Bipolar Disorder – When to Get Off Antidepressants
I try not to give medical advice here because I am not a doctor. But so many people ask me about this I felt I had to address getting off antidepressants without withdrawal. So many people with bipolar disorder (depression and others) need information about getting off psych meds and they are not getting it from their doctors.
This is the first in a three-part series:
- When to Stop Antidepressants in Bipolar Disorder
- How to Stop Antidepressants in Bipolar Disorder While Minimizing Withdrawal
- How to Stop Taking venlafaxine (Effexor) and Desvenlafaxine (Pristiq) – as they are particularly nasty to get off
This is an informational article only and should not be considered a recommendation. Talk to your doctor before any and all changes to your treatment. I’m not kidding about this.
These recommendations are primarily from PsychEducation.org and Dr. Jim Phelps with some commentary by me.
Bipolars Shouldn’t Take Antidepressants
Some doctors are on the fence about this, but more and more bipolar specialists are recommending people with bipolar disorder not take antidepressants. There are lots of reasons for this, and I have to tell you, they are compelling.
Why Shouldn’t People with Bipolar Disorder Take Antidepressants?
Some reasons people with bipolar shouldn’t take antidepressants:
- Antidepressants may not work in bipolar disorder – believe it or not, the literature is mixed on how well antidepressants even work for bipolar depression.
- Antidepressants can induce mania or hypomania (known as switching) – most of us have seen this and it happens all the time to bipolars who are prescribe antidepressants by non-psychiatrists because they just don’t understand the danger. And it is very dangerous because once switched, this type of mania or hypomania can be treatment resistant.
- Antidepressants can induce rapid-cycling or mixed moods – same as above, this cycling can be treatment-resistant.
- Antidepressants can worsen a bipolar’s illness overall – this is more controversial and I suspect varies case by case.
To be clear some people with bipolar disorder will always need antidepressants temporarily, or long term, for their mood, but more and more, doctors are saying to avoid them whenever possible. (Alternatives will be presented in a future article.)
When to Stop Taking Antidepressants
Here are some guidelines from Dr. Phelps about when to stop taking antidepressants in bipolar disorder:
- If they have been on antidepressants a short time, I stop them.
- Less than a week, stop; two weeks, cut in ½, a week later stop.
- Likewise, if they just increased their antidepressants dose I will do the above, decreasing to their previous dose and get rid of the rest later.
- If manic or severely hypomanic, get rid of antidepressants now. Usually can stop abruptly.
- If cycling or mixed get rid of the antidepressants.
- If they are not getting better after several add-on meds then slowly decrease.
- There are more exceptions to the above rules than there are rules.
When to Stay On an Antidepressant if You’re Bipolar
More guidelines from Dr. Phelps: When a bipolar should stay on an antidepressant:
- If the patient is doing well, no mixed state symptoms or cycling, leave it.
- I usually wait until the patient is doing better to much betterto stop an antidepressant; why:
- Trust is an issue. If the first thing we do is make them suffer more they will be unlikely to stay around long and may not even go to another psychiatrist.
- Even though we know the antidepressant is causing harm often time the patient thinks either the antidepressant is helping or every time they try to go off they feel much worse.
- Waiting until they are better is usually a good thing.
- Also waiting longer usually means that the patient is going to be more educated about bipolar in general.
When to Get Off an Antidepressant Recommendations
I think Dr. Phelps’ recommendations are good ones, otherwise I wouldn’t have them here, but note where he says there are more exceptions than he has listed, so keep in mind, you might fall into one of the unlisted exceptions.
And I think the part above where Dr. Phelps talks about trust and making sure the patient is better before messing around with their cocktail is key. It shows he’s respecting the patient and their health, not to mention the doctor-patient relationship which is very important.
Talking to Your Doctor about Getting off Antidepressants is Scary
I know it’s scary to think about going off antidepressants, even if you do think they are causing problems. But think about it, discuss it with your doctor and make the right decision for you. And don’t do anything until you read the next part about how to get off antidepressants without withdrawal.
Bipolar Disorder – Getting off Antidepressant Series
- Bipolar Disorder – When Not to Take Antidepressants
Coming up:
- Bipolar Disorder – How to Get Off Antidepressants without Withdrawal
- How to Get off Venlafaxine (Effexor) and Desvenlafaxine (Pristiq), Particularly Nasty Beasties
10 Responses to “Bipolar Disorder – When to Get Off Antidepressants”
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Just a comment, since I was happy to see a section regarding getting off psych meds. you can thank FishRobber for turning me on to your site.
I have not been through all of it, but intend to. I LOVE that you have dedicated so many pages and so much information to the subject and awareness of Bi-Polar Disorder!
Just a personal note: Been on Effexor twice in the last 20 years. Neither time did I have any problems when stopping that particular medication.
The only bi-polar medication, that I have been prescribed (and I am NOT a doctor either but my father was a psychiatrist, and I worked for him every break in school through college and after) when a patient MUST titrate down is Lamactil.
