How To Handle SSRI Withdrawal
Selective serotonin reuptake inhibitors (SSRIs) help many people manage symptoms of depression and other mental health conditions by normalizing brain functions associated with mood. However, while beneficial, sometimes stopping an SSRI may cause withdrawal symptoms, referred to as SSRI discontinuation syndrome. According to a report published in the Canadian Medical Association Journal, roughly 20% of people who take an antidepressant consistently for one month, followed by an abrupt decrease in dosage or an abrupt stop of antidepressant use, experience antidepressant discontinuation syndrome.
Patient education is an important step in reducing the risks of antidepressant withdrawal syndrome. Below, we’ll explore the symptoms of antidepressant withdrawal and how to prevent SSRI discontinuation syndrome.
The basics of SSRIs
SSRIs are a class of antidepressants that work to manage depressive symptoms by increasing serotonin levels in the brain. Serotonin is a neurotransmitter (a special chemical that acts as a messenger between brain cells) that plays a key role in mood control. For people with depression, neurotransmitters may not move between cells as they should. SSRIs may ensure there is an appropriate amount of serotonin communicated between brain cells so the areas of the brain that control mood can function optimally.
SSRIs are typically the first type of antidepressant prescribed for someone experiencing depression, because they are effective and the side effects are more tolerable compared to other antidepressant medications, like tetracyclic antidepressants.
SSRI side effects
It can be vital to be aware of any changes in your mind or body that arise when beginning, continuing, or ending treatment. SSRIs are typically designed to help you feel better, not worse. However, due to the way medications can react in different people's bodies, this is not always the case. Common side effects of SSRIs may include the following:
Insomnia
Changes in appetite
Lethargy
Weight gain or loss
Headaches
Nausea
Joint or muscle pain
Increased suicidal thoughts
If you or a loved one are experiencing suicidal thoughts, reach out for help immediately. The 988 Suicide & Crisis Lifeline can be reached at 1-800-273-8255 and is available to assist 24/7.
All of these side effects should generally be reported to your doctor, but the most important one about which to be aware is usually the last one on the list—increased suicidal thoughts. It may seem counterintuitive that medication for depression could cause someone to have thoughts of suicide, but since medications can affect people differently, this side effect may be a possibility.
It can also be important to know that many of these side effects (and others) can appear when you stop taking SSRIs, so you should be vigilant for signs of withdrawal as well.
Discontinuing SSRI treatment
You may choose to discontinue taking SSRIs due to negative side effects, or you may perceive that the medication is not helping your depression. Alternatively, it’s possible you planned to use medication as a short-term intervention and are ready to continue treatment with therapy alone. If you would like to continue using SSRIs, but you believe your current prescription is not effective, you might want to try switching to a different SSRI. Always speak to your doctor regarding starting, stopping, or changing medications.
Stopping antidepressants may be difficult, because of the possibility of experiencing withdrawal symptoms. Talk to your doctor if you would like to consider stopping treatment with an SSRI. In almost all cases, your provider will instruct you to start taking a lower dose of the medication before completely discontinuing its use. This process of weaning off SSRIs can reduce potential withdrawal symptoms. SSRIs have a short half-life (the time it takes for the medication’s concentration to decrease by half in the body), which means that people who take SSRIs have a moderate risk to a relatively high risk of experiencing withdrawal symptoms when discontinuing use.
Because SSRIs usually alter mood by influencing neurotransmitters and neurons, removing the SSRI from your brain can affect your mood while your body adjusts to its absence. For this reason, many people experience unpleasant SSRI withdrawal symptoms.
SSRI withdrawal symptoms
The symptoms of SSRI are described with the mnemonic FINISH:
F: Flu-like symptoms that may include fatigue, headache, and body aches.
I: Insomnia that may be associated with trouble sleeping due to vivid dreams or nightmares.
N: Nausea that may lead to vomiting.
I: Imbalance caused by light-headedness or vertigo.
