This article was co-authored by Padam Bhatia, MD. Dr. Padam Bhatia is a board certified Psychiatrist who runs Elevate Psychiatry, based in Miami, Florida. He specializes in treating patients with a combination of traditional medicine and evidence-based holistic therapies. He also specializes in electroconvulsive therapy (ECT), Transcranial Magnetic Stimulation (TMS), compassionate use, and complementary and alternative medicine (CAM). Dr. Bhatia is a diplomat of the American Board of Psychiatry and Neurology and a Fellow of the American Psychiatric Association (FAPA). He received an MD from Sidney Kimmel Medical College and has served as the chief resident in adult psychiatry at Zucker Hillside Hospital in New York.
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The use of any type of psychiatric drug – antidepressant, sleep medication, anti-psychotic or ADHD medications – isn’t always a permanent situation. Doctors often prescribe such drugs for a period in a patient’s life when such medication will be therapeutic for treatment of concentration issues, anxiety, sleeping disorders or other quality of life considerations. In some cases, the patient suffers side effects from the drugs themselves that cause more problems and quality of life issues than the psychiatric ailment itself. These types of medications often cause “discontinuation symptoms” which can possibly be avoided or lessened by a slow weaning process instead of stopping “cold turkey.” This article will suggest how to get off psychiatric drugs safely. It is important to note that you should never stop taking psychiatric drugs without first consulting your doctor.
The majority of respondents cited the main reasons they attempted to quit psychiatric drugs were health risks of long-term use and side effects.
Despite numerous obstacles and severe withdrawal effects, long-term users of psychiatric drugs can stop taking them if they choose, and mental health care professionals could be more helpful to such individuals, according to a new study.
While 1 in 6 Americans take a psychiatric medication for serious mental illness, there is little research on people’s experiences coming off the drugs. In the first large-scale study in the United States on this subject, Live and Learn, Inc., in partnership with researchers at the UCLA Luskin School of Public Affairs, UC San Francisco and New York University, began to fill this knowledge gap. Study findings are now available online in Psychiatric Services, a journal published by the American Psychiatric Association.
Surveying 250 long-term users of psychiatric medications who had a diagnosis of serious mental illness and chose to discontinue use, the study found that more than half succeeded in discontinuing usage, despite having little professional support while experiencing severe withdrawal symptoms including insomnia, crying and diarrhea. The majority of survey respondents cited the main reason they attempted to quit centered on health risks of long-term use and side effects.
Of the study’s respondents, 54 percent managed to stay off psychiatric medication for at least one year, with few reporting relapse or re-hospitalization. Eighty-two percent of those who discontinued use reported being “satisfied” with their choice.
“People stop taking their psychiatric medications whether or not they find the drugs helpful, and they do so at all stages of the medication experience — days, weeks, months, or years after taking them,” said David Cohen, professor and Marjorie Crump Chair in Social Welfare at UCLA Luskin and a co-author of the study. “This study is novel because it asks questions about stopping to take medications from the consumer’s point of view.”
Many industry-funded studies have asked patients why they stop taking their medications, but typically with a view to increase compliance, according to Cohen. By contrast, this study asks consumers what they experienced while coming off drugs, who helped them make and carry out their decision, and whether they were satisfied with their attempted or completed discontinuation.
“Over 70 percent of our study sample had taken medication for more than a decade; however, these individuals reported having little to rely on when discontinuing except the internet and social support in order to endure withdrawal. Limiting access to care through cuts to health and psychosocial services can only make that situation worse,” says principal investigator Laysha Ostrow, founder and CEO of Live and Learn, a California-based social enterprise that provides research, technical assistance and knowledge translation services to behavioral health systems. “Most were working with a provider at the time but did not find them helpful in the process. However, even though it was often complicated and difficult, the majority who were able to come off medication completely were satisfied with their decision to do so.”
Cohen said that there are still plenty of challenges for researchers who are examining this topic.
“There’s a lot of work to do to understand how people come off medications and how to help them do so safely, especially when they're taking several psychiatric medications simultaneously,” he said. “This study didn’t use a probability sample. Though it very carefully selected the 250 respondents, most with over 10 years’ history of taking medications, it should be a priority to confirm or modify these findings with a probability sample.”
The study was funded through a grant by the Foundation for Excellence in Mental Health Care.
Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be.
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
Verywell / Alison Czinkota
To be in a position where you feel ready to come off antidepressants is a good thing. Unfortunately, it’s not always easy. Antidepressants can be notoriously difficult to quit because stopping can produce withdrawal-like symptoms referred to as “discontinuation syndrome.”
