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When and How to End Antidepressant Treatment And Avoid Withdrawal Symptoms

Many experts are now recommending that individuals who have taken antidepressants for years should consider coming off the medication, if symptoms have been resolved. However, researchers warn that terminating this class of medication should happen gradually so as to reduce difficult and even dangerous withdrawal symptoms due to a physical dependence.

The new research suggests the best process is to follow a tapering schedule while consulting with a physician. Experts warn that stopping medication outright is almost never advisable.

The study, including withdrawal guidance, is found in The Journal of the American Osteopathic Association.

“I understand that many people feel safe in that their depression or anxiety is continuously managed by medication. However, these are mind-altering drugs and were never intended as a permanent solution,” said Mireille Rizkalla, Ph.D., Assistant Professor Midwestern University Chicago College of Osteopathic Medicine, and lead author on this research.

“Once the patient’s depression or anxiety has been resolved, the physician should guide them toward discontinuation, while providing non-pharmacologic treatments to help them maintain their mental health.”

Nevertheless, stopping a medication that someone has been taking for perhaps decades is never easy. Individuals often experience antidepressant discontinuation syndrome (ADS), which includes flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances often described as electric shocks or “brain zaps,” and hyperarousal.

Older, first-generation antidepressants (amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline), often come with additional risks for more severe symptoms, including aggressiveness, abnormal movement and behavior, cognitive impairment, and psychosis.

Discontinuing any antidepressant also carries a risk for gradual worsening or relapsing of depression and anxiety, as well as suicidal thoughts.

A recent report from the Centers for Disease Control (CDC) shared that a quarter of people taking antidepressants had been using them for a decade or more. Rizkalla believes this finding suggests that patients and physicians are overly reliant on medication without concern for long-term consequences.

“I think we have a real problem with patient care management, when it comes to prescribing antidepressants,” says Rizkalla. “We tend to put patients on an SSRI and more or less forget about them.”

She adds that, while relatively safe, antidepressants still carry side effects, including weight gain, sexual dysfunction and emotional numbing.

She also urges caution as the evidence for antidepressant risk factors is based on short-term usage. Moreover, and perhaps disturbingly, Rizkalla explains that sufficient research on the neurologic impact of taking antidepressants for decade is not available.

In the paper, the coauthors provide a tapering schedule for varying classes of antidepressants. However, they insist individuals consult their physician before and throughout the process to monitor their symptoms and progress.

Source: American Osteopathic Association/EurekAlert
 
Photo: Researchers provide a schedule for gradually reducing dosage for each class and type of antidepressant, along with associated withdrawal symptoms for which patients and physicians should monitor. Credit: JAOA.

When and How to End Antidepressant Treatment And Avoid Withdrawal Symptoms

Rick Nauert PhD

Rick Nauert, PhDDr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.

APA Reference
Nauert PhD, R. (2020). When and How to End Antidepressant Treatment And Avoid Withdrawal Symptoms. Psych Central. Retrieved on November 30, 2020, from https://psychcentral.com/news/2020/02/22/when-and-how-to-end-antidepressant-treatment-and-avoid-withdrawal-symptoms/154363.html
Scientifically Reviewed
Last updated: 22 Feb 2020 (Originally: 22 Feb 2020)
Last reviewed: By a member of our scientific advisory board on 22 Feb 2020
Published on Psych Central.com. All rights reserved.