Discontinuation syndrome and antidepressants

Discontinuation and change are part of life. We all start and stop various activities. Jobs change, relationships change. So, too, may medical treatments, such as antidepressants that help many people navigate depression and anxiety. Planning changes in advance tends to make things easier and smoother. You may start a medication for treatment and discover that it’s not helping your particular medical issue. Or perhaps you’re having side effects. Or maybe your condition has improved, and you no longer need the drug. If so, working with your doctor to change or stop taking an antidepressant slowly may help you avoid uncomfortable symptoms known as discontinuation syndrome.

What is discontinuation syndrome?

Discontinuation syndrome can be a consequence of stopping certain types of antidepressants: selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). You may have heard about this from a friend or on the news, or perhaps read a recent New York Times article on this topic. If you are taking an antidepressant, you may be concerned about your own response to stopping the medication.

Let’s clarify what the term means. Discontinuation syndrome describes a range of symptoms that may occur in patients taking SSRIs or SNRIs after stopping quickly. These can include:

  • nausea
  • feelings of vertigo
  • trouble sleeping
  • odd sensory symptoms, such as “pinging” feelings in the skin, or what some people describe as a “zapping” sensation in the brain
  • feeling anxious.

As many as one in five people who stop an antidepressant quickly may experience at least a mild version of these symptoms. Usually discontinuation syndrome occurs when a person has been taking medication for at least six weeks or longer. And it’s more likely to happen if you have been taking medication for a long time.

When people stop taking medication, some antidepressants leave the body quickly (short half-life), while others leave the body more slowly (long half-life). Discontinuation symptoms may occur in either case, especially if a drug is stopped abruptly.

Symptoms usually start two to four days after stopping the medicine. They usually go away after four to six weeks. In rare cases, they may last as long as a year.

What are SSRIs and SNRIs?

An SSRI is a type of antidepressant. Examples include fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). These drugs make a neurotransmitter called serotonin more available in the brain. Experts believe this helps reduce symptoms of depression and anxiety and regulate mood.

SNRIs are another type of antidepressant. Examples include duloxetine (Cymbalta) and venlafaxine (Effexor). These drugs work on two neurotransmitters: serotonin and norepinephrine.

These two classes of antidepressants are groundbreaking. Older antidepressants had many hard-to-tolerate side effects, including severe fatigue, dry mouth and eyes, and difficulty urinating. In contrast, SSRIs and SNRIs are generally well tolerated. Like all drugs, though, they do have side effects, including effects on sexual function, which can be difficult to talk about, but are important to tell your physician. Each drug is a little different, and an experienced psychiatrist can help people choose the best option for them.

We encourage patients to think broadly about treating depression. Treating depression with medicine can be very effective. Talk therapy, including cognitive behavioral therapy, also has been shown to be very helpful, as have exercise and social activities. Think about treatment for depression like a menu at a restaurant where you can choose foods from more than one column. Often, a combination of medicine and nondrug treatment maximizes the benefit of both.

What if you’re ready to stop taking an antidepressant?

Let’s suppose you have been on an SSRI like paroxetine for several years and having been working with a psychologist whom you really trust. Your depression is better and you feel ready to stop your medicine. To help you avoid discontinuation syndrome, work closely with the doctor who prescribes your medicine.

While some drugs can either be stopped or very quickly tapered, almost all SSRIs and SNRIs need to be slowly decreased. You may be instructed to drop the dose by small amounts each week, or perhaps every two weeks, or even every month. If you’ve been on a higher dose of medication, a taper may take as long as six months. It’s not worth rushing it because you don’t want to develop discontinuation symptoms. However, if you do, your doctor can increase the dose and then after a little while, you can try the taper again.

We have had patients tell us that physicians don’t want to start these antidepressants for fear of triggering discontinuation syndrome when it’s time to stop taking the medicine. But these are useful and safe medications for most people, and it’s worth exploring their potential carefully. Depression is a serious and common affliction that should be actively treated by all effective methods.

Christopher Bullock, MD, MFA, 1947–2018, was a psychiatrist, psychoanalyst, and writer. He loved Gary Snyder’s poetry; “all the junk that goes with being human” was a quote that inspired his life, his work, and his illness.

