An American Addiction Centers Resource

New to the Forums?Join or

When Should I Come Off My Antidepressant? 6 Things to Consider

Discussion in 'Prescription Drugs' started by Lizel, Aug 13, 2015.

  1. Lizel

    Lizel Community Champion

    The question of whether or not you should start taking antidepressants is complex and difficult to answer. But even fuzzier is the question of when or if you should stop. Last May, NPR ran a piece called Coming Off Antidepressants Can Be Tricky Business.

    Joanne Silberner writes:

    Several top psychiatrists say there’s just not enough data to say for sure when to try coming off an antidepressant. Drug companies generally test their new products for a few months or up to a year. They don’t spend much time looking into how to taper off their products. The dense informational inserts that come with prescription drugs have a lot of information on how to take the product, but no information on how to stop.

    According to the Johns Hopkins Depression and Anxiety White Papers, antidepressant use involves three phases:

    • The acute phase which is when a person first begins antidepressants until she feels full benefit, usually four to 12 weeks after.
    • Then she goes on to a continuation phase, with the goal of preventing a relapse or a return to the depressive episode. This can last anywhere from four months to a year, usually taking the same amount of the drug as was figured out in the acute phase. If a person is symptom free after this, she may go off her antidepressants.
    • However, for people who meet the following criteria, a maintenance phase, lasting a year or longer, is needed, either at the regular dose or a smaller dose:
      • A history of three or more episodes of major depression
      • A history of severe depressive symptoms
      • Current dysthymia (chronic low-grade depression)
      • A family history of mood disorders
      • Current anxiety disorder
      • Substance abuse
      • Incomplete response to continuation treatment
      • A pattern of seasonal depressive symptoms
  2. Lizel

    Lizel Community Champion

    The decision of when to go off is highly individualized. There is no “one size fits all” rule of thumb. Although many studies indicate that a year or more of an antidepressant is needed to treat a major episode of depression or anxiety, there are certainly patients that have needed only a few months of drug therapy.

    Says Silberner of NPR:

    There’s enormous variation among people when they stop antidepressants. A person whose depression kicked in after a major life tragedy may do OK without drugs once life stabilizes. A person whose depression came out of the blue is likely to be at higher risk of chronic depression. And within all that, there’s basic biology — people react differently to drugs and to withdrawing from drugs.

    The only rule that all doctors hold is that a person does not go off medication cold turkey, but by gradually lowering the dose. Stopping too suddenly puts you at risk for symptoms returning or for physical and mental withdrawal. Several of the newer antidepressants, especially, including Paxil, Luvox, Effexor, trazodone, Remeron, and Serzone will produce symptoms of dizziness, nausea, lethargy, headache, irritability, nervousness, crying spells, flu-like illness, and sleep or sensory disturbances–known as the “discontinuation syndrome” that occur within 24 to 72 hours after stopping the medication.

    About 20 percent of people who abruptly stop taking an antidepressant after more than six weeks of treatment experience the discontinuation syndrome.

    Whitney Blair Wyckoff of NPR lists these six suggestions from Dr. Richard Shelton, professor of psychiatry at Vanderbilt University, to keep in mind when considering coming off medication:
  3. Lizel

    Lizel Community Champion

    1. Consider the severity of your illness. Those with the best odds are people who were mildly ill, who haven’t been ill many times in their lives, and whose symptoms didn’t affect their ability to function in a meaningful way.
    2. Never come off cold turkey. That’s a bad idea under most circumstances, and that’s, unfortunately, where doctors tend to see people having the most trouble. Shelton recommend that people always consult with whoever is prescribing drugs for them.
    3. Don’t be in a hurry. To be able to taper off an antidepressant medication successfully, you want to do it slowly. And by slowly, there are no absolute rules. So, it can take a month or six weeks or two months.
    4. Try to start coming off during the spring or summer. Withdrawing during the fall and winter can be a big problem — especially for people living in Northern states.
    5. Choose a time that isn’t significantly stressful. For example, people who are going through a divorce should wait a while before thinking about starting to ease off antidepressants.
    6. Be realistic. According to Sheldon, about 80 percent of patients discontinue their antidepressants in actual practice settings. But most of these patients relapse, and half restart their medications.
  4. movingforward1

    movingforward1 Active Contributor

    I was misdiagnosed and given antidepressants for bipolar disorder. They made me psychotic and heightened my mania. If you feel a medication may be worsening your symptoms, please talk to your doctor.
  5. zaerine

    zaerine Community Champion

    Those are helpful information and tips.
    There could be natural ways to address depression too like having some family or friends to talk with and doing things to lessen the stress. Maybe try drinking soursoup tea if available since it is said to have anti depressant properties.
  6. kassie1234

    kassie1234 Community Champion

    I always think with anti-depressants if you feel ready to come off them, definitely consult with your doctor. I've known people who have tried to come off them without consulting their doctor and it didn't work out well for them. Your medical professional will be able to give you guidance and perhaps decrease your dosage over a certain period of time to wean you off them.
  7. kgord

    kgord Community Champion

    I think that when people are feeling better, and their life is more in order is potentially a time to quit. It is one of the choices that the individuals needs to make with their doctor and hopefully not a alone. It is one of the options that you need to consider carefully, and I am sure the right way to do it is to taper off.
  8. Mzpeaceful1

    Mzpeaceful1 Active Contributor

    After a horrific experience trying to come off of paxil a few years back, I am terrified of anti-depressants. I don't care how depressed I get, I will never take one again. It was one of the scariest withdrawals next to benzo withdrawal that I have ever been through...Nope don't want to go through that again...

    I know that some people get help from them but my experience with the few I have tried has not been so good. My desire in life is to stay drug free and be as healthy as possible without the help of medications.
  9. Ali16

    Ali16 Senior Contributor

    I was misdiagnosed as well, when I as a teenager. They were treating me for depression and anxiety. I did have anxiety but I actually had bipolar disorder, not depression. No one could figure out why I had such trouble sleeping and was so irritable all the time. They'd tried me on one mood stabilizer but decided I sang bipolar because the medicine made me physically sick. I went untreated until age 26 - when it cost me my career and financial security.
  10. Tremmie

    Tremmie Community Champion

    I came off my meds all of a sudden years ago, I wish someone had told me there could be consequences for doing that. Now I am being more careful. I need to come off a blood pressure medication known as ''Propanolol'', because this med is the ones that has made me gain weight in the last year :( So I am already taking a reduced dose of 40 mg daily, instead of the 80 mg a day. I am starting to drop some weight, it seems! So, by next year... maybe mid next year I might be Propanolol free :)

    My advice to anyone, no matter what medication you are taking... consult your doctor before quitting! He must guide you! Don't do it cold turkey and on your own! Coming off a controlled medication must be gradual and slow.
  11. amin021023

    amin021023 Community Champion

    What happened that made you hate anti-depressants that much? what withdrawal did you experience?
    dear I don't think it's a good idea not to take medications at all...sometimes it's really necessary to take medications to help you overcome a problem...
    but you have a point, I try to to keep medicating at minimum.
  12. deanokat

    deanokat Community Organizer Community Listener

    @Tremmie is right. You should always consult your doctor regarding changing anything to do with your RX meds. Not doing so can be very dangerous.
  13. bsthebenster

    bsthebenster Community Champion

    I think "don't quit cold turkey" is really important. Most anti-depressants effect serotonin. If the drug is quit cold turkey, the brain doesn't get a chance to balance the serotonin levels. This can cause a lot of mood issues. Another tip is to make coping strategies during and after the tapering process. Have a plan put in place before and this process might be a bit easier to manage.