Withdrawal from Psychiatric Meds Can Be Painful, LengthyAlthough this will not come as news to anyone who’s been on any one of the most common psychiatric medications prescribed — such as Celexa, Lexapro, Cymbalta, Prozac, Xanax, Paxil, Effexor, etc. — getting off of a psychiatric medication can be hard. Really hard.

Much harder than most physicians and many psychiatrists are willing to admit.

That’s because most physicians — including psychiatrists — have not had first-hand experience in withdrawing from a psychiatric drug. All they know is what the research says, and what they hear from their other patients.

While the research literature is full of studies looking at the withdrawal effects of tobacco, caffeine, stimulants, and illicit drugs, there are comparatively fewer studies that examine the withdrawal effects of psychiatric drugs. Here’s what we know…

28 Comments to
Withdrawal from Psychiatric Meds Can Be Painful, Lengthy

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  1. Oh, the rage against meds and psychiatrists… Let’s wipe cancer tratments also. You know, they have enormously bad adverse effects. Less animosity could have been nice.

  2. As a possibly misdiagnosed bipolar patient who ended up on 6 drugs (but I certainly had depression at one time), I think the problem is horribly under-addressed, even in your article. How would someone find a specialist in withdrawing drugs? How can we find solutions apart from reinstating the drug(s)?

  3. I was put on klonopin 22 years ago to treat RLS that interrupted sleep, but were not severe. In 2010 I decided it was time to go off.. the RLS had probably stopped. Well, they had, but getting off was not so easy. I had one of the better taper experiences and it’s taken me now 30 mos., with 2 to go. My story is not extreme, and had I any idea, I would not have started taking them.. Sinemet was a choice and I had not idea when the Doc asked my preference. I’ve been helping other people come off benzos and can assure you there are few doctors who understand how difficult tapering can be. Please read further. I am also a therapist and thinking of attending your June seminar in MA.

  4. Thanks for such a pointed and incisive article. What was left unsaid, of course, is the obvious reverse conclusion that psychotropics can cause addiction and/or dependency.

    If psychiatrists have known of this fact ever since the introduction of Prozac in 1987, why haven’t they told patients? Instead, all we have heard is their parroting of the pharma line that only benzos are difficult to withdraw from and even then it’s not so bad.

    Yet another black eye for a profession that cannot even lay claim to good “management” of symptoms.

  5. If “the syndrome usually resolves in days or weeks, even if untreated”, I’d probably just leave it untreated and let it go away. Only if it were interfering with someone’s life would I want to intervene.

    My personal experience with SSRI-discontinuation syndrome was that it was at most, just annoying. It was nothing I wouldn’t have been able to live with. And then, it was gone.

  6. one more day on those drugs and i would have been dead. but so glad to make money for those crooks.
    thanks for the shortened life.

  7. Dr. Grohol, thank you for bringing this to the attention of Psych Central readers.

    In the recursive echo chamber that is psychiatric research, psychiatry has published many articles emphasizing that withdrawal symptoms are mild and last only a few weeks. This includes Kotzalidis, 2007 quoted above.

    (These papers also obtusely imply that withdrawal symptom patterns are idiosyncratic, rather identifying them as autonomic destabilization.)

    One of Kotzalidis, 2007′s central sources is researcher Peter Haddad, who is cited in almost all antidepressant withdrawal studies.

    In a 2001 paper, Dr. Haddad wrote: “Most reactions are mild and short-lived and require no treatment other than patient reassurance. Severe cases can be treated symptomatically or the antidepressant can be reinstated before being gradually withdrawn. Reinstatement usually leads to symptom resolution within 24 hours. Some individuals require very conservative tapering schedules to prevent the re-emergence of symptoms.”

    Author or co-author of many papers about antidepressant withdrawal, Dr. Haddad is always careful to say “usually” or “most” when it comes to sunny predictions about how long withdrawal syndrome takes to resolve, because he knows there are cases where it takes many months or even years to resolve.

    Those reports of severe antidepressant withdrawal syndrome are unpublished and have been buried by the pharmaceutical companies, but researchers such as Haddad, Alan Schatzberg, and Richard Shelton are well aware of them.