Related Information: Understanding Depression

Comments:

  1. MacKenzie Keating

    My comment that I just posted was refused, as a message said that I just posted it. This is totally incorrect. Then I was kicked of the article. The truth hurts. More people are becoming aware of this travesty and abuse. I suggest you start reporting the truth of overprescribing and withdrawal. Many of us are suffering beyond human imagination.

  2. MacKenzie Keating

    Shame, shame on you for being so dismissive regarding the severity of discontinuation syndrome. That term in itself is so degrading. Call it what it is, withdrawal. I was polydrugged for eight years
    and ended up sicker than I was when I started. I ended up taking additional drugs to address the horrific side effects of these drugs. I was never given the opportunity to taper off and was forced to go cold turkey. I was also forced to cold turkey from prescribed benzodiazepams that was ongoing for over seven years. Something is very wrong with this picture. Today, the severity of withdrawal symptoms has taken my life away and I am a shell of what I was. Why not address the problem of over-prescribing psychiatric drugs? Benzodiazepams should not be prescribed for over two to four weeks, Why not address appropriate tapering according to The Ashton Manual? Many people have considered suicide, like myself due to horrific side effects from withdrawal that are ongoing for many months and years. . Our gaba and glutamate receptors have been compromised and need to be rebuilt and healed from most of these drugs which is only done by total cessation. Many have reported that this is worse than heroin or opiate withdrawal. Most of us are not addicts but are physically dependent. We placed too much trust in our psychiatrists and providers who should have been educated enough to know better. Many doctors and hospitals continue to be uneducated regarding these topics and this needs to stop. Some people require medication in order to safely function. However, the promiscuous prescribing and treatment with these drugs needs to be examined in order to safely prevent the horror of withdrawal that can be life threatening.

  3. m

    I was prescribed Klonopin and Celexa by the head of the department of psychiatry at Harvard University’s medical services while my husband was a graduate student there. I was not given informed consent about the dangers of these treatments, and every time I brought up the negative effects I was experiencing I was told they were “unrelated” – even when the side effects I was experiencing were listed in the drug information pamphlet! After experiencing serious cognitive decline (at age 30!), increasing anxiety, extreme muscle pain and other horrible and sometimes paradoxical side effects from the drugs, I slowly tapered off my medication (with a different psychiatrist’s guidance). The process of tapering and withdrawal was a hell that made my old “anxiety disorder” look like a walk in the part on a sunny day. In short, I became physically and cognitively disabled with severe symptoms which have been confirmed as iatrogenic in nature (caused by my psychiatric medication, taken exactly as prescribed). 6 years later after a hellish tapering and post-acute withdrawal process, I have improved greatly, but am still disabled. I was gravely harmed by Harvard’s health services. I wonder how many others like me are out there, not even aware that their symptoms or disability are iatrogenic in nature? This needs to change, Harvard.

  4. Andy D’Alessio- Contemptible afflictee

    Stop diminishing the devastation caused by these drugs. It’s a neurotoxic withdrawal syndrome, that can last years. They are permanently injuring people, in many cases they are having fatal consequences. We know the facts have been understood and suppressed, particularly with respect to class benzodiazepines, the older class – this is how I was initially injured. The U.K. health authorities routinely hide said consequences, behind misdiagnosis. Which is what happened to me. They then proceeded to treat the ‘error’ which resulted in me being forcibly withdrawn, hospitalised for 2yrs and subject to multiple, criminal malpractices, including the forcible polydrugging, on ever increasing amounts of further neurotoxins – including SSRI’s. What happened to me had serious life threatening implications. They nearly killed me. It’s absurd. You can’t make it up. That you geniuses have been recklessly prescribing both classes, interchangeably in a therapeutic capacity is one thing – but you are also treating the adverse effects of one, with the other. It’s not medicine. It’s quackery. For all your perceived wisdom, all the fancy letters after your name, the prestige of your institution – you facilitate and are complicit in – quackery. And you hate it now that a light is being shined upon your chicanery.