S: Sensory issues such as tingling or shock like sensations in the body and the brain, also called “brain shivers.”
H: Hyperarousal characterized by anxiety, irritability, or mania (abnormally high energy).
There is generally no clear-cut reason why some people experience SSRI withdrawal, and others do not. Someone may experience discontinuation syndrome after taking the medication for six weeks. The answer is likely due to the changes that SSRIs initiate in the brains of different persons. When certain people stop taking them, the brain may need more time to adjust to the changes.
Risk factors for experiencing SSRI withdrawal symptoms include:
Abruptly stopping antidepressants
Having taken antidepressants for a long time
Taking a high dose of antidepressants
Taking an antidepressant with a shorter half-life
Having experienced withdrawal symptoms after missing a dose of medication even when medication use continues
Other symptoms of SSRI withdrawal syndrome may mimic symptoms of depression relapse. When discontinuing SSRI treatment, many people feel especially anxious and possibly more depressed. If antidepressant withdrawal symptoms are not properly identified, this may lead to psychiatric misdiagnosis.
If someone experiences severe SSRI withdrawal symptoms or ongoing symptoms of withdrawal, their care team may recommend that they return to their previous dose of the same drug and resume tapering at a slower rate.
Seeking help for SSRI withdrawal
While it can be crucial to work closely with your doctor as you wean off SSRIs, it can also be helpful to speak with a licensed therapist regarding your experience and any withdrawal symptoms. A therapist may teach you helpful coping strategies and provide you with the professional support you deserve during this potentially challenging time. Talk therapy is almost always recommended as a complement to medication for depression. Weaning off an anti-depressant may be a particularly appropriate time for such professional support.
Benefits of online therapy
If you’re experiencing uncomfortable withdrawal symptoms after discontinuing antidepressants, it may be difficult to leave the house for a therapy session. Online therapy can empower you to receive the guidance and support you deserve from the comfort of your home. You can schedule sessions outside of typical office hours and choose between video calls, phone calls, and online chat.
Effectiveness of online therapy
More research may be needed regarding the efficacy of online therapy specifically for SSRI withdrawal symptoms. However, a growing body of research generally suggests that online therapy can be just as effective as in-person therapy at treating a wide variety of mental health disorders and concerns, including depression and its associated symptoms.
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Takeaway
If you’ve decided to stop taking SSRIs, it’s crucial to reach out to your doctor or psychiatrist to formulate a safe plan for slowly weaning off these medications. However, even with a plan for discontinuing SSRIs, it’s possible you may experience uncomfortable withdrawal symptoms. Working with a licensed therapist, in addition to your doctor, can be helpful in providing support and coping strategies.
What is antidepressant withdrawal?
Discontinuing antidepressant therapy can cause a syndrome—or a group of symptoms—called discontinuation syndrome. About 20% of people who stop an antidepressant develop withdrawal symptoms, such as sensory disturbances and brain fog. This syndrome is recognized by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Antidepressant drugs with a longer half-life are less likely to cause severe symptoms than those with a shorter half-life. (Half-life is the time it takes for the amount of medication still in your body to go down by half.)
What are the symptoms of antidepressant withdrawal?
Antidepressant withdrawal symptoms include nausea, brain fog, “brain zaps” (electric jolt sensations), insomnia, and irritability. It can be difficult to recognize antidepressant discontinuation syndrome because the symptoms are often vague and can mimic a relapse of a depressive or anxiety disorder.
Is SSRI/SNRI withdrawal permanent? How long does it last?
Selective serotonin reuptake inhibitor (SSRI) discontinuation symptoms typically last a few days to weeks, but they can last as long as several months. The same is true for symptoms caused by serotonin norepinephrine reuptake inhibitors.
What can you do about SSRI/SNRI withdrawal?
The best way to prevent withdrawal is to taper off the medication—that is, to slowly reduce the amount taken. This can take several weeks to months, depending on the strength of the medication and the dosage one takes.
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