What Is Discontinuation Syndrome And What Should I Do About It?

Updated December 21, 2022by BetterHelp Editorial Team

Learn About Discontinuation Syndrome

While depression can be a challenging mental health disorder, some medications can lead to significant improvement. However, if you don't take them according to your doctor's instructions, you may experience something called discontinuation syndrome.

What Is Antidepressant Discontinuation Syndrome?

Discontinuation syndrome is a physical reaction to stopping an antidepressant medication abruptly. This syndrome can cause changes in your body and brain that cause you to feel unwell physically and mentally. Doctors typically take you off an antidepressant gradually to avoid or minimize discontinuation syndrome.

Is Discontinuation Syndrome The Same As Withdrawal?

In the past, discontinuation syndrome was referred to as the withdrawal effect. To some, this gave the idea that antidepressants were harmful drugs. More recently, the term discontinuation syndrome has come into use.

The reason for the change is that what happens is different from the withdrawal effect you have from an addictive drug. Antidepressants aren't usually considered addictive. People who are on them don't tend to engage in drug-seeking behaviors to get more of them.

What happens with discontinuation syndrome is that the brain doesn't have the medication it's accustomed to having to help perform its normal function in mood control. When the medication is no longer there, the natural neural processes must take over the job completely. This can happen gradually and relatively painlessly when your doctor tapers down the dose, or it can happen abruptly, which causes the symptoms of discontinuation syndrome.

Symptoms Of Discontinuation Syndrome

Recognizing the symptoms of discontinuation syndrome may make your recovery easier. When you know what's happening, you can get help from your doctor. If you suspect it's happening, you can check your medications to make sure you've taken them as prescribed. If not, you can call your doctor immediately to ask if you should resume taking your antidepressants.

There are five main symptoms of this disorder. Doctors use the mnemonic device FINISH to help you remember each type of symptom you might have.

Flu-Like Symptoms

You might have symptoms you'd normally associate with having the flu. These can include a headache, lethargy, diarrhea, and appetite disturbances.

Insomnia

Sleep disturbances like insomnia may arise when you stop taking medications too abruptly. You might have trouble sleeping or be woken up by nightmares.

Nausea

You might also experience nausea and related gastrointestinal symptoms, such as abdominal cramping, abdominal pain, and vomiting.

Imbalance And Movement Problems

Balance issues may occur, depending on the type of antidepressant. Dizziness, lightheadedness, and vertigo may cause you to feel unstable and susceptible to falling or collapsing. Movement problems can include akathisia (a feeling of agitation and restlessness), twitches, jerks, tremors, or Parkinsonian movements.

Sensory Disturbances

Sensory disturbances typical with discontinuation syndrome include blurred vision, nerve feelings like you’re being shocked with electricity, numbness, and paresthesia, which is that pins-and-needles feeling that comes with pressure on a nerve.

Hyperarousal

Hyperarousal is extreme alertness. When this happens, you may feel every sensation as if it were multiplied many times. You may experience unusual emotions, such as agitation, irritability, anxiety, or sadness.

Other Symptoms

In extreme cases, you could experience severe symptoms. These are rare but important to address immediately. They include psychosis, catatonia, delirium, delusions, and hallucinations. As discontinuation syndrome symptoms, these are sometimes but rarely seen with MAOI antidepressants.

Symptoms Tend To Differ With Different Medications

Depending on the antidepressant you've been taking, you may experience symptoms that are different from those another person experiences or different from those you experienced when you discontinued a different antidepressant. For example, discontinuation syndrome symptoms after stopping selective serotonin reuptake inhibitors (SSRIs) may include dizziness, gastrointestinal discomfort, lethargy, anxiety, low mood, sleep problems, and headaches.

Learn About Discontinuation Syndrome

When Does Discontinuation Syndrome Happen?

When it arises, discontinuation syndrome usually happens within three days after you stop your medication abruptly. Sometimes, it can happen within hours of the first missed dose. The symptom usually runs its course in one to two weeks. With some medications, the timeline is about two to four days. However, in extreme cases, symptoms may last up to one month or longer.

Length Of Treatment Time

Whether you'll have discontinuation syndrome and whether it will be mild or severe may depend partly on how long you've been taking the antidepressant. It doesn't tend to happen unless you've been on a medication for at least six weeks before you discontinue it. If you've been on it for many months or even years, your chances of having symptoms are increased.

Medication's Half-Life

Abruptly stopping a medication with a short half-life may be more likely to result in symptoms. The half-life is the amount of time it takes for the amount of the drug in the body to be reduced by one-half.

For example, Zoloft discontinuation syndrome may be less likely than Cymbalta discontinuation syndrome in this regard, because Zoloft has a half-life of 26 hours, while Cymbalta has a half-life of only 11-16 hours.