    Want to earn my respect? Stop treating those harmed with contempt. Then find some courage and integrity and investigate how this folly has been allowed to proliferate – when global institutions still haven’t addressed the benzodiazepine catastrophe. Then address them both.

  5. Enlightened

    Your article is so off the mark that it’s laudable, and yet you consider yourselves ‘qualified’ on this subject.

    Whatever happened to the Hippocratic Oath?

    These drugs are neurotoxins. They are toxic to the brain. They’re harming people, often severely, but despite the overwhelming scientific and ancetodal evidence now available, you promote them as ‘safe and helpful’, and purposely downplay side effects as ‘adjustments’.

    Shame on you.

  6. MO

    Shame on Harvard for continuing to lie to patients about the severe and debilitating withdrawal of not only antidepressants but all psych meds. For some the withdrawal, which is a sign of brain damage CAUSED by the meds, can last years and cause a multitude of horrendous debilitating symptoms such as akathisia! This is not rare or happens to just 1 in 1000. There are tens of thousands or more anecdotes that need to be taken seriously. THAT is evidence-based medicine.

    I cannot believe that this article was posted in 2019 when there is so much overwhelming evidence of the damage that these drugs do and of their severe withdrawals. Of course, calling it discontinuation syndrome just makes patients believe the line that “it’s your condition coming back” and allows for psychiatrists and the medical profession to drug them even more, often to the patients peril resulting in more death and disability! ENOUGH with the lies!

  7. T

    Dear God. Whose paying you off? There are millions completely disabled by these meds! I’m talking 10+ years off. You need to start listening and stop writing. These meds are destroying people’s lives!

  8. Janice

    What a disappointing article. Discontinuation isn’t “a part of life” it’s a horrible thing I never agreed to when prescribed these class of meds. While I was on them years ago I would have said they were “life saving” because that’s what I was told and I believed I couldn’t function without them, despite increased suicidal ideations being on them that my doctor attributed that to my “disease progressing.” Fortunately, I got so fat on Zoloft (40 pound gain in 3 months without eating changes) which I was unable to lose in 2 years of working with a trainer and a dietitian, I finally asked for a med change to a “more slimming” SSRI (Prozac )and in the process developed Serotonin Syndrome. After being hospitalized for the Syndrome, which the ER doctor told me she sees “all the time” I decided these meds aren’t safe and I wanted off them. They were very painful to stop and it lasted several months. I know now I was lucky it only lasted several months. Probably the most surprising part was after a few months off, not only was doing fine, I was doing better. I lost weight, my emotional state was, if anything, improved. It’s been 7 years now and I haven’t had a suicidal ideation since I got off the drug. I am disappointed to read an article downplaying this horrible process most patients experience without informed consent, while praising these drugs that often barely beat a placebo rate, if at all.

  9. Elaine Billings

    My 42 year old son took antidepressants for 12 years. He was diagnosed with anxiety after the birth of his first child. A normal feeling that would have subsided on it’s own. Maybe just talking with someone who could reassure him. He got sexual dysfunction, weight gain, diabetes, stomach issues all from his “treatment”. In the spring of 2011 he told his wife he wanted his life back and tapered off according to his doctor’s advice. (Doctors are tapering patients too fast) He went into withdrawal from hell. He couldn’t sleep and anxiety like nothing he had previously. He didn’t know it was withdrawal and he called his doctor to get put back on them. Nine days after restarting Zoloft he shot himself. From the “treatment”! How the hell many people have to tell what happened to them from this evil drug, before something is done about it? How many people have to die?

  10. Meschelle Linjean

    I continue to have PSSD six years after 3.5 month RX of Lexapro. I should never have been prescribed the drug. I didn’t have depression other than dealing with a traumatic event and I had normal sexual functioning after the trauma (which was not sexual in nature) until two weeks into my RX when I developed severe genital anesthesia. I also developed oromandibular dystonia from an SSRI that continues episodically to this date.

  11. Mary

    I took Zoloft for 16 months in 2015-2016 and since then have had PSSD (post-SSRI sexual dysfunction), extreme emotional numbness, inability to feel love or infatuation, and other nasty side effects which have persisted long after the drug has left my system. Please recognize PSSD and the other nasty side effects that persist long after people come off these “antidepressants.” Countless lives have been ruined and deaths have been caused by PSSD.

