what to do when you dont want to take an antidepressant

Coming off your medication tin cause antidepressant withdrawal – and could set you lot upwardly for a relapse of depression

Can going off your medication cause antidepressant withdrawal symptoms (antidepressant discontinuation syndrome)? About 10% of women ages 18 and over take antidepressants. Every bit many of u.s.a. know, these medications tin be a godsend when depression has robbed life of its joy and made information technology difficult to muster the free energy and concentration to complete everyday tasks. Simply equally you lot brainstorm to feel amend and want to move on, how long should yous keep taking the pills?

If yous're doing well on antidepressants and not complaining of also many side effects, many physicians will renew the prescription indefinitely — figuring that it offers a hedge against a relapse of depression. But side effects that you may have been willing to put up with initially — sexual side effects (decreased desire and difficulty having an orgasm), headache, insomnia, drowsiness, vivid dreaming, or just not feeling like yourself — can become less acceptable over time, specially if you lot think you no longer need the pills.

The decision to go off antidepressants should be considered thoughtfully and made with the support of your physician or therapist to make certain you're not stopping prematurely, risking a recurrence of depression. Once you lot decide to quit, you and your md should take steps to minimize or avert the discontinuation symptoms that can occur if such medications are withdrawn likewise apace.

Why antidepressant withdrawal?

Antidepressants work past altering the levels of neurotransmitters — chemical messengers that attach to receptors on neurons (nervus cells) throughout the trunk and influence their activity. Neurons eventually accommodate to the current level of neurotransmitters, and symptoms that range from mild to deplorable may arise if the level changes as well much too fast — for instance, because you've suddenly stopped taking your antidepressant. They're mostly not medically dangerous just may exist uncomfortable.

Among the newer antidepressants, those that influence the serotonin system — selective serotonin reuptake inhibitors (SSRIs, now commonly known as SRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) — are associated with a number of withdrawal symptoms, ofttimes called antidepressant or SRI discontinuation syndrome. Stopping antidepressants such as bupropion (Wellbutrin) that do not affect serotonin systems — dopamine and norepinephrine reuptake inhibitors — seems less troublesome over all, although some patients develop extreme irritability.

Having discontinuation symptoms doesn't mean you're fond to your antidepressant. A person who is fond craves the drug and often needs increasingly college doses. Few people who take antidepressants develop a peckish or experience a need to increase the dose. (Sometimes an SRI volition stop working — a phenomenon called "Prozac poop-out" — which may necessitate increasing the dose or adding another drug.)

Antidepressant withdrawal can look like depression

Discontinuation symptoms tin include anxiety and depression. Since these may exist the reason y'all were prescribed antidepressants in the first identify, their reappearance may suggest that you're having a relapse and need ongoing treatment. Here'south how to distinguish discontinuation symptoms from relapse:

• Discontinuation symptoms emerge within days to weeks of stopping the medication or lowering the dose, whereas relapse symptoms develop subsequently and more gradually.

• Discontinuation symptoms frequently include physical complaints that aren't commonly found in depression, such as dizziness, flulike symptoms, and abnormal sensations.

• Discontinuation symptoms disappear quickly if you have a dose of the antidepressant, while drug handling of depression itself takes weeks to work.

• Discontinuation symptoms resolve equally the torso readjusts, while recurrent depression continues and may get worse.

If symptoms last more than a month and are worsening, it's worth considering whether you're having a relapse of depression.

Antidepressant withdrawal symptoms

Neurotransmitters act throughout the body, and you may experience physical equally well as mental effects when yous end taking antidepressants or lower the dose too fast. Common complaints include the following:

• Digestive. You may have nausea, vomiting, cramps, diarrhea, or loss of ambition.
• Blood vessel control. You lot may sweat excessively, flush, or discover hot conditions difficult to tolerate.
• Sleep changes. You may have trouble sleeping and unusual dreams or nightmares.
• Remainder. You may become light-headed or giddy or feel like you don't quite accept your "sea legs" when walking.
• Control of movements. Yous may feel tremors, restless legs, uneven gait, and difficulty coordinating speech and chewing movements.
• Unwanted feelings. You may have mood swings or feel agitated, anxious, manic, depressed, irritable, or confused — even paranoid or suicidal.
• Strange sensations. Y'all may have pain or numbness; you may become hypersensitive to sound or sense a ringing in your ears; you may feel "brain-zaps" — a feeling that resembles an electrical shock to your head — or a sensation that some people draw as "encephalon shivers."

Equally dire equally some of these symptoms may sound, you shouldn't let them discourage you if y'all desire to go off your antidepressant. Many of the symptoms of SRI discontinuation syndrome tin be minimized or prevented by gradually lowering, or tapering, the dose over weeks to months, sometimes substituting longer-acting drugs such as fluoxetine (Prozac) for shorter-acting medications. The antidepressants most likely to crusade troublesome symptoms are those that accept a short half-life — that is, they suspension downward and go out the trunk rapidly. (See the nautical chart "Antidepressant drugs and their one-half-lives.") Examples include venlafaxine (Effexor), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa). Extended-release versions of these drugs enter the body more than slowly but leave information technology just as fast. Antidepressants with a longer one-half-life, importantly fluoxetine, crusade fewer problems on discontinuation.