Discontinuation symptoms are typically mild and short-lived. However, for some people, symptoms can be severe enough to impact their day-to-day lives. By working with your doctor to gradually lower your dose over time (a process known as "tapering"), you may be able to minimize or even prevent many of these uncomfortable symptoms.
Antidepressant Discontinuation Syndrome
Antidepressant discontinuation syndrome is a set of symptoms that can occur after abruptly stopping or even or greatly reducing the dose of an antidepressant medication that you’ve been continuously taking for an extended period of time, generally greater than one month. Some estimates suggest that at least one in five people who stop taking an antidepressant abruptly experience these symptoms.
These symptoms, which are often referred to as withdrawal symptoms, usually begin within two to four days and can last for as long as one to two weeks.
Discontinuation symptoms can be grouped into six categories:
- Flu-like symptoms: Fatigue, nausea, headache, light-headedness, chills, and body aches
- Gastrointestinal: Nausea, vomiting, cramps, and diarrhea
- Hyperarousal: Anxiety, irritability, and agitation
- Imbalance: Dizziness, vertigo, and light-headiness
- Sleep disturbances: Insomnia, nightmares, and vivid dreams
- Sensory disturbances: Burning, tingling, electric-like or shock-like sensations
The severity of these symptoms can vary significantly. Some people have few or no symptoms when they stop their antidepressant medication, whereas others may find these symptoms extremely uncomfortable.
Discontinuation Syndrome vs. Relapse
Discontinuation symptoms can be very similar to the anxiety or depression symptoms that prompted you to take the medication in the first place. Some people are frightened that their depression or anxiety is returning full force upon stopping their medication, when actually what they are experiencing is a discontinuation syndrome that will resolve by itself in time.
For adults with depression who have achieved remission, the American Psychological Association recommends psychotherapy to help prevent relapse.
Timing can help you tell the difference between the two. If depression or anxiety recurs after stopping an antidepressant, it is often a gradual process that slowly worsens over time. In contrast, symptoms related to antidepressant withdrawal tend to occur quickly (days rather than weeks) and slowly improve over time.
Guidelines for Tapering
The best way to avoid or reduce these withdrawal-like symptoms is to not stop antidepressants abruptly. Specifically, the American Psychiatric Association recommends tapering antidepressants over the course of "at least several weeks."
Because there are no drug-specific tapering recommendations, your doctor will use their clinical judgment to determine your individual tapering schedule. They will consider several factors including the antidepressant you are taking (specifically, its half-life), your current dose, and how long you have been taking it.
The half-life of a drug refers to the time at which half of the medication is eliminated from your body and half remains. In general, drugs with short half-lives require a longer tapering period compared with drugs with long half-lives.
Antidepressants with relatively short half-lives, such as Effexor (venlafaxine), Paxil (paroxetine), and Zoloft (sertraline), should be tapered over a longer period than drugs with long half-lives like Prozac (fluoxetine).
What If I Have Symptoms While Tapering?
Remember that everyone is different when it comes to weaning off antidepressants. Some people can taper off an antidepressant—even one with a short half-life—in a matter of weeks without any significant symptoms. Others may have bothersome symptoms and require that the drug be tapered over a period of months.
If you experience discontinuation symptoms during a particular dose reduction (or shortly after discontinuation), your doctor may restart you at your original dose and then taper you off more slowly. If this doesn't work, your doctor may switch you over to a drug with a longer half-life such as Prozac.
A Word From Verywell
There are many reasons you may decide to stop taking antidepressants. Maybe you're having side effects. Or maybe your condition has improved and you no longer need medication.
Regardless of your reasons, if you're thinking about stopping your antidepressant medication, you should always talk to your doctor first. Your doctor will put you on a tapering schedule, prescribe the appropriate dosage, and support you during the transition. Working closely with them will help make your decision to quit taking antidepressants as safe and comfortable as possible.
Mustering solid evidence, two researchers have denounced the standard psychiatric guidelines for how best to wean patients from depression medications.
Thousands, perhaps millions, of people who try to quit antidepressant drugs experience stinging withdrawal symptoms that last for months to years: insomnia, surges of anxiety, even so-called brain zaps, sensations of electric shock in the brain.
But doctors have dismissed or downplayed such symptoms, often attributing them to the recurrence of underlying mood problems.
The striking contrast between the patients’ experience and their doctors’ judgment has stirred heated debate in Britain, where last year the president of the Royal College of Psychiatrists publicly denied claims of lasting withdrawal in “the vast majority of patients.”
Patient-advocacy groups demanded a public retraction; psychiatrists, in the United States and abroad, came to the defense of the Royal College. Now, a pair of prominent British psychiatric researchers has broken ranks, calling the establishment’s position badly mistaken and the standard advice on withdrawal woefully inadequate.
