In the UK, antidepressant prescribing has doubled in ten years (Iacobucci, 2019) and a recent survey found that 93% of patients were not told about the risk of withdrawal symptoms (Read, 2023). This can be problematic if you have been on antidepressants for the recommended time, have had good results and are ready to come off of them. I hope you find the below five pieces of advice helpful for navigating this next part of your mental health journey.
What are the symptoms of antidepressant withdrawal?
It is important to understand the withdrawal symptoms that can occur when you reduce antidepressants, especially when the effects are often misunderstood by prescribing clinicians.
These withdrawal symptoms are well documented but it can take time for change to make its way through to common practice. An important thing to note is that it can often feel like familiar symptoms of anxiety and depression which can make it complicated to decipher what might be returning symptoms and what is withdrawal. Other symptoms are more unique to the withdrawal experience. Around a third to half of people experience withdrawal symptoms (Royal College of Psychiatrists, 2020).
Symptoms that may feel new to you:
- dizziness or vertigo
- electric shock sensations in head
- flu-like symptoms
- problems with movement, such as problems with balance or walking, or involuntary movements
- sensory disturbance, such as smelling something that isn't there
- stomach cramps
- strange dreams
- tinnitus (ringing in the ears).
Symptoms that may feel like your original problem
- anxiety
- crying spells
- depersonalisation (feeling detached from your surroundings)
- depression
- disturbed sleep
- fatigue (feeling very weary)
- mania
- mood swings
- poor concentration and memory
- suicidal thoughts.
How long does antidepressant withdrawal last?
The difference between a mental health relapse and withdrawal symptom is the time-scale in which the withdrawal symptoms can present. It’s important to know that withdrawal symptoms can start very soon after the medication is stopped or reduced, sometimes even as soon as 1-2 days. Usually it takes a few days for withdrawal symptoms to appear and then they gradually get worse. The length of time the withdrawal symptoms are present can depend on the individual, the particular antidepressant and the length of time you have been taking the medication for. A mental health relapse will typically not occur so soon after reducing an antidepressant. This is the main difference between a withdrawal symptom and a relapse.
Read more: How Quickly Does Propranolol Work for Anxiety?
Is now the right time to stop your treatment?
It’s important to choose the right time to reduce or come off of an antidepressant. If you are going through a period of change such as moving house, starting a new job or grieving the loss of an old relationship it might not be the right time. How healthy is your environment? Are you surrounded by supportive people? Be patient with yourself if you choose to delay any medication changes to a better time.
Always consult a clinical professional
When you agree that it is time to stop, your doctor or prescribing mental health clinician can help you put together a withdrawal plan. You must never come off of antidepressant medication without clinical supervision. The plan must be flexible and should allow you to reduce the dose at a rate that you find comfortable – as slowly as you need to avoid distressing withdrawal symptoms. This is also called ‘dose tapering’. Dose reductions will usually get smaller as the dose decreases – some people need to get down to a very low dose before stopping and some need to spend longer at each dose than others before continuing to taper down.
Self care is even more important
Self-care is even more important as coming off of antidepressants puts the body under stress. This means that you need to make your well being even more of a priority than you do already. Where are the areas in your life that you could fit in more nurturing practices to help support your mind and body? There are many options and possibilities to improve your life and reduce stress so this is a great time to try something new. Our experienced Mental Health Practitioners are here to support you with individualised assessments and recommendations in this area.
References
- Iacobucci, G., 2019. NICE updates antidepressant guidelines to reflect severity and length of withdrawal symptoms. BMJ: British Medical Journal (Online), 367.
- Read, J., Lewis, S., Horowitz, M., Moncrieff, J., 2023. The need for antidepressant withdrawal support services: Recommendations from 708 patients. Psychiatry Research, Volume 326,
- Royal College of Psychiatrists 2020 (Stopping Antidepressants): https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/stopping-antidepressants#:~:text=When%20you%20agree%20that%20it,also%20called%20'dose%20tapering'.