Dosage

If you've been taking a high dose of an antidepressant, you may be more likely to have discontinuation syndrome than if you've been taking a low dose.

Why Would I Stop Taking My Antidepressant?

If you've just started taking an antidepressant, it may be easy to remember to take it because it's something new and not something you're so used to that you don't think about it much. You may wonder why, when someone chose to take an antidepressant in the first place, they would decide to stop taking it suddenly. It can happen in a couple of different ways and for many reasons.

Accidental Discontinuation

At first, you might go along fine, taking your medications as directed. Suppose that one day, you forget to take your antidepressant. That one day can turn into several, and the medication can get completely out of your system, causing discontinuation symptoms. This may happen if you're taking several medications and take them each day directly from their bottles instead of from a daily bill organizer.

Lack Of Medication

Discontinuation syndrome may happen simply because you don't have the medication when you need it. This can happen if you have sudden financial problems or you suddenly run out of medication. You may run out for other reasons, too. For example, if you don't drive and someone else usually picks up the medication, you may run out if they suddenly can't or won't take care of it.

Purposeful Discontinuation

At some point, you might decide not to take the medication anymore. Maybe it has done its job wonderfully and you no longer feel depressed, so you don't feel the need to keep taking the medication. Alternatively, you might not like taking the medication because of some of the side effects. For example, sometimes antidepressants can cause a person to shift into mania if they have bipolar disorder. They may stop the medication in an attempt to regain control.

How Dangerous Is Discontinuation Syndrome?

For most people, discontinuation syndrome doesn’t tend to present serious danger. It can be uncomfortable, and if you don't know what's going on, it can be alarming. However, it rarely causes any problems you can't manage for the couple of weeks it takes for the syndrome to fade away.

There are rare instances when severe symptoms can happen because of the physical effects of stopping a medication. Also, you may relapse and experience depression again. If that happens, the original disorder (such as depression) may cause problems.

What To Do About Discontinuation Syndrome

If you suspect you have antidepressant discontinuation syndrome, your doctor or mental health care provider is there to help. The most common symptoms tend to be mild. In most cases, it passes within a week or two without you doing anything about it.

Still, you might improve your situation by contacting your healthcare provider to ask about resuming your medication.

Start Taking Medication Again

Unless you have shifted into the manic phase of bipolar disorder, you may be able to alleviate the discontinuation symptoms by taking the medication again as directed. This may be the best course of action if you've only missed a few days. Then, when you see your doctor again, you can let them know what happened and what you did about it.

See Your Doctor If You Recognize The Symptoms

When you realize you may be experiencing discontinuation syndrome, consider calling your healthcare provider to find out if you need to be seen immediately. You may need their help in some cases, especially if you have severe symptoms or want to stop the symptoms of discontinuation syndrome faster.

Seeing your doctor may be more important if you aren't sure it's discontinuation syndrome or if starting back on the antidepressant doesn't help. It may turn out that you have a different condition that has similar symptoms. 

Organize Yourself To Take Medications More Regularly

If you forget your medications often, it may be because you've never developed a system for making sure you take them. You might start by getting a pill box that has different compartments for each day of the week. You can fill it every week and take your medications from the designated compartment each day. If you're unsure whether you've taken it, you can check to see if the compartment is empty.

Another thing you can do to make sure you take your antidepressant is to set reminders. You can set a daily reminder on your smartphone, laptop, or tablet. Then, take the medication as soon as possible after the reminder tone sounds.

Talk To Your Doctor Before Discontinuing A Medication

Suppose you aren’t feeling well and suspect a medication may be the cause. In that case, you might prevent or minimize the effects of discontinuation syndrome by talking to your doctor before stopping an antidepressant. Your doctor can give you a specific schedule for reducing the medication gradually if you decide you aren't going to take it anymore. They can also let you know what to expect as you reduce your dosage. In some cases, they might strongly suggest that it isn't the best time to stop the medication. In other cases, they may recommend a different medication that suits you more.

Talk To A Counselor To Address Your Mental Health Concerns

Medication may not always the best answer, and it's rarely the total solution for mental health concerns. In many instances, therapy may improve your success with antidepressants. A therapist may also be able to help you understand the risks of stopping medications abruptly. 

You might try online therapy if you’re not feeling well enough to go to a therapist’s office. Research shows that online therapy is just as effective as in-person therapy, including for depression and anxiety. With BetterHelp, you can talk to a licensed therapist from the comfort of your home and message them via live chat in between sessions if you have any questions.

Takeaway

If you have questions about discontinuation syndrome or if you’re thinking about stopping your medication, know that you are not alone. A licensed therapist can help you navigate this process safely and effectively. Take the first step and contact BetterHelp today. 

