tried unsuccessfully to discontinue their antidepressant medications, later achieved success by following an individualised gradual tapered reduction of their dose. 

Groot and van Os (2000) reported a 70% success rate with 66% still being medication free after 1-5 years.  

It is difficult to achieve gradual dose reductions for antidepressants if you are relying only on standard pharmacy dispensing. 

The manufacturers of these medications make the tablets in dosages for therapeutic effect, without consideration of the time when the drugs are to be ceased. The advice given by the manufacturers for withdrawal of the medication is vague and non-specific, with schedules that are shorter than recommended. 

These schedules are no better than sudden withdrawal and are therefore more likely to result in people restarting the treatments (Horowitz and Taylor, 2019). 

The problem is that the ready-made tablets or capsules cannot be divided into small enough segments to achieve the gradual dose reduction that is needed for the flexible and personalised tapering needed to avoid withdrawal symptoms.