    Haddad goes on to say: “Discontinuation symptoms have received little systematic study with the result that most of the recommendations made here are based on anecdotal data or expert opinion. Research is needed to provide a firm evidence base for future recommendations.”

    The “expert opinion” comes from U.S. committees underwritten in 1997 by Lilly (manufacturer of Prozac) and 2006 by Wyeth (manufacturer of Effexor). (Schatzberg and Haddad served on both committees.)

    “Expert opinion” about withdrawal syndrome, then, is molded, if not dictated, by commercial interests.

    In short, whatever medicine knows about antidepressant withdrawal syndrome is based on anecdotes collected by a few researchers, recycled throughout the entire body of literature on the subject. This reflects the doctors’ opinions (possibly influenced by pharma consulting contracts), not the experience of patients.

    If you want to see patient experiences, hundreds of thousands of posts all over the Web report withdrawal syndrome lasting many months or years.

    I’m still recovering from my own withdrawal from Paxil in October 2004.

    On my peer support web site for tapering and withdrawal syndrome, SurvivingAntidepressants.org, there are many reports of prolonged withdrawal syndrome, as well as many more about difficulty in tapering. (Case histories may be read here http://tinyurl.com/3o4k3j5 )

    What’s emerged is that, at the risk of destabilizing their nervous systems, some people need very gradual tapering taking months or years to go off psychiatric medications.

    If only people could find “a specialist who focuses on helping people discontinue psychiatric drugs”! I know of only a few such knowledgeable practitioners in the entire world. (I’m always looking for doctors who understand tapering to refer people to, if you know of such, please contact me through SurvivingAntidepressants.org.)

    Every doctor who prescribes psychiatric medication should be well-versed in tapering techniques. Few know anything. (Do NOT skip doses to taper!!!!) This is a disgrace to all of medicine.

  8. You have to wonder why physicians forget the basic mantra that is the basis of medicine: to go from least to most invasive.

    Why psychiatrists allowed managed care to eviscerate us in denying our rights to be therapists is Chamberlain-esque as an analogy. To embrace the failed premise of biochemical imbalance is the slow death of ingesting trace amounts of arsenic every few days these past 2 decades.

    But, the lie has been perverted so the public knows nothing else but pills give skills. And we are a culture of dependency, it is just so pervasive, people can’t differentiate what is appropriate versus disruptive. Hence the leadership we have in the political groups across this country!

  9. Sounds like another psychologist who hasn’t had the medical training nor experience to “know” what we psychiatrists know. I hope the writer of this article isn’t generalizing when he assumes that patients’ are the “guinea pigs” of psychiatrists. This is a notion that invokes anger in me as a psychiatrist. When a primary care physician changes to a different antihypertensive or diabetic medication, is it assumed that the patient is a guinea pig in this instance? I doubt it! This type of physician is assumed to simply be doing what’s best for the patient. Personally, I try to “know” my patient beyond simply picking a psychotropic drug out of the proverbial hat. I’ve actually seen over years of training how difficult the withdraw symptoms can be and for the writer of the article to assume that we base our knowledge only on research is just that…an ASSUMPTION! The balance of research, training, education, and EXPERIENCE all culminate into choosing the best options for our patients. I really do wish psychologists and the like would make better attempts and not overgeneralizing!!!

    • Sounds like another psychiatrist or doctor who hasn’t had the personal experience of actually ever having to have gone to one of his profession and be given an antidepressant medication with no mention of withdrawal symptoms made. And another psychiatrist or doctor who dismisses legitimate concerns over how psychiatric meds are commonly prescribed today.

      As the psychiatrist knows, I’m sure, most antidepressants are prescribed by general practitioners — not psychiatrists. Do you think they go into a detailed explanation of withdrawal effects of these drugs every time they write a prescription?

      And while I think it’s great you take time to get to “know” your patients before prescribing a medication to them, the fact (and science) remains that there is no data supporting your choosing Med A over Med B — unless they have a pre-existing or other medical condition. There’s no laboratory or other test you can look at that tells you Med A is going to work better than Med B in Random Patient M. Zero.

      I’m glad there are good psychiatrists like you out there, but for most people, it’s pot luck to be able to find someone like you.

