How to Stop Antidepressants While Minimizing Withdrawal
While antidepressants can absolutely be life-saving medications, sometimes antidepressants aren’t the right medication at the right time for you. Or sometimes, it’s just time to try to get off of antidepressants. (For simple depression, this is often done if you have been stable for 6-12 months.)
But the key to getting off antidepressants successfully is to minimize withdrawal symptoms because otherwise you may feel like you’re trapped on the antidepressants. Additionally, the withdrawal symptoms may get mistaken for returning illness symptoms, which you do have to watch for, but if possible, it’s best not to get withdrawal and returning symptoms confused.
So, here are some tips on the best way to get off antidepressants while minimizing withdrawal.
Learn About Getting Off Antidepressants
Firstly, by reading this you are taking the first step. Learning about your antidepressant, the time it takes to get off, and what might happen, is an excellent first thing to do. Your doctor can guide you in this process.
DO NOT STOP ANTIDEPRESSANTS SUDDENLY.
DO NOT STOP THEM ON YOUR OWN.
ALWAYS TAPER ANTIDEPRESSANTS UNDER THE SUPERVISION OF A DOCTOR.
(And as always, I am not a doctor and none of this should be considered medical advice. Only your doctor can offer that.)
Taper Antidepressants More Slowly
I can’t comment on individual doctors, but I will say in studies and in the literature they take people off medication, including antidepressants, way too fast. This is likely because they don’t want to wait around to do it the right way, but still, it gives people the false sense that you can get off antidepressants quickly – you shouldn’t.
Track Your Mood During Antidepressant Decrease
I know, it seems like I’m trying to strong-arm you into tracking your mood, but during medication tapering, it’s essential. You need to track your mood every day during medication changes – this goes for all mental illness – as well as write down when you change dosages because:
- You need to know if you’re getting worse
- You need to know if you do better at a lower dose, but not off the drug completely
- You’ll have those records should you try to do it again in the future (or with another medication)
Please, please, please, even if you track your mood at no other time, do it when withdrawing from medication. (More on mood tracking here.)
(If you don’t want to track every part of your mood, then at least track the global assessment of functioning (GAF).)
Wait Six-Eight Weeks between Antidepressant Dosage Decreases
Seriously.* You are waiting so long between antidepressant dosage decreases because:
- You want to prevent withdrawal
- You do not want to induce mania, cycling or a mixed mood which is a real danger in bipolar
Changes to the Antidepressant Taper Schedule
You may want to slightly alter the antidepressant dosage decrease schedule:
- Increase speed if feeling better as dosage decreases
- Decrease speed if anxiety is a factor
- Decrease speed if feeling worse on a lower dose
- Decrease speed if feeling good at a specific dose (that might be the right dose for you)
- Decrease speed for any reason if you feel the need
Never try to decrease or get off an antidepressant when:
- You’re in a time of stress
- There is an upcoming holiday
Decrease the Antidepressant in the Lowest Dose Possible
This does not mean cutting your current pill. Some pills cannot be cut for safety reasons. This means getting a prescription for the smallest increment available and decreasing the antidepressant dosage by that much.
When you’re closing in on getting off the antidepressant completely, slow down even more. Cut the pill if you can. If you can’t, alternate on the higher dose for one day and then the lower dose for one day.
Exceptions to the Antidepressant Withdrawal Rules Above
As with all things in life, there are exceptions:
- If you’ve been on the antidepressant a very short time you may be able to get off of it quickly
- Fluoxetine (Prozac) may sometimes be tapered more quickly
- Venlafaxine (Effexor), desvenlafaxine (Pristiq) (and sometimes other antidepressants) can be too hard to get off of using this method (see next article in series)
Getting Off an Antidepressant Takes Too Long
Look, you are getting off a medication that has altered the chemicals in your brain. This is not a minor event. While this method is slow, it gives you the very best chance of successfully getting off the medication without inducing withdrawal or worsening illness symptoms.
Don’t Freak Out When Coming Off Antidepressants
Remember not to freak out. Some withdrawal symptoms and some bipolar/depression symptom fluctuation may occur and you’ll still be all right. Just maintain a close relationship with your doctor to make sure it isn’t the start of something more serious
How to Get Off of Antidepressants with Minimal Withdrawal Series
Previously we saw:
Up next is:
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If Your Doctor Doesn’t Get This, Send Them to Psycheducation.org for Their Own Education
* This information (and other information in this article) is provided by psycheducation.org and Dr. Jim Phelps.
7 Responses to “How to Stop Antidepressants While Minimizing Withdrawal”
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Thank you, Natasha.
There are perhaps 200-300 articles on antidepressant withdrawal syndrome or antidepressant discontinuation syndrome (as the pharmaceutical companies like to call it).
I am sorry to say I’ve read most of them. (Sorry because it’s time-consuming and not the lightest reading you can imagine.)