FAQs

Below are some commonly asked questions on this topic:

What Does Discontinuation Syndrome Feel Like?

Antidepressant discontinuation syndrome can cause flu-like symptoms, which are characteristic of many drug withdrawal symptoms. However, while some people experience nausea, fatigue, lightheadedness, increased vulnerability to light, vertigo, and vivid dreams, people who have stopped abruptly can have withdrawal reactions like hyperarousal, trouble sleeping, and sensory disturbances (e.g., sight and hearing problems).

Is Discontinuation Syndrome Fatal?

Although some of the withdrawal symptoms associated with antidepressant discontinuation syndrome might not sound severe, the adverse reactions can be dangerous and even life threatening, due to suicidal ideation being a significant risk factor.

  • If you or a loved one is experiencing suicidal thoughts, reach out for help immediately. The 988 Suicide and Crisis Lifeline can be reached at 988 and is available 24/7.”

Another potentially dangerous condition is serotonin syndrome. This can happen when people build up too much serotonin in their bodies from the overuse of SSRIs. To recover from serotonin syndrome, people can initiate antidepressant discontinuation under the guidance of a professional to help manage the short-term withdrawal symptoms.

How Do You Fix Discontinuation Syndrome?

Treatment for antidepressant discontinuation syndrome usually involves talking to your healthcare provider to find ways to cope with the uncomfortable symptoms of antidepressant withdrawal. While it may be challenging, getting exercise and incorporating a healthy diet may be helpful in allowing the withdrawal syndrome to subside easier. 

What Is The Difference Between Withdrawal And Discontinuation Syndrome?

The primary difference between antidepressant discontinuation and the short-term withdrawal as it relates to substances like alcohol, tobacco, or narcotics is that people trying to wean off antidepressants don’t tend to crave or exhibit drug-seeking behavior from their discontinuation.

However, as with any other drugs, withdrawal syndrome may occur with antidepressants. These are psychotropic drugs involved in the psychiatric treatment of mental health disorders. They that can alter your brain chemistry and control mood and should only be discontinued under the guidance of a healthcare provider.

Antidepressant discontinuation syndrome may occur when an individual suddenly stops using an antidepressant treatment, such as selective serotonin reuptake inhibitors (SSRI) or serotonin norepinephrine reuptake inhibitors (SNRI).

Does Your Brain Go Back To Normal After Stopping Antidepressants?

For many people, antidepressants like SSRIs aren’t something they want to take for the rest of their lives, and after successful treatment, they may decide to stop.

According to the Canadian Medical Association Journal, approximately 20% of people experience symptoms when ending antidepressant use even when reducing the dose. However, the brain may eventually readjust and go back to its state prior to receiving the medication.

Instead of stopping treatment abruptly and increasing the risk of discontinuation symptoms, it may be best to talk to the provider who prescribed the medication to discuss how to gradually taper off the medication.

How Long Does It Take To Feel Normal After Stopping Antidepressants?

Not all antidepressants are created equally; some have a short half-life while others have a longer half-life, which is the rate at which a medication leaves the body.

Antidepressants with the longer half life can extend the time it takes for a person to feel normal. Medications with short half-lives tend to leave the body more quickly, but symptoms may feel harsher when you end treatment.

Nonetheless, some people start feeling better within a handful of days, whereas it can take a few weeks for other individuals. It varies on a case-by-case basis, since prescription drug is different, as is each person.

What Is The Hardest SSRI To Come Off Of?

As mentioned in the previous question, the hardest SSRIs to come off of tend to be the ones with the shorter half-lives due to having the potential for stronger withdrawal symptoms.

Some commonly prescribed SSRIs that have a short half-life and may increase the risk of discontinuation syndrome include duloxetine (Cymbalta), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa). In contrast, the safest antidepressant drug to come off of cold turkey is believed to be fluoxetine (Prozac) because of its reputation as a long-acting antidepressant and its long half-life.

Does Brain Fog From Antidepressants Go Away?

Although antidepressants may help with brain fog, there are situations where they can cause it, including when you’re going through antidepressant discontinuation syndrome. Like other symptoms, this may dissipate within a few weeks of ending antidepressant therapy.

What Does Brain Zap Feel Like?

Brain zaps can be a common symptom of antidepressant withdrawal syndrome and are perhaps best described as a sudden jolt or electric shock in the brain. However, they can also extend to other parts of the body in the form of shivers and tremors. The shock-like sensations can be startling and disruptive. In addition to antidepressants, addictive behaviors related to alcohol abuse may also lead to brain zaps.

Why Does Discontinuation Syndrome Happen?

Antidepressant discontinuation syndrome tends to happen because the body has become accustomed to the use of antidepressants and their effects. Stopping their use can create adverse effects because the body is experiencing withdrawal symptoms.

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