Thursday, 7 February 2013

How long does it take to get off antidepressants?

The short and flippant answer to this question is “how long is a piece of string”. But seriously...

If you’ve read my previous post about antidepressant withdrawal, you’ll know that experts all recommend a slow taper off antidepressants to mitigate unpleasant withdrawal symptoms. So, how slow is slow?

In his book TheAntidepressant Solution, Dr Joseph Glenmullen suggests initiating your withdrawal by dropping down to the next lower pill size and monitoring the symptoms of your reaction to the decrease, which tend to peak 5-10 days following the drop[i]. He recommends using a checklist to monitor symptoms and severity, which is available here. This is also a good list to check out if you just want to know what kinds of symptoms are likely with withdrawal, but don’t be too horrified—most people only experience a few of these.

Once you’ve made a drop, don’t initiate the next drop until you feel comfortably stabilized, usually 2-4 weeks later.  If you are taking more than one drug, don’t withdraw from more than one drug at a time.

So if you are taking 10 mg of Prozac (fluoxetine) or Paxil/Seroxat (paroxetine), you’d drop to 0 mg straight away. If you’re taking 40 mg of Prozac or Paxil/Seroxat, you’d drop to 20, then 10, then 0, thus three withdrawal periods. If you’re taking 150 mg of Welllbutrin, you’d drop to 75, and later to 0. As a general rule, Prozac—which lingers in the body longer—is easier to get off than Paxil or most other “short life” antidepressants. If you’ve been on a drug for only a few days, you probably don’t need to taper off it.

 IF the withdrawal reaction you experience from a drop is severe (i.e., seriously debilitating or dangerous[ii]), Glenmullen recommends resumption of the drug at the former dose and in a few weeks, commencing a slower taper. This means using a pill cutter (or a very sharp paring knife or razor blade) to trim your tablets or obtaining your antidepressant in a liquid form from your pharmacist which you can then titrate.

At  you’ll find a great internet support community where folks can ask questions, read up on the latest theories about AD withdrawal, and get support from others with antidepressant withdrawal experience. There, they recommend dropping your antidepressant more slowly, by 10% of your previous dose every 3-6 weeks. The PaxilProgress folks also believe withdrawal symptoms get more severe as you approach 0 mg.

I think it makes sense to try Glenmullen’s faster version first and, if you run into problems, you’ll know to slow down and decrease by smaller increments.  As noted in my previous article, at least 20% of users do NOT have any significant problems getting off their antidepressant.

My next blog entry offers 10 tips for making withdrawal easier.

For more information on psychiatric drugs and alternative ways to understand and resolve a variety of mental "illness" issues, see my new book Reframing Mental Illness.

[i] I am summarizing whole chapters of this book with this statement. Glenmullen incorporates several tables suggested how each particular drug and dose can best be stepped down, and lots of helpful information if you are having trouble. I recommend reading the book, especially if you experience difficulties getting off your drug(s).
[ii] That is, you are unable to function normally for a period of time (we’re talking more than just feeling like you’ve got the flu, which is common) and/or you experience suicidal or homicidal thoughts or hallucinations.

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