In a paper published Tuesday in Lancet Psychiatry, the authors argued that any responsible withdrawal regimen should have the patient tapering off medication over months or even years, depending on the individual, and not over four weeks, the boilerplate advice.
The paper is by far the strongest research-backed denunciation of standard tapering practice by members of the profession.
“I know people who stop suddenly and get no side effects,” said Dr. Mark Horowitz, a clinical research fellow at Britain’s National Health Service and University College London, and one of the paper’s authors.
But many people, he said, “have to pull apart their capsules and reduce the dosage bead by bead. We provided the science to back up what they’re already doing.”
The field of psychiatry has conducted few rigorous studies of antidepressant withdrawal, despite the fact that long-term prescription rates in the United States and Britain have doubled over the past decade, with similar trends in other Western countries.
More than 15 million Americans have taken the medications for at least five years, a rate that has almost more than tripled since 2000, according to a New York Times analysis of federal data.
Outside researchers who have studied withdrawal said the new paper was a welcome contribution. “I think what they’ve presented really reinforces what I’ve observed in clinical practice in many patients, and it’s almost identical to the tapering regimen I use,” said Dr. Dee Mangin, the chair of family medicine at McMaster University in Canada, who was not involved in the paper.
Dr. Mangin, who is completing her own two-year study of Prozac withdrawal, added, “The other important thing is that it validates patients’ own reports of their experiences. It’s tremendously frustrating when patients describe a different experience than physicians expect, and don’t feel they’re being heard.”
Dr. Horowitz and his co-author, Dr. David Taylor, a professor of psychopharmacology at King’s College London and a member of the South London and Maudsley N.H.S. Foundation Trust, decided to address the topic in part because of their own experiences with medication.
Dr. Horowitz said he had severe withdrawal symptoms after tapering down after 15 years on antidepressants. Dr. Taylor had previously written about his own struggles trying to taper off.
The two researchers began by visiting online forums in which people on antidepressants advised one another how best to withdraw. Those sites consistently recommended “micro-dosing,” reducing doses by ever smaller amounts over months or years, sometimes by removing one bead at a time from capsules.
The two researchers dug into the literature and found a handful of studies that provided evidence for that method.
In one 2010 study cited in the new paper, Japanese researchers found that 78 percent of people trying to taper off Paxil suffered severe withdrawal symptoms. The research team had them taper much more slowly, over an average of nine months and for as long as four years. With this regimen, only 6 percent of subjects experienced withdrawal.
In another study, Dutch researchers in 2018 found that 70 percent of people who’d had trouble giving up Paxil or Effexor quit their prescriptions safely by following an extended tapering regimen, reducing their dosage by smaller and smaller increments, down to one-fortieth of the original amount. This is the regimen recommended in the new paper.
Dr. Horowitz and Dr. Taylor also cited brain-imaging evidence. Antidepressants such as Paxil, Zoloft and Effexor work in part by blocking the serotonin transporter, a molecule that works in the synapses between brain cells to clear out the chemical serotonin, which is thought to help impart a sense of well-being in some people. By blocking the transporter, antidepressants prolong and enhance serotonin’s effects.
But the brain-imaging studies found that inhibition of the transporter increases sharply with addition of the drug and, by extension, also drops sharply with any reduction in dosage. The standard medical advice, to reduce dosage by half — for instance, by taking a pill every other day — and end medication entirely after four weeks, does not take this into account, the two researchers argued.
“Doctors have in mind that these drugs act in a linear way, that when you reduce dosage by half, it reduces the effect in the brain by a half,” Dr. Horowitz said. “It doesn’t work that way. And as a result, there’s a huge load in terms of the effect on brain receptors, and patients are being advised to come off way too quickly.”
Laura Delano, executive director of Inner Compass Initiative, a nonprofit organization that runs The Withdrawal Project and focuses on helping people learn about safer psychiatric drug tapering, said: “I didn’t know about the benefits of slow tapering when I came off five meds in five months, and had a very difficult time in withdrawal.”
The new paper, she added, “speaks to how hard it is to get this information into the clinical world. We laypeople have been saying this for a long time, and it’s telling that it took psychiatrists coming off meds themselves for this information to finally be heard.”
Dr. Horowitz and Dr. Taylor called for more, and more careful, research to be done on withdrawal, to bring their field up to speed, and to develop withdrawal strategies tailored to individual patients and individual drugs.
“I think psychiatrists are taught to learn things from textbooks and from well-conducted studies,” Dr. Horowitz said. “We don’t have many of those for withdrawal, so it makes it hard to believe it’s real. And psychiatrists spend a lot more time prescribing things than stopping them.”