      • Dr. Grohol,

        Not yet another assumption! Why would you assume that I’ve never had the experience of going to a doctor/psychiatrist who didn’t take the time to explain potential side effects?! Wow!!! Doctors are people too as you know and we unfortunately sometimes encounter the types of physicians you describe in your article. And you are also very wrong in assuming that I’m yet another physician who “dismisses” how psychotropic meds are commonly prescribed today. I must tell you that it frustrates me to the core when I ask a new patient if their last physician covered certain side effects (especially potentially life threatening ones) and they tell me no. One woman was prescribed Valproic Acid and she was of childbearing age and I could tell by the look of surprise on her face that no one had covered the potential risks of anticonvulsants on a developing fetus! So I’m with you on this! And primary care physicians simply don’t have the time in a typical day to cover all this. Oh, and by the way, psychiatrists ARE doctors (we certainly went to medical school and have the loans, 36-hour calls to prove it). Not sure why there is still confusion about this. But I digress…I am in total agreement with you that it is “pot luck” for most people to find a psychiatrist such as myself. I wish everyone could find someone with the careful oversight/conscientiousness that I try to put forth on a daily basis. I hope that after our friendly correspondence that you at least no longer include myself in the general population of psychiatrists whom you’ve formed preconceived notions about….until later!

      • My apologies for the generalizations; you’re apparently one of the good ones. I suspect if most psychiatrists followed your footsteps (and that of other great psychiatrists I know and value), psychiatry as a profession would be more respected.

        Just like finding a good therapist or a good psychologist, finding a good psychiatrist can often be a frustrating exercise. I wish there was a better way.

    • If you know how to taper people off psychiatric drugs so as to minimize withdrawal symptoms, please contact me at SurvivingAntidepressants.org

      Case histories here http://tinyurl.com/3o4k3j5
      About withdrawal syndrome here http://survivingantidepressants.org/index.php?/forum/16-from-journals-and-scientific-sources/
      About tapering techniques here http://survivingantidepressants.org/index.php?/forum/14-tapering/

    • From my personal experience, and that of these people at http://bit.ly/jAjLKr , finding a good psychiatrist is very difficult — maybe 1 in 50.

      Even among psychiatrists, gross overmedication is common.

      Finding a psychiatrist or any prescriber who knows how to taper people off psychiatric medications to minimize withdrawal symptoms is even harder.

      If you are a prescriber who is conversant with tapering methods, please contact me at SurvivingAntidepressants.org for local referrals and save lives.

    • Lep, how well do you “know” our patients? How long are your appointments and med checks? How often do you see them?

      What advice do you give folks for tapering? (For example, by what percentage of dose should they taper? How long between drops?) How do you handle folks who experience poopout? DO you prescribe a slow taper for them or do you do quick switches from one antidepressant to another? Do you prescribe anti-psychotics to people on anti-depressants to help boost the effects of the ADS?
      How many of your patients, whom you know well, are on multiple psych meds? How many of them are are more psych drugs now than they were five years ago?

      Until you mention concrete examples of how you treat the people who are taking the drugs (aside from mentioning side effects), you don’t sound so different from the psychiatrist who mistook Paxil poopout for breakthrough symptoms of anxiety, then prescribed antipsychotics to combat the uncontrollable crying jags and irritability. Fast forward five years after quick switch to celexa, repeat, rinse…

      You need to describe what you do for folks on the drugs for a while, before putting yourself up for canonization for mentioning side effects.

  10. I’ve just started tapering from SSRI after 10 years. Yes, my doctor said take a pill every other day. He also said benzodiazepines would not be difficult to stop (wrong), so I knew to look for second and third opinions and personal experience wherever I can find it.

    Thanks the sensible discussion about this. Looking forward to more.