Too easing the transition, tapering the dose decreases the adventure that depression volition recur. In a Harvard Medical School study, almost 400 patients (ii-thirds of them women) were followed for more than than a year later they stopped taking antidepressants prescribed for mood and feet disorders. Participants who discontinued rapidly (over i to 7 days) were more than likely to relapse within a few months than those who reduced the dose gradually over two or more weeks.

Antidepressant drugs and their half-lives*
Drug	One-half out of body in	99% out of body in
Serotonin reuptake inhibitors
paroxetine (Paxil)	24 hours	4.iv days
sertraline (Zoloft)	26 hours	5.4 days
escitalopram (Lexapro)	27 to 32 hours	6.ane days
citalopram (Celexa)	36 hours	7.3 days
fluoxetine (Prozac)	Four to six days	25 days
Serotonin and norepinephrine reuptake inhibitors
venlafaxine (Effexor)	five hours	ane day
duloxetine (Cymbalta)	12 hours	2.5 days
desvenlafaxine (Pristiq)	12 hours	2.v days
Dopamine and norepinephrine reuptake inhibitor
bupropion (Wellbutrin)	21 hours	4.iv days
*Discontinuation symptoms typically start when 90% or more of the drug has left your organisation. Source: Adapted from Joseph Glenmullen, M.D., The Antidepressant Solution: A Footstep-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and "Addiction" (Free Press, 2006).

How to get off antidepressants

If you're thinking about stopping antidepressants, you should go step-by-step, and consider the following:

Take your time. Y'all may be tempted to stop taking antidepressants equally soon equally your symptoms ease, but depression can return if you quit too soon. Clinicians generally recommend staying on the medication for half-dozen to nine months before considering going off antidepressants. If you've had three or more recurrences of depression, make that at least two years.

Talk to your clinician about the benefits and risks of antidepressants in your detail situation, and work with her or him in deciding whether (and when) to stop using them. Before discontinuing, you lot should feel confident that you lot're functioning well, that your life circumstances are stable, and that you lot can cope with whatsoever negative thoughts that might sally. Don't try to quit while you're under stress or undergoing a significant change in your life, such as a new job or an illness.

Brand a plan. Going off an antidepressant usually involves reducing your dose in increments, allowing two to six weeks betwixt dose reductions. Your clinician can instruct you in tapering your dose and prescribe the appropriate dosage pills for making the change. The schedule will depend on which antidepressant you're taking, how long you've been on it, your electric current dose, and any symptoms you had during previous medication changes. It'due south likewise a good idea to go on a "mood calendar" on which you record your mood (on a scale of one to 10) on a daily basis.

Consider psychotherapy. Fewer than 20% of people on antidepressants undergo psychotherapy, although information technology'due south oftentimes important in recovering from low and avoiding recurrence. In a meta-assay of controlled studies, investigators at Harvard Medical Schoolhouse and other universities found that people who undergo psychotherapy while discontinuing an antidepressant are less probable to have a relapse.

Stay active. Bolster your internal resources with good nutrition, stress-reduction techniques, regular sleep — and particularly physical activeness. Exercise has a powerful antidepressant effect. Information technology'south been shown that people are far less likely to relapse after recovering from depression if they practice iii times a week or more. Do makes serotonin more available for binding to receptor sites on nervus cells, and then it can compensate for changes in serotonin levels as y'all taper off SRIs and other medications that target the serotonin system.

Seek support. Stay in touch with your clinician as you go through the process. Let her or him know about any concrete or emotional symptoms that could be related to discontinuation. If the symptoms are mild, y'all'll probably be reassured that they're just temporary, the result of the medication clearing your system. (A curt course of a non-antidepressant medication such as an antihistamine, anti-feet medication, or sleeping assistance tin can sometimes ease these symptoms.) If symptoms are astringent, you might need to go back to a previous dose and reduce the levels more than slowly. If you lot're taking an SRI with a short half-life, switching to a longer-acting drug like fluoxetine may help.

You may desire to involve a relative or close friend in your planning. If people around you realize that you lot're discontinuing antidepressants and may occasionally be irritable or bawling, they'll exist less probable to take information technology personally. A shut friend or family member may likewise exist able to recognize signs of recurring depression that you might not perceive.

Complete the taper. By the fourth dimension you cease taking the medication, your dose will exist tiny. (You may already have been cut your pills in half or using a liquid formula to reach progressively smaller doses.) Some psychiatrists prescribe a unmarried 20-milligram tablet of fluoxetine the day later the last dose of a shorter-acting antidepressant in society to ease its final washout from the body, although this approach hasn't been tested in a clinical trial.

Check in with your clinician one month after you've stopped the medication altogether. At this follow-up engagement, she or he will check to make sure discontinuation symptoms have eased and there are no signs of returning depression. Ongoing monthly check-ins may exist advised.

Paradigm: AlinaTraut/Getty Images

To learn what y'all can exercise to go the slumber you need for optimal health, safety, and well-being, but the Harvard Special Health Report Improving Slumber: A guide to a skillful night's rest.

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Source: https://www.health.harvard.edu/diseases-and-conditions/going-off-antidepressants

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