How To Get Off Antidepressants
Medically reviewed byJohn Schaffer, LPCC
March 25, 2019
Some people can stop using antidepressants without significant trouble, while others find it more difficult. How easily someone can come off an antidepressant depends on their body chemistry, the rate at which their body metabolizes the drug, and what type of antidepressant they are using. Often times the best way to stop the use of a substance is to seek professional help.
Antidepressants are a class of drugs used to treat symptoms of depression, social anxiety, and, in some cases, pain. The National Health and Nutrition Examination Survey data indicated the number of Americans taking antidepressants increased from 13.4 million between 1999 and 2000 to 34.4 million between 2013 and 2014. While these drugs have helped millions of people ease their depression and anxiety, there are still many aspects researchers don’t fully understand about antidepressants.
Steps To Tapering Off Antidepressants
The following steps are a brief guide on how to get off antidepressants. Stopping antidepressant use should be a decision that is carefully weighed. It is best to talk to your primary care provider or mental health professional before stopping an antidepressant to ensure safety and comfort.
1. Stop Use Slowly
The best way to get off antidepressants is to taper the dose. However, tapering may not be applicable in all situations, as some antidepressant medications don’t break down into smaller doses. Antidepressants that cannot be broken up are usually part of the tricyclic class of antidepressants, which tend to be easier to quit, compared to other classes.
It is never a good idea to suddenly stop taking an antidepressant medication. The rate at which antidepressants are removed from the body dramatically influences the brain’s response. When antidepressant molecules are suddenly removed from the brain, it can cause the brain to go into a type of shock, which can result in distressing withdrawal symptoms.
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2. Have A Plan
Everybody will have a different experience stopping the use of antidepressants. Generally, healthcare providers recommend reducing antidepressant doses in small increments, with two- to six-week adjustment times between dose reductions. Individual circumstances can influence how well someone tolerates quitting antidepressants.
Having a plan in place may increase someone’s likelihood of successfully getting off their medication. Some people may still experience withdrawal symptoms, even with a well-structured tapering schedule.
Ceasing antidepressant use can also cause rebound symptoms. Rebound symptoms are classified as the same or similar symptoms someone experienced before they started antidepressants, only more intense. In most cases, rebound symptoms resolve within a few days after the last dose. However, some people may need to start retaking their antidepressants to address these symptoms fully.
3. Consider Alternative Mental Health Treatments
Most people start taking antidepressants after a brief visit with their primary care doctor without symptoms of clinical depression. Fewer than 20 percent of people on antidepressants see a psychotherapist regularly, even though doing so is considered a vital component of dealing with depression. Researchers at Harvard Medical School and other universities have found that people who participate in talk therapy are less likely to experience an antidepressant relapse.
Other things that may help individuals improve their mood include proper nutrition, yoga, and meditation. Proper nutrition is essential because diet can influence someone’s hormone levels, which in turn influence mood. A poor diet can lead to a poor mood just as a balanced diet can contribute to a balanced mood. And although yoga and meditation are newer treatments in the U.S., they have been used in other parts of the world for centuries to help with depression symptoms.
4. Stay Active
Studies have reported that exercise may be just as effective at boosting someone’s mental state as some antidepressants. Many observational studies have suggested that active people are not as likely to become depressed, compared to their inactive counterparts. It appears that even modest exercise, such as a daily casual stroll can improve depressive symptoms.
Exercise should be a part of someone’s daily routine. While most studies have focused on the effects of aerobic exercise on mood, some researchers theorize that other types of exercise, such as resistance training, may also be beneficial in reducing depression symptoms.
5. Communicate And Seek Support
It is important to stay in touch with a support network while discontinuing antidepressants. Informing a healthcare professional about any physical or emotional symptoms that could be related to discontinuation can help ease any worries that it is the depression returning. Primary healthcare providers can help evaluate symptoms and determine the best course of action.
Mild symptoms are usually just a temporary result of the medication leaving the body. But, if symptoms become severe, it may be recommended for an individual to go back to a previous dose and reduce the level more slowly. People taking antidepressants with a short half-life, which are processed quickly in the body, may find this more difficult, and switch to a longer-acting drug to help them reduce their antidepressant use.