  12. Knif li

    SSRI not only have terrible withdrawal effects but can also cause permanent damage to ones body. I myself suffer from PSSD, emotional numbing and cognition problems after 5 months sertraline, my life felt apart because of it. I never was warned about the terrible side effects these medications can cause. I would have never taken them if i knew.

  13. Ryan

    Recognize PSSD! I came off of prozac to quickly several years ago and my libido has been demolished ever since. On top of this I now also have sexual dysfunction. There is a large community of people who have had the exact same sexual side effects with no recovery. PSSD Forum provides the proof that something needs to be done about this!

  14. JohnS

    Harvard – Please provide a link to independent, non-Pharma funded studies that prove only 1 in 5 patients experience withdrawal symptoms, and that they resolve in 4-6 weeks. Oh, wait…you can’t? So much for evidence based medicine. Psychiatrists’ anecdotal “clinical experience” doesn’t count as an evidence base.

  15. Julian

    Mentally and sexually disabled because of SSRIS.

  16. Alex_Rox

    Please recognize Post SSRI syndrome. These shitty drugs leave me zombified, asexual, not a human anymore, with cognitive impairment. I’m not depressed, psycotich, anxious, but not a man anymore.

  17. A

    Side effects of the SSRI’s can last after the drug withdrawal: anhedonia, cognitive impairment, alterations in sexual function ad blunting emotion (known as PSSD). This effects has to be considered before using these drugs that are prescribed like candies.
    Mechanism and effects also at epigenetic level that these drugs can cause should be study better.

  18. Scott

    Took these drugs for slight social anxiety. While on them they dulled me down to the point where anxiety was no longer a thing. I decided to discontinue due to being overly angry towards my family. Not long after I started experience panic attacks and complete sexual dysfunction. Tried to get back on them but the damage was done. Developed tinnitus soon after, lost most of my eyesight, and attempted suicide twice . Now one year later I am a shell of my former self. I feel no joy, no love for my family or anything I once did, have complete sexual dysfunction, dementia like symptoms, and can’t even see my tv anymore without glasses. I would take social anxiety over this 100x over. My life no longer exists. I pray everyday for a cure.

  19. Ravi Achan

    I took SSRIs for one month in 2016 for anxiety, I had a very overactive mind and it was starting to get in the way of living a fulfilling life. The SSRI fixed that problem, by making me feel completely empty inside my head, and blunting all my emotions. I thought those symptoms would improve when I went off the drug but they have unfortunately persisted for three years now.

    I’ve explored many different non psychiatric avenues when it comes to getting back to baseline; I exercise every day, eat healthily, make sure I have an active social life, I’ve reduced my stress levels etc. Yet nothing has given me even a flicker of my prior experience.

    My only avenue left is to go back to a psychiatrist to find a chemical solution, but after my experience I’m concerned by the possibility of causing additional long lasting harm to myself.

    I only hope that they do some exhaustive large, long lasting trials with these drugs

    • Purple dude

      Stopping them, even slowly and as directed, can cause irriversible side effects? The truth about these tablets is not made clear when they are given out and it’s a disgrace the lack of support given to anyone trying to stop. Not to mention liquid doses for tapering are available but unrealistically expensive.

      Doctors don’t care about us, just profit

  20. Noname

    Not just severe, debilitating, years-long withdrawal what everyone needs to be aware of as a possibility before even considering to take ANY psychiatric drugs. What is even WORSE than this: the 100+ PERMANENT neurotoxic effects resulting in toxic brain damage, chronic fatigue syndrome, drug induced dementia and cognitive decline, PSSD (irreversible chemical castration and inability to feel human emotions) between many more. The permanent effects are so terrible that they can lead to job loss, permanent disability, home loss, destruction of families, loss of financial savings and ultimately people have taken their own lives due to the extensive injury and physical suffering these drugs cause. One single pill is enough to destroy a person permanently. Took SSRI for 3 weeks 4 years ago and still suffer from debilitating effects including complete and permanent loss of my sexuality, genital anesthesia, cognitive decline, chronic fatigue syndrome.

