Depression is a difficult and sometimes even life-threatening disorder. For many people with depression, antidepressant medication makes a dramatic improvement in the quality of life. These medications are powerful in other ways, too. If you don't take them according to your doctor's instructions, you may experience 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 'withdrawal effect.' 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 addictive. People who are on them don't engage in drug-seeking behaviors.
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 neural natural 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.
Recognizing the symptoms of discontinuation syndrome can make your life much 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 simply start taking them again, at least until you talk to your doctor.
It's easy to remember the main symptoms of this disorder. Doctors use the mnemonic FINISH' device to help you remember each type of symptoms you might have.
You might have symptoms you'd normally associate with having the flu. These can include a headache, lethargy, diarrhea, and appetite disturbances.
Sleep disturbances like insomnia tend to go with the territory when you stop taking medications too abruptly. You might have trouble sleeping or be woken up often by nightmares.
Nausea is bad enough, but you might also have related 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 ready to fall or collapse. Movement problems can include akathisia (a feeling of agitation and restlessness), twitches, jerks, tremor, or Parkinsonian movements.
Sensory disturbances typical with discontinuation syndrome include blurred vision, nerve feelings like your being shocked with electricity, numbness, and paresthesia, which is that pins and needles feeling that comes with pressure on a nerve.
Hyperarousal is extreme alertness. When this happens, you feel every sensation as if it was multiplied many times. You may experience unusual emotions, such as agitation, irritability, anxiety, or sadness.
In extreme cases, you could experience severe symptoms. These are rare, but extremely 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 different symptoms than someone else or than another time when you discontinued a different antidepressant. For example, SSRI discontinuation syndrome symptoms are dizziness, gastrointestinal upset, lethargy, anxiety, low mood, sleep problems, and headaches.
Discontinuation syndrome, when it happens, 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, which can be a long time to struggle with these feelings.
Length Of Treatment Time
Whether you'll have discontinuation syndrome and whether it will be mild or severe depends partly on how long you've been taking the antidepressant. It doesn't usually happen unless you've been on the medication at least six weeks before you discontinue it. If you've been on it for many months or even years, your chances of having severe symptoms are increased.
Abruptly stopping a medication with a short half-life is more likely to result in symptoms. So, what is a drug's half-life? 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 is 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.
If you've been taking a high dose of an antidepressant, you're 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, chances are you see some need for it. And, when you first start out, 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 much about it. You may wonder why, when you chose to take the antidepressant in the first place, you would decide to stop taking it suddenly. It can happen in a couple of different ways and for many reasons.
You might go along fine, taking your medications as directed. One day, you forget to take your antidepressant. One day can turn into several, and the medication can get completely out of your system, causing discontinuation symptoms. This often happens when you're taking several medications and take them each day directly from their bottles.
Lack Of Medication
Discontinuation syndrome may happen simply because you don't have the medication when you need it. If you have sudden financial problems or you may just as 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 it up, you are in a bad position if they suddenly can't or won't take care of it.
At some point, you might decide not to take the medication anymore. Maybe it's done its job wonderfully. You're no longer depressed, so you don't feel the need to keep taking the medication. Or, you might not like taking the medication because doing so makes you feel like you aren't normal. Sometimes antidepressants can cause you to shift into mania if you have bipolar disorder. You may stop the medication in a desperate attempt to regain control.
How Dangerous Is Discontinuation Syndrome?
For most people, discontinuation syndrome isn't dangerous at all. It's certainly uncomfortable. If you don't know what's going on, it can be alarming. But, it rarely causes any problems you can't live with for the couple of weeks it takes for the syndrome to fade away.ost people, discontinuation syndrome isn't dangerous at all. It's certainly uncomfortable. If you don't know what's going on, it can be alarming. But, it rarely causes any problems you can't live with for the couple of weeks it takes for the syndrome to fade away.
There are very rare instances when severe symptoms can happen because of the physical effect of stopping the medication. Also, you may relapse and become depressed again. If that happens, the original disorder (such as depression) may cause problems.
What To Do About Discontinuation Syndrome
The first thing to remember if you suspect you have antidepressant discontinuation syndrome is not to panic. You can deal with this, and your doctor is there to help. The most common symptoms are mild. In most cases, it will pass within a week or two without you doing anything about it.
Still, you can improve your situation in two ways: by starting the medication again and by seeing your doctor.
Start Taking Medication Again
Unless you have shifted into the manic phase of bipolar disorder, you may be able to put an end to the discontinuation symptoms without much help. Simply start taking the medications again as directed. This is usually the best course of action if you've only missed a few days or less. Then, when you see your doctor again, 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 suffering from discontinuation syndrome symptoms, it's best to talk to your American family physician to find out if you need to be seen immediately. You'll need your doctor's help in some cases, especially if you have severe symptoms or want to stop the symptoms of discontinuation syndrome faster.
Seeing your doctor is doubly 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 and a re-diagnosis might be required with the assistance of the Diagnostic and Statistical Manual of Mental Disorders. If restarting the med doesn't help, you'll need your doctor's recommendations on what to do next, which can involve reaching out to a mental health professional who is very familiar with the Diagnostic and Statistical Manual.
