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.
Nauert PhD, R. (2020). When and How to End Antidepressant Treatment And Avoid Withdrawal Symptoms. Psych Central. Retrieved on March 30, 2020, from https://psychcentral.com/news/2020/02/22/when-and-how-to-end-antidepressant-treatment-and-avoid-withdrawal-symptoms/154363.html