Let me start with a warning- do not stop your antidepressant yourself! You and your doctor should first discuss and decide together to discontinue your treatment. I am writing this short article to tips on quitting your antidepressant, as it can be tricky sometimes. Some people also do not know that it is possible to stop their antidepressants, so I want to bring a bit of hope.
Doctors decide for each case what is the road ahead concerning medication. The doctor and patient should choose together to what are the pros and cons of stopping. It would be best to remember that it is best to continue and take the entire course of antidepressants in most cases. You might feel much better after a month or so on an antidepressant, but stopping it could result in a relapse. If you have another episode of depression, the psychiatrist will usually treat you for longer than the last episode (and you may end up with life-long treatment).
There should be many symptoms if you change from one SSRI (selective serotonin reuptake inhibitor) to another. If you abruptly stop an SSRI, you could experience discontinuation symptoms such as:
• Dizziness
• Fatigue
• Headache
• Nausea
• Anxiety
• Chills
• Insomnia
• Irritability
• Myalgia
• Tremor
Less common symptoms include electric-like shocks, ataxia, auditory and visual hallucinations, and hypertension.
The factors that appear to be associated with more severe discontinuation symptoms include:
• Shorter antidepressant elimination half-life (e.g., <24 hours)
• Anxiety symptoms at the onset of treatment
• Higher antidepressant dose
• Longer duration of treatment (e.g.,>5 to 8 weeks)
• Prior history of discontinuation symptoms
Discontinuation symptoms can occur with any SSRI, but the greatest risk by far is on Paroxetine, followed by the rest, and Fluoxetine has the least risk. This very low risk of discontinuation symptoms is the reason why many psychiatrists often change to Fluoxetine when they decide to stop an SSRI. Paroxetine is notoriously difficult to stop, and the abrupt stopping of Paroxetine can lead to hospitalization or confusion with other medical conditions (e.g., a stroke).
Bear in mind that you can also relapse from your depression when you stop your antidepressant too quickly. Discontinuation symptoms usually start within 1-4 days after stopping, and the symptoms of depression can return a week or two later.
Points to consider when stopping your SSRI antidepressant:
• Discuss it with your doctor first
• Understand discontinuation symptoms, and the fact that you may have discontinuation symptoms does not mean that you are addicted to your antidepressant
• Stop your antidepressant gradually, usually over 2-4 weeks
• Management of discontinuation symptoms includes tapering slower or switching to Fluoxetine.
Guidelines on how to stop other commonly used (non-SSRI) antidepressants:
• Venlafaxine: Same as Paroxetine, difficult to stop, I always switch to Fluoxetine
• Duloxetine: taper over 2-4 weeks
• Agomelatine: can be stopped immediately if on low dose (25mg)
• Buproprion: can be stopped immediately if on low dose (150mg)
• Mirtazapine: taper over 2-4 weeks
• Trazodone: taper over 2-4 weeks
• Tricyclics (e.g., Trepeline): taper over 2-4 weeks
• Vortioxetine: can be stopped immediately if on low dose (10mg)
To conclude: stopping your antidepressant is usually an option. But to decrease your suffering from discontinuation symptoms and prevent a relapse, have a consultation with your doctor first.
Good luck!
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REFERENCES:
Discontinuing antidepressant medication in adults, M Hirsch, RJ Birnbaum, UpToDate, 2021