Many people experience withdrawal symptoms when trying to stop antidepressants. So how can you stop safely?

Around one in seven Australians take antidepressants. The decision to start is often made in times of crisis, with the idea that it might help for a while and then be stopped. Most people don’t start taking antidepressants thinking they will be on them for life.

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

However, about half of people taking antidepressants have been using them for more than 12 months. People may experience unpleasant withdrawal symptoms when trying to stop antidepressants, leading them to restart or continue antidepressants.

A recent Lancet systematic review found that about one in six to seven people experience withdrawal symptoms when stopping antidepressants. This is likely an underestimate because most of the people included 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 stopping taking the drug. Common symptoms included dizziness, headache, nausea, insomnia and irritability.

Withdrawal symptoms are more common in people who have been taking antidepressants for a long time. But the Lancet study mainly included people taking antidepressants for a short time — usually for about three to six months, but sometimes as little as a week.

Thus, the finding that one in six people who stop taking antidepressants experience withdrawal symptoms is likely an underestimate; this figure only applies to a small subset of people who have taken antidepressants.

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

Determine what is actually causing the symptoms

Some people continue to take antidepressants long-term believing they are treating or preventing symptoms of anxiety or depression, but because many symptoms are similar, they may only be treating or preventing withdrawal symptoms.

However, long-term use (more than 12 months) of antidepressants is not trivial. Taking antidepressants for more than 12 months can cause:

• emotional numbness
• sexual dysfunction, which can last a long time, including low libido and difficulty achieving orgasm in men and women
• weight gain
• lethargy or fatigue
• increased risk of falls in older people.

Poor awareness and recognition of withdrawal symptoms has led doctors and patients to misinterpret withdrawal symptoms as a “relapse” of anxiety or depression and a continued need for medication.

The confusion is easy to understand since some withdrawal symptoms are also symptoms of anxiety and/or depression.

Symptoms of withdrawal include nervousness, irritability, insomnia, fatigue and restlessness.

Symptoms of anxiety include “feeling nervous, anxious, or nervous” and “becoming easily bored or irritated.”

Symptoms of depression include “difficulty falling or staying asleep,” “feeling tired or having little energy,” and “being restless or agitated.”

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

• dizziness, vertigo (spinning sensation), or dizziness
• electric shock sensations (brain zaps)
• imbalance
• increased sensitivity to light or noise
• tinnitus
• nausea, diarrhea, or stomach upset
• muscle spasms or cramps
• vivid dreams or nightmares
• tremors
• confusion
• sweat.

How did people stop taking antidepressants?

Until recently, information on how to minimize withdrawal symptoms to allow people to safely stop antidepressants was limited.

Previous advice was often to halve the dose, halve it again, then stop; or take antidepressants every other day; or to switch to another antidepressant.

But while well-intentioned, these methods likely led to withdrawal symptoms.

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

So how can I stop safely?

Brain imaging techniques support slowly decreasing the antidepressant dose to cause a steady change in the brain to minimize withdrawal symptoms.

“Hyperbolic tapering” uses smaller and 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 (off) gives a constant change in the brain.

Slow, hyperbolic tapering of the drug’s dose can minimize withdrawal symptoms, giving the brain time to adjust to the absence of antidepressants and safely stop.

Updated clinical guidelines now recommend this approach of slow hyperbolic antidepressant tapering.

At the University of Queensland, we are conducting a randomized controlled trial in general practice to test the effectiveness of antidepressant-specific hyperbolic taper programs developed to help people stop antidepressants safely.

The mini-doses of antidepressants needed for tapering are not readily available in Australia. But people can access mini-doses of antidepressants through a compounding pharmacist (or for some antidepressants, by crushing a tablet and mixing it with water or diluting a liquid formulation, in consultation with your doctor).

If you are considering stopping antidepressants, talk to your doctor, who can support you and follow you through the stopping process safely.