Antidepressants: How to reduce or taper off your Medications

 

Warning!
Most psychiatric drugs
cause withdrawal
reactions, which can
include life threatening
emotional and physical
reactions. Withdrawal
from psychiatric drugs
should be done carefully
under experienced clinical
supervision.

Various studies suggest 50-86% of people experience withdrawal symptoms when coming off of
their antidepressant, making some people feel they are addicted or dependent on them.
Symptoms range from mild to severe, with some estimates of 25% of people that experience
withdrawal having severe withdrawal symptoms. 1,2,3,4,5,6,7,8,9,10, 11 Antidepressant withdrawal can
occur in those who have taken the drug for only one to two months, 12,13 and up to 78% of
people taking their antidepressant feel that they are addicting. 14 Some antidepressant users
who have also used opiates, cocaine, or other drugs of abuse say it was more difficult to get off
their antidepressant than these other drugs. 23 Fortunately, we know that a slow and gradual
antidepressant taper reduces the risk of distressing withdrawal symptoms occurring.
Some common symptoms of antidepressant withdrawal: worsened mood, irritability, anxiety,
agitation, crying spells, poor concentration, dizziness, electric shocks/head zaps, blurred
vision, burning sensations, tingling, nausea, vomiting, fatigue, muscle pain, chills or
temperature dysregulation, insomnia, vivid dreams, as well as suicidal and homicidal
thoughts and urges. As you can see, some of these symptoms overlap with things you may
have been experiencing when you originally started the drug. This is why withdrawal symptoms
are often wrongly interpreted as a return of your mental health condition or the emergence of
a new one. Careful assessment is crucial.

There are many reasons a person might be interested in reducing or stopping their
antidepressant. One reason is there is a long list of potential adverse effects, some of which are
very common. Some of the most common adverse effects of antidepressants are 60% of
people report feeling emotionally numb, apathetic, or indifferent. 15 50-90% of people
experience sexual dysfunction in a variety of forms. 15,16,17,18,19,20,21 The overall effect of
antidepressants could be described as feeling an increased distance or disconnection between
antidepressant users and their worlds. 22 These effects could be useful for some at least for a
time. It is important to continually assess whether the antidepressant is having an overall
useful effect for you or not. If you are interested in reducing or coming off of your
antidepressant, this is something I specialize in and I would love to discuss options with you
including the possibilities of a slow and gradual antidepressant taper.

 

Sources:
1. Barr, L.C., Goodman, W.K., Price, L.H., (1994). Physical Symptoms
Associated with Paroxetine
[Paxil] Discontinuation [withdrawal], American Journal of Psychiatry, 151:289
2. Black, D.W., Wesner, R., Gabel, J. (1993). The Abrupt Discontinuation
[withdrawal] Fluvoxamine [Luvox] in Patients with Panic Disorder, Journal of Clinical Psychiatry, 54:146-49
3. Fava, M., Mulroy, R., Alpert, J., Nierenberg, A.A., Rosenbaum, J.F. (1997). Emergence of
adverse events following discontinuation [withdrawal] of treatment with extended-release venlafaxine
[Effexor], American Journal of Psychiatry, 154 (12): 1760-2.
4. Giakas, W.J., Davis, J.M. (1997). Intractable withdrawal from venlafaxine [Effexor] treated with
fluoxetine [Prozac], Psychiatric Annals, 27:85-92
5. Kasantikul, D. (1995). Reversible delirium after discontinuation of fluoxetine [Prozac], Journal of the
Medical Association of Thailand, 78:53-54
6. Kessing, L., Hansen, H.V., Demyttenaeire, K., et al. (2005), Depressive and bipolar disorders: patients’
attitudes and beliefs towards depression and antidepressants, Psychological Medicine, 35:1205-13
7. Perahia, D.G., Kajdasz, D.K, Desaiah, D., et al. (2005), Symptoms following abrupt
discontinuation of duloxetine treatment in patients with major depressive disorder, J Affect Disord,
89:207-12
8. Pyke, R.E. (1995). Paroxetine [Paxil] withdrawal syndrome, American Journal of Psychiatry,
152:149-50
9. Read, J., Cartwright, C., Gibson, K., (2014), Adverse emotional and interpersonal effects
reported by 1829 New Zealanders while taking antidepressants, Psychiatry Res, 216:67-73
10. Young, A., Haddad, P., (2000), Discontinuation symptoms and psychotropic drugs, Lancet, 355:1184
11. Coming off antidepressants. Royal College of Psychiatry.
http://www.rcpsych.ac.uk/expertadvice/treatmentswellbeing/antidepressants/comingoffantidepressants.aspx
12. Coupland, N.J., Bell, C.J., Potokar, J.P. (1996). Serotonin reuptake inhibitor withdrawal, Journal
of Clinical Psychopharmacology, 16:356-62
13. Haddad, P.M. (2001). Antidepressant Discontinuation Syndromes, Drug Safety, 24: 183
https://doi.org/10.2165/00002018-200124030-00003
14. Raven, M., (2012), Depression and antidepressants in Australia and beyond: a critical public health
analysis (PhD thesis). University of Wollongong, Australia; http://ro.uow.edu.au/theses/3686.
15. Read, J., Cartwright, C., Gibson, K., (2014), Adverse emotional and interpersonal effects reported by 1829
New Zealanders while taking antidepressants, Psychiatry Res, 216:67-73
16. Kirsch I. (2014). Antidepressants and the Placebo Effect. Zeitschrift fur Psychologie, 222(3), 128-134
17. Baton, R. (2006). SSRI-associated sexual dysfunction. American Journal of Psychiatry, 163:1504-1509
18. Modell, J.G., Katholi, C.R., Modell, J.D., et al. (1997). Comparative sexual side effects of bupropion,
fluoxetine, paroxetine, and sertraline, Clinical Pharmacology and Therapeutics, 61:476-87
19. Montejo-Gonzalez, A.L., Llorca, G., Izquierdo, J.A., et al. (1997), SSRI-Induced Sexual Dysfunction:
Fluoxetine [Prozac], Paroxetine [Paxil], Sertraline [Zoloft], and Fluvoxamine [Luvox] in a Prospective,
Multicenter, and Descriptive Clinical Study of 344 Patients, Journal of Sex and Marital Therapy, 23:176-94
20. Montejo, A., Llorca, G., Izquierdo, J., et al. (2001). Incidence of sexual dysfunction associated with
antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for
the study of psychotropic-related sexual dysfunction, J Clin Psychiatry, 62 (suppl 3): 10-21
21. Patterson, W.M. (1993). Fluoxetine-induced sexual dysfunction, Journal of Clinical Psychiatry, 54:71
22. Teal, Jay. (2009). Nothing Personal: An Empirical Phenomenological Study of the Experience of “Being-on-
an-SSRI”. Journal of Phenomenological Psychology. 40. 19-50. 10.1163/156916209X427972
23. Healy, D. (2016). Psychiatric Drugs Explained (6th ed., p. 261). N.p.: Elsevier.

Author
Tyler Mostul Psychiatric Mental Health Nurse Practitioner

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