Antidepressants can help people effectively manage symptoms of depression as well as other mental health conditions. However, these individuals may, at some point, stop taking their antidepressant – for a wide variety of reasons – and if they do so abruptly, they’re at risk of developing a condition called antidepressant discontinuation syndrome (ADS).
Important note: Most people do not develop antidepressant discontinuation syndrome — it is largely avoidable.
What Is Antidepressant Discontinuation Syndrome?
Antidepressant discontinuation syndrome is a condition that occurs in roughly 20% of patients within two to four days following an abrupt stoppage or reduction of an antidepressant. The flu-like symptoms that come with the syndrome vary and are more likely in individuals who have been continuously taking their medication for one month or more and who stop suddenly or quickly without an adequate taper.
That being said, not everyone experiences effects from discontinuing an antidepressant. The duration of treatment, dose of the medication, the type of antidepressant, and speed of taper are all factors that play a role in the occurrence of antidepressant discontinuation syndrome.
What Is the Difference Between Antidepressant Discontinuation Syndrome and Withdrawal?
Antidepressant discontinuation syndrome is when there is a cluster of symptoms after suddenly stopping antidepressant medication whereas withdrawal refers to a set of symptoms that occur after someone stops a substance that has caused physical dependence.
What Are the Stages of Antidepressant Discontinuation Syndrome?
If you are suffering from antidepressant discontinuation syndrome, symptoms may occur in stages, as they often do. The two main stages are acute and protracted:
- Acute: Symptoms that last for one to two months are referred to as the acute stage. During this stage, you may experience flu-like symptoms, greater amounts of fatigue, and increased feelings of anxiety and depression.
- Protracted: If your symptoms last longer than six months, this is referred to as the protracted stage. On average, those experiencing the protracted stage have symptoms for around 37 months.
What Are the Symptoms of Antidepressant Discontinuation Syndrome?
The symptoms of antidepressant discontinuation syndrome begin a few days to weeks after stopping the medication and include:
- Flu-like symptoms
- Trouble with sleep
- Gastric symptoms such as nausea
- Equilibrium disturbances such as dizziness
- Changes in mood such as irritability
Other symptoms may include vomiting, cramps, diarrhea, tremors, difficulty coordinating speech, and mood swings. Symptoms of ADS are generally mild and typically peak within the first week.
How Long Does Antidepressant Discontinuation Syndrome Last?
Symptoms of antidepressant discontinuation syndrome occur within two to four days after medication cessation and may last from several weeks to months. Additionally, if the same or a similar medication is started or the taper is slowed, symptoms of ADS may resolve within a couple of days. In some rare cases, symptoms may last up to one year.
If you are currently experiencing symptoms of antidepressant discontinuation syndrome that have lasted a year, consult your provider for the best individualized support.
Which Antidepressants Can Cause Discontinuation Syndrome?
Any and all antidepressants can cause antidepressant discontinuation syndrome. However, it is more commonly associated with two subtypes of antidepressants: serotonin-selective reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). This commonness may be related to the wider use of this class in the treatment of mental health symptoms.
Which Antidepressant Has the Worst Discontinuation Symptoms?
Among the SSRIs, paroxetine is linked to the highest occurrence of the syndrome, while fluoxetine is associated with the lowest. In addition, due to SNRI’s brief half-life (how long a medication stays active in your body), discontinuation of this particular medication may lead to a higher frequency of the syndrome and more severe symptoms.
Which Antidepressants Are Hardest to Wean Off of?
Medication with shorter half-lives may be harder to wean off of and typically cause more discontinuation syndrome symptoms. The shorter the half-life is, the quicker the effects of discontinuation will happen as there is a faster turnaround rate of active substances in your body. Examples of medications with shorter half-lives would include Lexapro, Zoloft, and venlafaxine.
Medications with longer half-lives are easier to wean off of as the active ingredients in the medication stay in the body longer, making it less noticeable to the consumer that they are coming off the medication. Due to the gradual descent from the peak of medication, stopping its intake may have less of an impact and cause fewer symptoms. An example of a medication with a longer half-life is fluoxetine (Prozac).
How Do You Avoid Experiencing Antidepressant Discontinuation Syndrome?
There are a series of ways one can try to avoid or lessen the symptoms of antidepressant discontinuation syndrome. However, it’s important to first provide this reminder: Antidepressant discontinuation syndrome doesn’t happen to everyone.
That said, here are a couple of tips to help ensure you avoid ADS:
- The first tip may be obvious – antidepressant discontinuation syndrome can be completely avoided by not suddenly discontinuing an antidepressant unless for emergency reasons!
- Consult your provider before and throughout your stopping any medication to devise a plan to safely stop your intake of antidepressants.
- In the case you have to stop taking a medication, taper off the medication by reducing the dose over time before completely stopping the medication — this will lessen the possibility of experiencing ADS. Your provider will help you taper off properly.
- You can also utilize a longer-acting antidepressant such as fluoxetine (Prozac) that has a longer half-life, which will reduce the risk of developing discontinuation syndrome from other antidepressants with shorter half-lives.
What Are the Benefits of Getting Off Antidepressants?
There can also be benefits of getting off antidepressants, which vary from person to person.
For example, one may decide they want to try to stop their antidepressant to explore if it is still helpful or necessary. Or, if someone experiences side effects from a medication, they may decide to stop the medication to avoid these side effects if the burden is greater than the benefit the medication provides.
Remember: If you decide you’d like to stop taking your antidepressant medication, it is imperative to consult your psychiatric provider or doctor first. Together, you can work to do so safely and avoid or minimize the symptoms of antidepressant discontinuation syndrome.