People come off antidepressants for a variety of reasons. In a best-case scenario it is because medication has helped and they feel it’s time to move forward, but this is only one outcome. When the Royal College of Psychiatrists in the UK conducted a survey of 817 people on this very topic they identified six key reasons why people stop:
Felt better (219)
Didn’t help (175)
Wanted to try without (45)
On advice of doctor (21)
It was also interesting to learn how people stopped and what effect stopping antidepressants had. In this sample 36 percent stopped suddenly and 63 percent experienced withdrawal symptoms, with some antidepressants more likely than others to cause withdrawal symptoms.
The drugs most likely to cause withdrawal symptoms were Venlafaxine (82%), Escitalopram (75%), Paroxetine (69%) and Duloxetine (69%). Those less likely to cause withdrawal were Sertraline (62%) and Citalopram (60%). The least likely to cause withdrawal symptoms were Fluoxetine (44%) and Mirtazepine (21%).
The top five symptoms associated with withdrawal were anxiety (70%), dizziness (61%), vivid dreams (51%), head zaps or shocks (48%) and stomach upsets (33%), although it is also worth mentioning that flu-like symptoms came a close sixth at 32%.
Many people experience withdrawal symptoms for as long as six weeks although a few people find they last longer.
What are the reasons for these symptoms? We have have to remember that antidepressants work at the neurotransmitter level. When they are first taken people generally feel the effects of antidepressants fairly quickly, but over time the side effects start to reduce as the body adapts. Once the medication is established it remains in the body for a period of time following discontinuation. Symptoms of withdrawal generally occur once 90% of the drug has left the body.
Depending on the antidepressant you were prescribed, the washout period may be as short as a day or as long as 25 days. Over time the concentration of the drug in the body gradually reduces until it finally leaves the body altogether. Effexor, for example, is 99% out of the body in a day, whereas Prozac levels reduce more gradually over a period of nearly four weeks.
It isn’t cast iron that you will feel withdrawal symptoms. Some people experience only very mild symptoms. Discontinuation of antidepressants is best undertaken as a process under the guidance and supervision of a medical doctor. Suddenly stopping can result in something of a mood crash so it is better to accept the fact that a gradual reduction in dose is likely to be recommended.
Jerry Kennard, Ph.D., is a chartered psychologist and associate fellow of the British Psychological Society. Jerry’s clinical background is in mental health and, most recently, higher education. He is the author of various self-help books and is co-founder of positivityguides.net.