Choosing to involve a relative or a close friend in this process can also be helpful. Close friends and family may be able to recognize signs of recurring depression that individuals themselves are not able to perceive. Individuals may find that being open about their situation will help the people around them to be more understanding and potentially more supportive.
Can Antidepressants Stop Working?
When symptoms of depression improve after starting an antidepressant, some individuals may need to continue to take the medication to prevent the symptoms from recurring. However, over time, some people may find that their antidepressant may lose its effectiveness. Doctors do not fully understand why this so-called “poop-out” effect happens or why it only happens to some people and not others.
Other possible reasons an antidepressant may not be as effective include:
- worsening depression
- an underlying medical condition (hypothyroidism)
- starting a new medication
- undiagnosed bipolar disorder
- increase in age
In most cases, depression symptoms get better with adjustments to the dose and type of medication.
Abuse And Misuse Of Antidepressants
While the majority of individuals prescribed antidepressants do not misuse the medication, certain classes of antidepressants do carry the potential for abuse. Antidepressant abuse potential also increases for individuals who have a history of substance abuse.
Although there is limited research on the misuse and abuse of antidepressants, the research available consists mainly of case reports, which document individual experiences with antidepressant abuse. These case studies reflect that most cases of antidepressant abuse occur in individuals with a co-occurring disorder, such as an additional substance use disorder or mental health disorder.
The most commonly reported motivation for abusing antidepressants is to achieve a psychostimulant-like effect. Individuals have reported abusing antidepressants at higher than recommended doses and in a variety of ways, including snorting the crushed up drug or making a solution from the powder and injecting it.
Possible side effects vary based on each antidepressant class and its chemical properties. Some commonly reported side effects include seizures, confusion, and psychotic-like symptoms.
It is possible for an individual to experience antidepressant withdrawal if they abruptly stop the medication, especially if they have been taking it for six weeks or more. Symptoms of antidepressant withdrawal are sometimes referred to as antidepressant discontinuation syndrome and usually last for a few weeks. Certain antidepressant classes are more likely to cause withdrawal symptoms than others.
There are five general classes of antidepressants. Each class has a different chemical structure which causes it to interact with the brain uniquely.
Classes of antidepressants include:
- selective serotonin reuptake inhibitors (SSRIs)
- serotonin-norepinephrine reuptake inhibitors (SNRIs)
- tricyclic antidepressants (TCAs)
- monoamine oxidase inhibitors (MAOIs)
- atypical agents
Experiencing antidepressant withdrawal doesn’t necessarily mean someone is addicted to the medication. Addiction is more commonly characterized by intense drug cravings and an inability to control the use of a substance, and most antidepressants don’t cause these issues. However, withdrawal symptoms do indicate a physical dependence on the medication is possible. The symptoms of physical dependence can be challenging to deal with alone.
Symptoms that may arise while quitting antidepressants include:
- mild to extreme anxiety
- insomnia and vivid dreams
- headaches and dizziness
- tiredness and irritability
- flu-like symptoms, including achy muscles and chills
- nausea and vomiting
- brain zaps (electric shock or jolting sensations in the brain)
- rebound depression symptoms
Sometimes it may be difficult to tell the difference between withdrawal symptoms and returning depression after stopping an antidepressant medication. Staying in communication with a doctor or other healthcare professional is the best way to monitor symptoms and ensure personal comfort is maintained.
Finding Help To Get Off Antidepressants
Trying to get off antidepressants can be a complicated process. When antidepressants were initially developed, they were not intended for long-term use. Instead, they were used to treat depression symptoms in the short-term so that individuals could get back to their lives more quickly. It is rare, but possible, for someone to become addicted to their antidepressant. Even if someone isn’t addicted, dealing with unpleasant withdrawal symptoms can be challenging to face alone.
Some people may find that additional help during this transition can help them get off their antidepressant. Addiction treatment options such as a brief inpatient program or outpatient treatment may be the springboard that launches an individual into an antidepressant-free lifestyle. Daily, ongoing support and the tools to negate adverse withdrawal effects may be all someone needs to say goodbye to their antidepressant use for good.Article Sources
Harvard Health Publishing: Harvard Medical School - Going Off Antidepressants
The New York Times - Many People Taking Antidepressants Discover They Cannot Quit
National Center for Biotechnology Information: Substance Abuse and Rehabilitation - Abuse And Misuse Of Antidepressants