Antidepressant Withdrawal

Given I wrote a master’s thesis on this topic[i], it’s probably surprising that it’s taken a while for me to write a webpage article about antidepressant withdrawal. Or perhaps not so surprising, since this is a very big topic for a rather brief web page.

Firstly—and this is really important—if you are thinking about discontinuing your antidepressant medication, DO NOT do it cold turkey. That is, don’t just suddenly stop taking your medication. Nasty things can happen, and every doctor, every psychiatrist, every pharmacist, even the pharmaceutical manufacturers will tell you this. If you decrease your dose slowly, those nasty things are less likely to be overwhelming, and if you are fortunate, you might hardly even notice you’ve altered your meds. See my next post for guidelines on tapering your antidepressant.

Here’s why antidepressant drug withdrawal can be a problem. Neurotransmitters are the chemical molecules that allow your cells to communicate with each other. When you take antidepressants, you disrupt the natural function of your cells and how they use neurotransmitters to communicate. Most antidepressants target the specific neurotransmitters serotonin, norepinephrine (noradrenalin), and/or dopamine. The most popular antidepressants, SSRIs (Selective Serotonin Reuptake Inhibitors) such as Prozac (fluoxetine), Paxil (peroxetine), and Celexa (citalopram), target serotonin.

Nerve cells in your brain and body communicate by releasing these neurotransmitters into the tiny gap between cells where they can be taken in by the adjacent cell. Any extra neurotransmitters not taken up by the receiving cell are reabsorbed into the releasing cell. When you take an SSRI antidepressant, it blocks the releasing cell’s reuptake of unused neurotransmitter, leaving the excess serotonin in the gap between cells. This brief animation shows how they work.

Pharmaceutical companies have pushed the idea that serotonin is a “brain” chemical, but in actuality, only about 10% of the serotonin in your body is in your brain; the rest of your body’s serotonin—which is also a hormone--is in your digestive tract and blood where it helps to regulate your digestion and ensure cardio-vascular health (heart and blood).

It’s not clear how your body compensates for the drug’s action, but some researchers think the extra serotonin (or other neurotransmitter) in the gap means cells come to produce less serotonin over time; others suggest the drug-blocked reuptake receptors may decay from disuse; and still others suggest that cells may grow more reuptake receptors to help mop up the excess serotonin in the gap created by the drug. Whatever the case, when you remove that drug from your system after you’ve been taking it for a while, your system tries to revert back to its normal function, but the process of cell communication—not to mention digestion and blood/cardiac function--has now been physically altered by the drug. So your cells have to go through the whole compensation thing all over again.

Estimates suggest that 20-80% of people withdrawing from antidepressants will experience problems[ii] that may last a few days, weeks or months and can, in extreme cases, last years or result in resumption of the drug as the only viable way to alleviate long-term withdrawal symptoms. Some of the side effects of antidepressant withdrawal mimic symptoms of depression or anxiety. Others, like extreme fatigue, brain zaps[iii], bizarre and disturbing dreams, dizziness, hypomanic behaviour, and digestive upsets[iv] may be unexpected[v]. 

One of the most common responses to antidepressant withdrawal is increased volatility of emotions for a while: what used to make you somewhat irritable may suddenly cause you to erupt with anger, a moderately sad movie may reduce you to tears, and a pleasant activity may rocket you to euphoria. This will pass, usually in a few days, but it’s helpful for you, your family, and perhaps your co-workers to be aware that this is a drug withdrawal reaction and not “you”.

One reason why abrupt discontinuation is a concern is the small but significant risk of increased suicidality that may come with this increased emotional volatility, an increased risk that also occurs with initiation of the drug[vi]. This is also a good reason to consult your doctor before embarking on a discontinuation process. Doctors routinely monitor when you go on the drugs, but won’t know you are discontinuing them unless you tell them.

You should also tell the people you are living with (i.e., family) that you are decreasing your dose, and ask them for their support, even if your withdrawal symptoms are relatively mild. It helps if those around you can “cut you some slack” during what might be a somewhat challenging time.

Lastly, if you’ve decided to discontinue your AD, pick a time when stress levels are low. Don’t decide to discontinue your drug if you are feeling plagued by work stress, in the middle of a messy divorce, or selling your house—it won’t help!

In my next post on this topic, I share some guidelines for determining how fast you can comfortably discontinue your antidepressant.  You might also want to read my posts/articles on related topics:

Psychiatric Med Use Continues to Rise

The Serotonin Story

Where Did Prozac (Fluoxetine) Come From?

60 Minutes: Unhappy Pills

Anxiety and Depression 

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.

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[i] Collateral Damage: A Mixed Methods Study to Investigate the Use and Withdrawal of Antidepressants Within a Naturalistic Population. http://researcharchive.vuw.ac.nz/handle/10063/1501

[ii] http://www.psychologytoday.com/blog/side-effects/201107/antidepressant-withdrawal-syndrome

[iii] Brief, sharp, electrical-like sensations in the head

[iv] Very few people get ALL of these. Thank goodness!

[v] Details can be found in my thesis, but for a quicker and easier to read summary, here’s an excellent article by Christopher Lane from Psychology Today: http://www.psychologytoday.com/blog/side-effects/201107/antidepressant-withdrawal-syndrome

[vi] http://www.ncbi.nlm.nih.gov/pubmed/19758520 or, for a more dramatic summary: http://rense.com/general29/ei.htm