If you’re interested, I’ve posted many of the more central ones in the Journals area of my site http://survivingantidepressants.org, in the http://survivingantidepressants.org/index.php?/forum/16-from-journals-and-scientific-sources/ Jim Phelps’s recent paper in Medical Hypotheses is among them.
Thank you for publishing this advice. I’m very glad Jim Phelps has looked at the problem of withdrawal from psychiatric medications, which has been ignored by medicine, to psychiatry’s eternal shame.
I do have a bone to pick. “The lowest dose possible” Is NOT the smallest dosage available from the manufacturer. While some pills with timed-release coatings will lose their timed-release quality when they are pierced, others can be cut up. Compounding pharmacies can make up special dosages in capsules and liquid form. Some people even powder their tablets and use an electronic scale to measure out dosages.
Why go to all this trouble? Because some people can tolerate only much smaller reductions, even down to a fraction of a milligram at a time. If you’ve tried to reduce using the manufacturer-supplied dosages and failed, you are one of these people.
Special rules apply to Cymbalta and Effexor XR capsules. People sensitive to withdrawal generally open the capsule and count out pellets to taper. [ ]
There are lots of ins and outs to tapering, depending on the drug. SurvivingAntidepressants.org has tips in its Tapering forum at http://tinyurl.com/42ewlrl
And — there is no relationship between developing withdrawal symptoms and your psychiatric diagnosis. People who have difficulty withdrawing are simply vulnerable in some as-yet undefined way to the action of the drugs. This is not any kind of neurological or psychiatric flaw. Severe withdrawal is bad luck and has not been investigated by medicine; although it is a significant adverse event, it has not been factored into psychiatric drug risks.
Hi Altostrata,
Thanks for your comment.
Phelps isn’t the only one looking at withdrawal. If you look in the article he actually talks about how several of his colleagues and himself came up with those recommendations. There are many others looking at it too although they call it “antidepressant discontinuation syndrome.”
This is only the second in a three part series and in the third part I talk about getting off of Pristiq and Effexor and other difficult to manage medications and I talk about the things you mentioned.
You can find that article here: http://natashatracy.com/treatment-issues/withdrawal/antidepressants-effexorpristiq-venlafaxinedesvenlafaxine/
- Natasha Tracy
Hey Tracy,
Great article, with lots of helpful tips. I particularly like your focus on reducing very slowly. I took 15 mg of Cipralex for about 18 months, then my doctor and I decided to reduce gradually to find out if the medication was still necessary. Over the past 18 months, I’ve gradually reduced the amount I take. I expect to stop taking it entirely over the next month. Over this time, I’ve met with my doctor every three months to see how things are going and to decide the next steps in terms of reducing medication. I’ve appreciated my doctor’s slow approach. So far, I’ve experience no withdrawal difficulties.
Thanks for yet another great article!
cheers,
Jennifer
Jennifer,
It’s so great to hear that some doctors get it right. Not only did your doctor withdraw you slowly, but they actually stopped to think about whether you needed the med in the first place. Definitely a good example of doctoring.
And nice that you have had no withdrawal. It would be nice if it were always like that :)
- Natasha Tracy
First I must tahnk you for following me on twitter. Because of your follow I looked into this wonderful blog. As a psychotherapist for a few decades and a close relative of a “consumer” I have learned all about the negative aspects of all sorts of medications. Certainly it is important to minimize or eliminate meds as much as possible. And all of your suggestions are relavant amd important. However, you neglect one aspect that almost everybody also neglects. If one wants to get off of antidepressants it is important to address the ratio between negative and positive emotions in your life. After a person has conquered the major cuases of depression, it is difficult to keep it at bay if nothing is done to improve life in a very real positive direction. This is beyond the relief aspect. Modern Positive Psychology has developed methods and techniques to increase positivity in your life and this will help keep people off of drugs. While some people do this eaisly, most people who have mental illness or live with mentally ill loved ones need help, support and guidance to acquire positivity skills. It is worth while looking into.
Hi Ari,
You’re welcome, of course :) Always nice to have a psychotherapist in the house.
I haven’t addressed the psychological aspects of going off meds, just about going off of them from a physical perspective, but yes, certainly many people could bolster their efforts by obtaining quality therapy during the process.
I consider each person’s psychology to be so individual that saying “positive and negative” emotions is sort of not the point because:
- Many people on meds are in therapy or have been
- This minimizes the kind of symptomology experienced by many
- The reason someone may be trying to stop an antidepressant is to try another, or reduce the cocktail, not necessarily get off antidepressants (or meds) altogether
Personally, I’ve had it up to the roof of my apartment with therapy and it has nothing to do with whether or not I choose to go off a medication, but that’s me.
I think therapy is useful but there are things it can do and things it can’t and while supportive therapy can be helpful, generally getting off meds is a physical battle, I would say more, than a psychological one. It’s the physical withdrawal that will get you every time. You need to be psychologically ready before you start.
I think therapy is really irrespective of medication. If you need it, you need it, no matter what you’re doing with your meds.
- Natasha Tracy