Antidepressants: How to reduce or taper off your Medications

Warning!

Most psychiatric drugscause withdrawalreactions, which caninclude life threateningemotional and physicalreactions. Withdrawalfrom psychiatric drugsshould be done carefullyunder experienced clinicalsupervision.

Various studies suggest 50-86% of people experience withdrawal symptoms when coming off oftheir 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 experiencewithdrawal having severe withdrawal symptoms. 1,2,3,4,5,6,7,8,9,10, 11 Antidepressant withdrawal canoccur in those who have taken the drug for only one to two months, 12,13 and up to 78% ofpeople taking their antidepressant feel that they are addicting. 14 Some antidepressant userswho have also used opiates, cocaine, or other drugs of abuse say it was more difficult to get offtheir antidepressant than these other drugs. 23 Fortunately, we know that a slow and gradualantidepressant 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, blurredvision, burning sensations, tingling, nausea, vomiting, fatigue, muscle pain, chills ortemperature dysregulation, insomnia, vivid dreams, as well as suicidal and homicidalthoughts and urges. As you can see, some of these symptoms overlap with things you mayhave been experiencing when you originally started the drug. This is why withdrawal symptomsare often wrongly interpreted as a return of your mental health condition or the emergence ofa new one. Careful assessment is crucial.

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

Sources:

1. Barr, L.C., Goodman, W.K., Price, L.H., (1994). Physical SymptomsAssociated 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 ofadverse 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 withfluoxetine [Prozac], Psychiatric Annals, 27:85-92

5. Kasantikul, D. (1995). Reversible delirium after discontinuation of fluoxetine [Prozac], Journal of theMedical 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 abruptdiscontinuation 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 effectsreported 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, Journalof Clinical Psychopharmacology, 16:356-62

13. Haddad, P.M. (2001). Antidepressant Discontinuation Syndromes, Drug Safety, 24: 183https://doi.org/10.2165/00002018-200124030-00003

14. Raven, M., (2012), Depression and antidepressants in Australia and beyond: a critical public healthanalysis (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 1829New 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 withantidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group forthe 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.