I can only say that I agree with a lot of what I’ve read here, and my father spent 25 years of his practice getting patients OFF of the results of over-prescribing by other physicians :)
I do not believe that a truly diagnosed bi-polar -as opposed to the thousands suddenly being diagnosed with the disease who do not in fact have it- is capable nor should be encouraged to give up all of their meds and rely on (unproven) vitamin supplements, etc.
Mental disorders are a disease of a neuro-chemical imbalance, at the very least.
Totally agree with your posts advising exercise,writing, etc. but to take a bi-polar patient off of their meds can be deadly.
If diagnosed with depression, THEN the meds are to stabilize moods so that therapy can be accomplished; the end goal coinciding with an end to the medication.
Once again I’m happy to have found your site. Many thanks!
Hi Rashael,
Nice to meet you. Thanks for dropping by. Take your time, there’s a lot of stuff here :)
Nice to see someone hasn’t had a hard time getting off Effexor. My history with getting off meds varies, but I too have been able to get off meds that other’s find difficult sometimes. It’s really an individual thing.
“The only bi-polar medication, that I have been prescribed when a patient MUST titrate down is Lamactil.”
That’s sort of true. Yes, Lamictal (lamotrigine) must be tapered because of the risk of a possibly-lethal rash, but other meds carry a similar risk, so they _must_ be tapered too.
“I do not believe that a truly diagnosed bi-polar -as opposed to the thousands suddenly being diagnosed with the disease who do not in fact have it- is capable nor should be encouraged to give up all of their meds and rely on (unproven) vitamin supplements, etc.”
I tend to agree. I really disagree with encouraging people to get off meds. And I also agree that those with a serious illness really don’t have much of a shot off meds and “alternative” methods are just ideas. If they worked, you could taken them _with_ meds and then taper off the meds. But somehow no one thinks of it that way.
Nevertheless, some people _will_ go off meds so I can only hope they do it under supervision and in the safest way possible.
- Natasha Tracy
You are more daring than I to take on this subject as a lay person! I hope no one decides to do this without supervision because they think you are implying it is OK to do.
Iambipolar2,
Well, I told people not to do it without talking to their doctor. If they don’t listen to me, then I really can’t help them.
See, I wrote an article on getting off Pristiq and it was just a personal article but I get _way_ too many hits on it. So I’m trying to do this series so people will have some solid information to lean on if they’re trying to get off antidepressants.
And yes, it’s always a concern that people will do things just because they read it on the internet. I try to do everything I can to tell people not to and I try to provide the most reliable information, but you can’t save everyone from themselves, unfortunately.
- Natasha Tracy
Thank you for this post. This is really helpful to me.I have read on a blog about a man who has successfully got rid of anti-depressants. I will go back to attach his link when I find it; he was very inspiring.
If you don’t mind, I will cite a counseling webpage. This could be of help for future post references. Have a good day.
Hi Frances,
Well, I don’t consider “getting rid” of antidepressants inspiring, per se. They are right for some people and not right for others.
- Natasha Tracy
I currently take 100mg of Seroquel in the evening and 50 mg of Zoloft in the a.m. So far seems to be a good combination. For maybe 2 years I took Lamictal and Effexor neither drug was effective singly or in combination. I have been working on my emotional state with exercise, healthy eating, journaling, high self-care etc. I have found medication is only part of the puzzle for managing Bipolar, but I do not work, I am in my 3rd year of Social Security Disability. I do have a MSSW in Social work, not sure if returning to work is an option…..
And thank you very much for your work–you are awesome.
Hi Pam,
Yes, a combination can work well for some people. As long as there is a mood stabilizer (like an antipsychotic) on board, the risk is lessened.
You’re right, medication is only part of what it takes to get better. We need to do all the thing “normal” people do too, except more of it. But medication can get us to a place where we’re actually capable of doing those things.
Hopefully, one day you will feel confident enough to go back to work. Maybe part time. Or volunteer somewhere at first. It can help build up your confidence.
Why thank-you so much. I shall take your awesome indeed.
- Natasha Tracy
I’ve been afraid of taking any sort of antidepressants after trying celexa while before stabilization by lamictal. The mixed and manic states that it provoked took only a few days to happen and about a week to recover from. I wish that I had been better informed at the time because I would definitely have refused it and opted for a different course, like increasing my lamictal instead. However, this is hindsight, I learned my lesson, and that’s the way it seems that all knowledge of drugs really is. This is great though for educating and preparing people for how to take antidepressants if they are bipolar, your contribution to the literature is heavily appreciated by me (as well as all the other posts you have here).
Hi James,
Honestly, you’re lucky you recovered in a week. That type of state can take many weeks for some people to recover from.
Most of us wish we were better informed when we started but it’s really hard to be. Knowledge grows over time and you just don’t have that time when you’re starting out. I only hope that people can prepare for the future as many people aren’t aware of the concerns around antidepressants and bipolar even after being bipolar for a long time.
Thank-you for your kind words.
- Natasha Tracy