Antidepressant discontinuation syndrome (ADS), or antidepressant withdrawal, includes all the symptoms people might experience when they stop taking their antidepressants, such as nausea, headaches, or sleep difficulties.
Research suggests that 27% to 86% of people who attempt to stop antidepressants, whether on their own or supervised by a doctor, experience ADS.
Healthcare professionals prescribe antidepressants to treat various conditions, including:
- anxiety disorders
- depression
- obsessive-compulsive disorder (OCD)
- chronic pain syndromes (pain that lasts for months and even years)
You might choose to stop taking your antidepressants after deciding with your doctor that it’s the best decision for your mental health.
Tapering your dose slowly is important to avoid symptoms of withdrawal. Read on to find out about the symptoms of ADS and how to best manage these symptoms once you stop taking your antidepressants.
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ADS can be split into three categories:
- acute withdrawal, which involves new symptoms that last for less than 6 weeks
- rebound, which involves the same symptoms lasting less than 6 weeks but with greater severity
- persistent withdrawal, which involves new symptoms or the same symptoms lasting more than 6 weeks and with greater severity
Some of the possible symptoms of ADS include:
You may also experience symptoms of your condition coming back, such as:
- anxiety
- depression
- suicidal thoughts or ideation
Multiple types of antidepressants are available, including:
Some of these antidepressants have been linked with certain withdrawal symptoms. Tricyclic antidepressants have been associated with hallucinations. Additionally, high blood pressure was a common withdrawal symptom for people who were discontinuing their SNRI.
Experts don’t know the exact cause of ADS. But there are some risk factors that make some people more likely to experience symptoms. These include:
- the duration of treatment with antidepressants
- stopping antidepressants suddenly instead of reducing the dose gradually
- higher dose of the drug
- younger age
- having a history of discontinuation symptoms
- higher risk medications
Researchers have identified certain antidepressants that have a higher risk of causing ADS than others. The following table lists them and how likely it is for someone to experience ADS after taking them:
| High risk | Moderate risk | Low risk |
|---|---|---|
| fluvoxamine (Luvox) | sertraline (Zoloft) | bupropion (Wellbutrin) |
| imipramine (Tofranil) | trazodone (Desyrel) | doxepin (Silenor) |
| nortriptyline (Pamelor) | vortioxetine (Trintellix) | fluoxetine (Prozac) |
| paroxetine (Paxil) | amitriptyline (Elavil) | milnacipran (Fetzima) |
| phenelzine (Nardil) | clomipramine (Anafranil) | escitalopram (Lexapro) |
| tranylcypromine (Parnate) | desipramine (Norpramin) | mirtazapine (Remeron) |
| venlafaxine ER (Effexor ER) | desvenlafaxine (Pristiq) | citalopram (Celexa) |
| doxepin (Sinequan) | vilazodone (Viibryd) | |
| duloxetine DR (Cymbalta DR) | levomilnacipran (Savella) |
It’s important to taper your antidepressants slowly instead of stopping them suddenly. Stopping suddenly can raise the risk of experiencing ADS.
Your doctor may recommend adjusting your dose every 1 to 4 weeks, slowly reducing it to see how you’re doing. They’ll treat each case on an individual basis and adjust medications according to your specific needs.
Some things to keep in mind while tapering your antidepressant include:
- Remember that your symptoms are not life threatening and they are reversible.
- If your symptoms are severe, your doctor can restart your antidepressant and reduce the dosage more slowly
- In certain cases, it may be possible to taper your antidepressant faster if the dose is low.
- Gradual tapering is the safest way to discontinue antidepressants. But it may not always prevent ADS from occurring.
- Tapering may not always be necessary if you’ve taken the antidepressant for less than 4 weeks.
- In certain cases, it may be useful to switch to fluoxetine when trying to discontinue another antidepressant.
These are general guidelines, and it’s important to speak with your doctor for advice on what the best tapering option is for you specifically. Your personalized treatment path may depend on your condition, the severity of your symptoms, and the antidepressant you’re taking.
If you want to stop taking your current antidepressant but you don’t mind starting a different one, cross-tapering may be an option for you.
This involves slowly reducing the dose of your current antidepressant while slowly increasing the dose of your new antidepressant. This could help ease the transition to a new medication and ensure you’re not experiencing unpleasant symptoms.
If you do experience unpleasant symptoms due to ADS, your doctor or healthcare professional may focus on a treatment plan suitable for you. This can involve addressing your symptoms and providing advice or prescribing medications that can reduce them.
If you’re experiencing headaches, they might advise you to take acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen (Advil). If you have nausea, they could prescribe you anti-nausea drugs like ondansetron.
Always reach out to your doctor if these symptoms are affecting your quality of life. Know that you can work together and come up with strategies that can make this journey less challenging.
ADS is an umbrella term for all the symptoms you might be experiencing when you’re discontinuing your antidepressant. Withdrawing from an antidepressant you were previously taking could result in unpleasant symptoms, including headaches, nausea, or sleep difficulties.
Do not stop taking your antidepressant all of a sudden, and discuss safe tapering options with your doctor. If your withdrawal symptoms are severely affecting your quality of life, they can prescribe medications to reduce them and help you feel better.