Given the choice, most of us would rather not take medicine. There may be unpleasant side effects or we may simply desire to live as drug-free as possible. All are valid reasons, and most patients know to talk to their doctor before stopping, say, heart or allergy meds. Those with depression would be wise to do the same, because stopping antidepressants improperly can lead to a host of health problems, including the return of depression.
[See: Am I Just Sad — or Actually Depressed?]
Deciding to go off antidepressants “should be considered thoughtfully and made with the support of your physician or therapist to make sure you’re not stopping prematurely,” according to Harvard Health Publications, from Harvard Medical School. There may in fact be no need to stop. “People have been on antidepressants for 20 or 30 years, with no evidence of any harm,” says Dr. Anita Everett, president of the American Psychiatric Association. But if all parties agree to try stopping medications, “you and your physician should take steps to minimize or avoid the discontinuation symptoms that can occur if such medications are withdrawn too quickly,” Harvard Health reports.
The Mayo Clinic says that patients may experience antidepressant withdrawal, also known as antidepressant discontinuation syndrome, if they stop taking the drug abruptly, particularly if they have been on the drug longer than six weeks. Suddenly stopping medication may cause symptoms within a day or two, including:
— Anxiety.
— Insomnia.
— Vivid dreams.
— Headaches.
— Dizziness.
— Fatigue.
— Irritability.
— Flu-like symptoms, such as aches and chills.
— Nausea.
— Electric shock sensations.
And it increases the risk that depression will recur. One Harvard Medical School study of nearly 400 patients who were followed for more than a year after they stopped taking antidepressants found that those who stopped quickly, over one to seven days, were more likely to relapse within a few months than those who tapered their dosage slowly, over two or more weeks.
A Shock to the Brain
Antidepressant withdrawal is not the same as being addicted. Antidepressants are not addictive. But they do alter brain chemistry. They work by changing the levels of neurotransmitters, the brain chemicals that attach to nerve cells throughout the body. “Suddenly stopping any medication that affects the brain can be problematic,” Everett says. “Some cause short-term chemical changes, some cause long-term changes in brain circuitry. You have to be respectful of these changes. The brain adapts to the medicine over time, so taking them away can be a shock to the brain.”
The symptoms that such a shock may cause are unsettling, but not usually dangerous. “The modern antidepressants, the SSRIs and SNRIs, are pretty safe to use,” says Michael Schoenbaum, a senior advisor at the National Institute of Mental Health who has done extensive research into antidepressants. “Unlike older-generation medications, broadly speaking you are not at acute physical risk. You are exposing yourself to a recurrence of symptoms, but those are not life-threatening things.”
The way to avoid these symptoms is to wean off antidepressants. How long that takes depends on the medication. Each drug has a “half-life,” which represents the amount of time it takes for the body to break the chemical down and flush it out of the system. Antidepressants that have a short half-life and leave the body quickly are most likely to cause symptoms. Harvard cites venlafaxine (Effexor), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa) as examples. Drugs with a longer half-life, like fluoxetine (Prozac), cause fewer symptoms. Tapering doses of the short half-life drugs gives your body time to adjust to lowering levels of neurotransmitters. That can take from several weeks to several months. And the physician may prescribe another, longer-lasting drug like fluoxetine to help during the transition.
[See: How to Find the Best Mental Health Professional for You.]
Six Steps to Success
Harvard Health offers a clear, six-point plan to successfully stop antidepressants:
1. Don’t rush. Mental health professionals typically recommend staying on antidepressants for six to nine months, or longer if depression is recurring. So don’t stop without your doctor’s full evaluation of your condition and his or her consent to the idea.
2. Plan. Work with the doctor to determine how to taper your medications based on your particular prescription, the dose, how long you have been on it and how you may have reacted to other changes in medication. Once you start, keep a daily “mood calendar” to record your mood on a 1-to-10 scale.
3. Start or continue psychotherapy. Therapy is as important as, if not more than, medication, yet fewer than 20 percent of people on antidepressants also engage in psychotherapy. Studies have shown that patients in psychotherapy while tapering off an antidepressant are less likely to have a relapse. “We like things to happen fast, and we just want to take a pill, but some types of depression actually do better with therapy,” Everett says. “It is a very viable treatment to try before starting medication or as an alternative to medication.”
4. Live healthfully. Eating a healthy diet, practicing stress-reduction techniques, getting adequate sleep and, most importantly, exercising are all helpful in reducing symptoms. Exercise increases levels of serotonin, which can help balance the changes caused by medications that affect the serotonin system.
[See: The Many Ways Exercise Fights Depression.]
5. Ask for help. Consult with your physician throughout the process and alert him or her to any symptoms. Enlisting relatives or close friends to keep an eye on things may be helpful as well, both so they are aware of possible symptoms like irritability, and to recognize the signs that depression may be recurring. “Depression sort of creeps back into lives over the course of days or weeks, and people are not necessarily able to realize this or associate it with stopping medication,” Schoenbaum says. “It doesn’t seem like a direct cause and effect, because the effects are gradual.”
6. Finish the plan. Follow the course you and your doctor agreed upon, and then see the doctor again a month later to discuss discontinuation symptoms, if any, and check for signs of recurring depression. The doctor may advise ongoing follow-up as well.
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How to Stop Antidepressants Safely originally appeared on usnews.com