  11. Thanks for the post and ongoing discussion. My comment is quite simple. I was recently advised by my psychiatrist to quit taking my Effexor XR (37.5mg) cold turkey since the side effects of withdrawal wouldn’t be worse than the side effects it was causing me while taking it. The withdrawal was a living HELL!!! I have not started on a new anti-d yet. I have been on more than fifteen different medications and combos of medications that have not worked. At this point, I am not sure which scares me more – the depression or the thought of trying one more medication!! Just to reassure everyone, yes I am seeing my therapist. I can’t get in to see my psychiatrist for another 6 weeks due to her schedule. I am thinking about a change in doctors, not because I don’t think mine is trying her hardest to help, but I need someone who is more available during times like this.

    • Norelle, if I were you, after all that trial and error I might conclude that perhaps psychiatric medications are not for me.

      After you’ve experienced a severe withdrawal reaction or other adverse reaction, often they work differently, too. They are powerful drugs and your nervous system can become sensitized to them.

      It can take a long time for your nervous system to settle down from an adverse reaction like severe withdrawal or history of adverse reactions. What you’re experiencing now might be iatrogenic — drug-caused — rather than a psychiatric disorder.

  12. In the course of my work with those coming off psych meds I’ve learned that there are few people, even among critics of psychiatry that have a clue at the potential severity of psychiatric drug withdrawal syndromes. That also means there are virtually no professionals that can offer meaningful support when people encounter serious issues. We remain dependent on each other.

    Other than those who’ve directly experienced protracted withdrawal or those who have lived with those who have experienced it, it simply remains under appreciated and therefore under treated and under recognized even, as I said, among critics of psychiatry. It’s rather horrifying for those of us who find ourselves struck by such illness. While perhaps a minority, we are not an insignificant minority. I alone have had contact with 1000s of us.

    The other thing to consider is that we are perhaps not even a minority because the fact is so many issues with withdrawal are not recognized at all and are instead considered and then treated as the “underlying illness,” many folks simply get sicker and sicker on meds and never even know why they’re ill. Those people never come to understand that all the multiple trials of drugs and the numerous times of coming off and on them has actually been the cause of their illness.

    Generally, prolonged withdrawal syndrome is not recognized by medicine. You will find very few doctors to diagnose it and still fewer to treat it. I found that being well-educated and finding doctors who respected how much effort I put into educating myself helped me. It must be said, though, that it is also a curse because for every doctor who appreciates a knowledgable patient there are likely 15 or 20 or maybe even more who feel threatened by that same patient. Still, it is a plus to know what we are doing.

    I hope this perilous situation changes as people learn from one another. For now far too many people are not in a position to get appropriate care or know how to properly educate themselves.

  13. Dr. Grohol, I too thank you for writing a blog entry on psych med withdrawal as in my opinion, it is a vastly ignored issue.

    As an FYI, I took nearly 4 years to taper off of 4 psych meds which was done with the help of the slow tapering advice from internet withdrawal boards. In my opinion, if I had depended on the advice of my psychiatrist, it would have been done way too quickly and there is no doubt in my mind I would have failed. I would have ended up having to go back on the drugs to cover withdrawal issues that I am sure would have been falsely blamed as a relapse.

    You go on to say, “In some extreme cases, a specialist who focuses on helping people discontinue psychiatric drugs might prove helpful.” Dr. Grohol, I know you mean well with this advice but the chances of that happening are as great a the NRA and Mark Kelley/Gabrielle Giffords agreeing on gun control issues.

    These people simply do not generally exist with the exception of the folks who appear on the Surviving Antidepressants board tapering list. And if you think you have found someone, they will seem like they know what they are doing until suggesting that you take another horrific med to cover the withdrawal effects of the first one, thus perpetuating the viscous cycle of being in what I call psych med “h-ll”,

    You then say, “I wouldn’t let the problems with withdrawing from some of these medications prevent me from taking the drug in the first place.”

    Personally, as one who did not have an easy time with withdrawal, even with a slow tapering schedule, in my opinion, that is the first thing you should think about and I wish to god I had. Knowing how ineffective antidepressants are long term and realizing I had plenty of non drug options would have made me realize the risks outweighed the benefits. In my opinion, unless a med will provide super benefits regarding your quality of life and in my opinion, most psych meds fail that criteria big time, I would ran as fast as I could from a doctor who wanted to prescribe them.

    The days of treating mental health problems with just meds without offering other options and yes that includes issues like schizophrenia need to end. Peoples lives depend on it.