  21. Dan c

    I am 30 years old male and my life is ruined by Fluvoxamine. I took fluvoxamine for Anxiety for around 2 years. After discontinuation It caused me Post SSRI Sexual Dysfunction(PSSD) now more than 5 years. I don’t feel love, zero libido, Anhedonia, No plessure in ejaculation so cannot be in a relationship so some day have to die alone. People suicide because of this condition.
    Universities should focused on researching this and find a cure. This is not depression and PSSD is very real.

  22. Mike

    SSRI’s destroyed my sexuality. PSSD is very real and I never had informed consent about what these medications do, or are thought to do, in the human brain. Pyschiatry has violated my body and my soul and to make it worse, they deny it. I have to inject myself to get an erection that I cannot feel. I am not advocating people not use these drugs because some people really need them. I’m advocating for psychiatry to come clean and take ownership of what they caused and that truly have no idea what they are doing or what these drugs do in the brain.

  23. Zz

    The mentioned things are just small problems. Permanent problems like pssd are the real ones.

  24. Vinicius Alves

    my life was ruined by this drugs

    i feel like a lab rat now, trying every chemical strategy to get back to baseline but it seems that the epigentic damage is done or too complex

  25. Leon Peterson

    Another symptom you should include is PSSD. I along with many others have experienced this long after stopping SSRIs. It’s ruining way too many lives with no treatments available to not be further studied/looked into by experts.

  26. Cory Cline

    These meds are dangerous and people are still experiencing the side effects years after discontinuation of them. PSSD (Post SSRI Sexual Dysfunction) is real and has destroyed people lives with some committing suicide.

  27. Linda Bowman

    I have been diagnosed as Bi Polar since age 40. Regular therapy for 20 years. Other than one year of extreme trauma, I have been very stable for many years and taking my medication religiously. Now retired and having no therapy, I would like to explore discontinuing some of my medications. I feel very stable and have been for at least 10 years.
    We have moved to another state in retirement and I have not yet searched for a therapist, as I feel entirely stable. Any recommendations?

    • Gretchen Tyree, RN, BS

      Linda: I would think carefully before discontinuing your meds for bipolar disorder, and seek advice and support from a knowledgeable physician (psychiatrist preferred). You are most likely stable because your meds are keeping you that way. It is like having a panic disorder, being treated by Xanax and stopping the Xanax. The panic may come back. But with the aid of a professional, you have a safety net in case the symptoms return. I say don’t go off your meds until you have talked to a professional. I see that you aren’t in therapy as well and I think being away from both treatments is unsafe.

      • Purpletrumpet

        Gretchen, ‘professionals’ know shit about withdrawal. Bipolar can be managed without meds. Withdrawal often mimics a relapse in symptoms when the ‘professional’ will say ‘you must go back on your meds’ which is utter rubbish.

  28. Owe Whel

    “Discontinuation syndrome” is a very disingenuous, sugar-coating of the truth about stopping these drugs- it’s WITHDRAWAL. Even if SSRIs do not produce ‘cravings’ akin to alcohol or cocaine, the effects of stopping are physically and psychologically devastating to many, especially for those of us who were on them for a decade-plus. Nausea, vomiting, food intolerance, akathisia, suicidality – some ongoing years after stopping.

    As rough as it is, I hope there is continuing education on this phenomenon so that patients don’t get stuck in a vicious loop cycle of stopping-starting under the mistaken belief that they are having “recurrent” depression or some other new-onset psychiatric disorder. Personally, I would recommend walking away from psychiatry altogether for SSRI ‘survivors’, but that is just me and I cannot say what is best for anyone other than myself.

    • M. LeDonne

      Having tried and failed to withdraw from sertraline over and over again, I couldn’t agree more. The term “discontinuation syndrome” is like saying, “The good news is that sertraline is not addicting, the bad news is that it’s really, really hard to stop.” I managed to conquer nicotine after nearly 30 years of smoking but, sadly, I believe I have met my match with sertraline.

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