Antidepressant Withdrawal and Detox

Suddenly quitting antidepressants can cause uncomfortable withdrawal symptoms like dizziness and tremors. Gradually reducing doses under medical supervision can ease potential discomfort.

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What is Antidepressant Withdrawal?

Antidepressants are medications used to treat symptoms of depression, such as sadness and anxiety. Different antidepressants may also be used in the management of anxiety, panic attacks, obsessive compulsive disorders, some chronic pain syndromes, eating disorders, and post-traumatic stress disorder. For some people with depression, these drugs can correct a chemical imbalance. Those who have taken antidepressants for over six weeks are more likely to have withdrawal symptoms if they stop taking the drugs.

People taking antidepressants should never stop “cold turkey.” Quitting suddenly throws the brain into a state of imbalance that can be worse than before. The resulting symptoms are both psychological and physical.

Medical professionals often refer to withdrawal from antidepressants as “discontinuation syndrome.” This is because “withdrawal syndrome” implies a physical dependence or addiction is present, and antidepressants are considered non-addictive. Discontinuation syndrome and withdrawal both describe the same effects caused by quitting antidepressants.

Some doctors believe “discontinuation” undermines the serious effects of quitting antidepressants.

The term ‘discontinuation syndrome’ that is currently used minimizes the potential vulnerabilities induced by [antidepressants] and should be replaced by ‘withdrawal syndrome’.

- Giovanni Andrea Fava M.D. et al, Psychotherapy and Psychosomatics, 2015

Withdrawal Symptoms

Quitting antidepressants may produce symptoms similar to benzodiazepine withdrawal. However, withdrawal from antidepressants is typically less intense. The longer someone takes antidepressants, the worse their symptoms are likely to be.

Some of the symptoms from quitting antidepressants can include:

  • Fever
  • Headache
  • Nausea
  • Panic attacks
  • Tremors
  • Hallucinations
  • Lightheadedness
  • Confusion
  • Anxiety
  • Dizziness
  • Vivid dreams
  • Diarrhea
  • Ataxia

Some people quitting antidepressants have also experienced a phenomenon called “brain zaps.” A brain zap is an electric, shock-like sensation in the brain. People quitting antidepressants, especially teenagers, may be prone to suicidal thoughts and actions. Anyone deciding to stop taking antidepressants should first talk to a doctor.

Withdrawal or Relapse Depression?

Abruptly discontinuing antidepressants can lead to rebound depression, or symptoms returning even stronger than before. Rebound depression is a symptom of withdrawal and eventually fades away. Not everyone experiences rebound depression.

Some people who stop taking antidepressants relapse into a depressive state that is not a symptom of withdrawal. People who relapse into depression are usually put back on their medication before they attempt to quit again. It can be difficult to tell the difference between depression caused by withdrawal or relapse.

Doctors can help determine the difference between withdrawal symptoms and a return of depression.

If symptoms last more than a month and are worsening, it’s worth considering whether you’re having a relapse of depression.

- George I. Papakostas, M.D., psychiatry at Harvard Medical School, 2010

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Withdrawal Duration

The onset and duration of withdrawal can be drastically different from person to person. For some, symptoms don’t emerge until several weeks from the last dose. Other people may already have made it through their withdrawal symptoms in that time.

An important factor in the duration of withdrawal is how long the person took antidepressants. Someone who took an antidepressant for six months usually has less intense symptoms than someone who took the medication for two years. Certain antidepressants are more likely to cause negative withdrawal symptoms. People taking Paxil and Effexor often have more intense withdrawal symptoms. These drugs have short half-lives and leave the body faster than drugs with long half-lives. The faster an antidepressant leaves the body, the worse the withdrawal symptoms. This is because of the sudden imbalance of chemicals in the brain.

Antidepressants with longer half-lives, like Prozac and Zoloft, linger in the body for days. Withdrawal from these antidepressants lasts longer than short half-life drugs but are less intense.

Approximate half-life of popular antidepressants:

  • Effexor – 6 hours
  • Zoloft – 24 hours
  • Paxil – 29 hours
  • Lexapro – 30 hours
  • Celexa – 36 hours
  • Prozac – 5 days

Antidepressant Withdrawal Timeline

Days 1-3 Depending on the drug, most people experience the first signs of withdrawal symptoms in the first few days of quitting. Even if the user tapers their dose, mild symptoms may appear.
Days 4-5 Withdrawal symptoms become more intense before they begin to fade. Users start experiencing dizziness, nausea, shakiness and fever. Those who took antidepressants in higher doses for a longer time have more intense symptoms.
Weeks 1-3 Withdrawal symptoms typically persist for up to three weeks. The symptoms gradually fade during this time. Most people who quit taking their antidepressants stop having symptoms after three weeks.
Weeks 4+ There are many factors that affect how long withdrawal symptoms last. Some people have symptoms that last several months.

 

Detox and Tapering Down Use

Detoxing from antidepressants is the process of letting the drugs leave the body. Medical detox can help limit withdrawal symptoms. Antidepressant detox involves gradually stepping down doses until the user can safely stop taking them.

“To be able to taper off an antidepressant medication successfully, we want to do it slowly. So, it can take a month or six weeks or two months. But we just simply step the dose down slowly over time.”

- Psychiatrist Dr. Richard Shelton, NPR, 2010

There isn’t an exact science to tapering someone’s antidepressant dose. Some people initially cut their dose in half and then reduce their dose by quarters. Some taper down in as little as a month while others taper down over several months. A doctor should track and adjust doses according to their patient’s specific needs.

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Treatment for Antidepressant Withdrawal

Detox is the first step to quitting antidepressants. Treatment then can progress to involve therapy and counseling. Counselors can help users understand and move past the underlying causes of their depression.

Sometimes, people taking antidepressants also abuse drugs like alcohol and marijuana if their medication isn’t working. Polydrug use like this can worsen symptoms of depression and increase the risk of addiction. If you need help giving up antidepressants and/or another substance, contact a treatment provider today.

 

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