    • I couldn’t agree more with these particular comments, and a special kudo to DocJohn for writing this article. It’s a very important issue for so many, myself included. However, it’s clearly complicated. Have had great treatments, docs, therapists, meds over the years, and some, not so much at all. This comes from sixty years of life struggling with many mental health issues, seeing family, friends, struggle, and others in some previous teaching jobs I’ve had, working with special needs folks. We must keep trying to improve!

  14. Hello,
    Thank you for taking the time to write this article.
    Yet, I would like to state that the heart of this social problem is not a lack of research about withdrawal, rather it stems from a dominant narrative about what should be done to treat those in psychic pain.
    Psychiatric drugs are the first line of treatment in many cases and are administered to people suffering by diagnosing them with a simplistic tool known as the DSM.
    I feel this needs to change. Not just in psychiatry, in the larger medical community and beyond.
    “Fixing” underlying symptoms with drugs appears to work at first, of course! Many of us suffer from a lack of sleep, racing thoughts, anxiety, and the medication (over a few days) brings these emotions down to a tolerable level.
    However, at this time, when the complex human experience has been tamed, perhaps it is time to administer care, empathy, sympathy, love.
    Perhaps this sounds silly? But I think not. Grief and trauma can be healed through thinking differently, talking, hugs, love, trust, unconditional positive regard..in my experience.
    Long term use of psychiatric medication hurts those suffering from trauma on more than one level. It hurts their bodies, and it hurts their self esteem because they are stigmatized and are in a dependent situation with their doctors and may feel that hope has been lost.
    Maybe I’m a radical, but I think it’s time for a new story. A story that tells those suffering that they can and they will get better. And that medication is helpful for symptoms, yet wellness is in the hands of the patient. Offer options, offer help, offer love.
    We are dealing with trauma and we need empowerment.
    Thanks!
    Take Care.

  15. I certainly am one of those you speak of who suffered a severe withdrawal syndrome. And, nearly three years after stopping prozac, have still to regain ANY emotion, still have memory and concentration problems, taste, smell and hearing problems. Thankfully my severe physical and psychological symptoms have abated but those first few years were all about survival and I would never wish the experience on anyone. There should be warnings about the possibilities of withdrawal when you are introduced to these medications. I was not prepared for what would happen after discontinuing this drug. The experience is in a realm of its own.

  16. I wont bore you all with my story, suffice it to say I no longer take any antidepressants, benzos or z dtugs.
    I now firmly believe in what Dr Hirsch (Harvard) said on 60 Minutes – that Ads are only a fraction better at relieving depression than a placebo.I will never put myself in harms way agin, nor will I ever trust another psychitrist. My former doctor had me on all the above meds for over 12 years, then closed his practice and left me hanging. That was monthes ago, and I have never felt more ill. This doctor knew what happened, yet never even bothered to call me. Im done.

  17. I’m collecting cases of withdrawal syndrome at SurvivingAntidepressants.org Register and start a topic to tell your story in the Introductions forum.

    These case histories are to document the problem, educate physicians, and track progress as people recover — which most do, eventually, though it can take years.

  18. Doctor many of the anti-medication posters here are zealots involved in what has been called a cult that attacks medical science. This group believe in conspiracy theories involving Big Pharma and psychiatry (like Scientology).

    Word to the wise.

  19. Doctors dunno anything abt getting through withdraw, i be try ed detox and everything there is to find to get through this stuff …. but its all about if do wanna stop… i m in my day 6 and felling horrible ,, i hate Denmark and the treatments here

  20. Weeks and months? Are they kidding? Im suffering for almost 3 years now from protracted withdrawal symptoms. IT IS HELL. There is just no other way to heal the mind… you must do it naturally…be with nutrition and peers/family help. My withdrawal was horrendous…from having out of this world thoughts that are penetrating your head up to having an ulcer for 1 whole year! And having muscle contractions inside your body where you dont know where its coming from…. Geeze… if I only knew I could heal my mental illness by eating a lot of greens with food (cabbage, brocillis and lettuce) and doing excercise, sunlight walks and revisiting my Catholic faith… I would not have taken those dangerous and uneccessary drugs.

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