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 can start by getting a pill box that has different compartments for each day of the week. Fill it every week and take it from the designated compartment each day. If you're unsure whether you've taken it, just 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
Through patient education, you can 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 any case, having a frank discussion with your doctor can help you prevent problems now and in the future.
Talk To A Counselor To Resolve Your Mental Health Issues
Medication isn't always the best answer, and it's rarely the total solution for mental disorders. In most instances, therapy can improve your success with antidepressants. What's more, a therapist can help you understand the risks of stopping medications abruptly and the rewards of taking care of your mental health issues.
Below are some commonly asked questions on this topic:
What does discontinuation syndrome feel like?
Antidepressant discontinuation syndrome can have features that resemble flu like symptoms, which is characteristic of many drug withdrawal symptoms. However, while people experience nausea, feel fatigued, and encounter 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. (i.e, sight and hearing problems)
Is discontinuation syndrome fatal?
Although some of the withdrawal symptoms associated with antidepressant discontinuation syndrome, like nausea, might not sound severe at first glance to some people, the adverse reactions can be dangerous and even life threatening, due to suicidal ideation being a significant risk factor. They are by no means exclusive to rare cases.
Another potentially dangerous condition that’s essentially the opposite of antidepressant discontinuation syndromes, is serotonin syndrome. This is a concern that happens when people build up too much serotonin in their bodies from the overuse of SSRIs. However, to recover from serotonin syndrome, people will initiate antidepressant discontinuation under the guidance of a professional to help manage these short term withdrawal symptoms.
How do you fix discontinuation syndrome?
Antidepressant discontinuation syndrome treatment usually involves finding ways to cope with the uncomfortable symptoms of antidepressant withdrawal. While it may feel extremely challenging, due to the flu like symptoms, getting exercise and incorporating a healthy diet can be helpful in allowing the withdrawal syndrome to subside easier. According to the J. Clin. Psychiatry systematic review, there aren’t any specific guidelines in the management of antidepressant discontinuation, so these strategies are currently the best ways to find relief.
What is the difference between withdrawal and discontinuation syndrome?
Antidepressant discontinuation syndromes and antidepressant withdrawal reactions are essentially synonymous with each other. Symptoms occur when an individual suddenly stops using an antidepressant treatment such as selective serotonin reuptake inhibitors (SSRI) or serotonin norepinephrine reuptake inhibitors (SNRI)
These are psychotropic drugs involved in the psychiatric treatment of several different mental disorders, including, depression, anxiety, and panic disorder, and like any other drugs, withdrawal syndrome is always a likely possibility. These are potent medications that can alter your brain chemistry and the way you think and feel and regulate mood, and therefore, selective serotonin reuptake inhibitor discontinuation should be taken as seriously as any form of drug withdrawal.
The primary difference between antidepressant discontinuation and the term withdrawal as it relates to substances like alcohol, tobacco, or narcotics, is that people trying to wean off antidepressants don’t usually crave or exhibit drug seeking behavior from their discontinuation
Does your brain go back to normal after stopping antidepressants?
For many people, antidepressants like selective serotonin reuptake inhibitors aren’t something they want to take for the rest of their lives, and after successful treatment, they may decide to stop.
Instead of stopping treatment, ending use abruptly and cold turkey, and increasing the risk of selective serotonin reuptake inhibitor discontinuation symptoms, people are instructed to partake in gradual tapering off with the guidance of their doctor or psychiatrist who prescribed the medication.
Eventually, the brain does readjust and go back to normal, and people can do what they can to minimize or avoid antidepressant discontinuation syndrome. With that in mind, according to the Canadian Medical Association Journal, approximately 20 percent of people will experience symptoms when ending antidepressant use even when reducing the dose.
How long does it take to feel normal after stopping antidepressants?
Not all antidepressants are created equal, and case reports show that some may have a short half-life whereas others can have a longer half life, which is the rate in which it leaves the body.
Naturally, those with the longer half life can extend the time it takes to feel normal but it can make the withdrawal syndrome feel more manageable. Medications with short half-lives will leave the body quicker, but symptoms can feel harsher when ending 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 each person and prescription drug is different.
What is the hardest SSRI to come off of?
As mentioned in the previous question, the hardest selective serotonin reuptake inhibitors tend to be the ones with the shorter half-lives due to having the potential to have stronger withdrawal symptoms.
Some commonly prescribed SSRIs that have a short half-life and can increase the risk of selective serotonin reuptake inhibitor 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 usually help with brain fog, there are situations where it can cause it, including when going through antidepressant discontinuation syndrome. Like other symptoms, people can generally expect this one to go away within a few weeks of ending antidepressant therapy.
What does brain zap feel like?
Brain zaps are a common symptom of antidepressant withdrawal syndrome and are best described as a sudden jolt or electric shock in the brain but it can also extend to other parts of the body in the form of shivers and tremors. The shock-like sensations can be very startling and disruptive. In addition to antidepressants, brain zaps can also be affiliated with addictive behaviors related to alcohol abuse.
Why does discontinuation syndrome happen?
Antidepressant discontinuation syndrome happens because the body has become accustomed to the use of antidepressants and their effects during the course of treatment, and so, stopping its use creates adverse effects because the body is experiencing withdrawal symptoms.