New Research Says Slow Tapering of Antidepresssants Works Best: A Look at the Alternatives

Patients need to know the best way to stop their antidepressant use to ensure they remain stable, healthy, and symptom-free.

Whether antidepressants change lives or cause destabilizing side effects, there are plenty of people who think about stopping their prescription.

But for years, psychiatrists have warned about the dangers of suddenly stopping antidepressants. So, what does one do to avoid the risks?

There are a few options, according to a new study published in The Lancet. People could stop taking the drug abruptly, they could taper off the drug gradually, they could come off the drug quickly, or they can continue taking the antidepressant with no changes at all. 

As it turns out, there may be only one safe solution. According to the research, slowly tapering off the drug with the support of a psychiatrist is the safest option of all. Otherwise, people who take antidepressants may feel symptoms that no one wants to experience. 

The public may find it helpful to understand how antidepressants affect the brain and body. Understanding the effects of antidepressant use is crucial to knowing how to manage both the use and discontinuation of the medication.  

Antidepressants have been lauded as miracle drugs by the public. These medications target neurotransmitters such as serotonin, a compound responsible for carrying messages to the nerve cells in the brain. In most cases, antidepressants block the reabsorrption ofr these neurotransmitters, which allows for better mood regulation. Medications that do this are known as Selective Serotonin Reuptake Inhibitors (SSRIs). These drugs include Sertraline (Zoloft), Fluoexitine (Prozac), Citalopram (Celexa), Fluvoxamine (Luvox), and Escitalopram (Lexapro). SSRIs are the most common of all antidepressants because they cause fewer severe side effects.  

Despite their prevalence, the abrupt cessation of SSRIs is known to induce serious withdrawal symptoms, a condition referred to as Antidepressant Discontinuation Syndrome. The severity of this condition explains the importance of the new research. A recent study found that one in six people experience withdrawal symptoms after ceasing to use antidepressants. This discovery dates back to the 1950s, not long after the first antidepressants were discovered.

Eli Lilly, a fierce advocate of the pharmaceutical industry, was the man behind Eli Lilly and Company, a business that was responsible for the manufacturing and production of three notable drugs, including insulin, penicillin, and notably, Prozac. (released to the public in 1988). As part of the industry's ongoing redefining of drug dependency, Lilly's company was financially linked to researchers who discovered that an older class of habit-forming drugs known as trycylic antidepressants was linked to severe withdrawal effects when discontinued.  These drugs were reported to cause stomach distress, movement disorders, mania, and sleep disturbances, among other effects.

As research continued, newer classes of antidepressants were manufactured, resulting in fewer, less severe side effects without the risk of dependency. Today, experts know that even newer drugs, including SSRIs, and their alternatives, Selective Norepinephrine Reuptake Inhibitors (SNRIs), and Monoamine Oxidase Inhibitors (MAIOs), can cause withdrawal effects when reduced or discontinued. 

Withdrawal symptoms due to antidepressant discontinuation are severe and may last for months or years, but generally take place when a patient is taking antidepressants for at least four weeks. The timeline aligns with the length of time it takes for the medication to build up in one's system. In most cases, people experiencing these effects must return to taking the drugs to alleviate symptoms, which are  diverse and may include any of the following effects:

• Insomnia (trouble sleeping)/sleep disturbances (nightmares, drowsiness)
• sensory disturbances (tremors, vertigo, dizziness, poor balance)
• Flu-like symptoms (nausea, sweating, diarrhea, headaches)
• Depression/suicidal ideation
• Anxiety

Living with discontinuation syndrome is highly discouraged by psychiatrists, as the symptoms, in worst cases, can lead to long-term impairment or disability. Moreover, the  risk for suicide is increased when discontinuation syndrome is a factor. Psychiatrists have come up with guidelines to reduce or eliminate the risk of withdrawal in patients who want to stop their use of antidepressants. Following them is likely to improve both mood and well-being.

The timeline and severity of antidepressant withdrawal symptoms is influenced by the length of time the drug has been in the body, and the dosage in which the medication was taken. At high doses, patients are likely to experience more severe effects, though this is by no means guaranteed.  Given the potential for health complications, withdrawal must be avoided at all costs.  Patients who withdraw face an increased risk for relapse, meaning they be more likely to experience a severe depressive episode.

Psychiatrists' recommendations align with the new research. Patients can avoid physical or mental distress, and can resume normal functioning. Patients who adhere to the appropriate discontinuation method can still pursue goals and continue with their treatment plan, provided they keep up with counseling or therapy as needed. 

However, certain lifestyle choices or behaviors will affect the severity and duration of withdrawal. Should withdrawal effects persist, become disabling, or place the patient at risk to themselves or others, following expert guidelines will reduce the burden patients carry. That said, alternatives aside from tapering with support are more likely to be harmful.

Psychiatrists who wish to support patients through fast tapering may face difficulty reducing or eliminating withdrawal effects, as they may occur within three days. Effects may become uncontrollable or too severe within a week of fast tapering. Without being able to support their patients, psychiatrists can't monitor or alleviate withdrawal effects because patients are likely to be ill and unable to adhere to their treatment plan.

Psychiatrists wishing to prescribe helpful medications or resume an antidepressant are placed in a bind should the patient choose to taper off the medication too quickly without support. Psychiatrists require weekly interaction with patients experiencing withdrawal. However, patients who aren't supported may choose to live with withdrawal effects indefinitely, which increases the severity and duration of withdrawal effects.

Even with slow tapering, withdrawal effects may present in patients, especially if tapering doesn't continue for over four weeks. Though patients may experience less severe withdrawal effects, support is still necessary to avoid the possibility of relapse. Patients who taper off antidepressants slowly over four weeks still need support, as depressive symptoms may return or worsen without monitoring and intervention from a psychiatrist.

Following expert guidelines set forth by mental health professionals will decrease the risk for relapse and help to ensure patients' stability. Pyschiatrists recommend a healthy lifestyle to reduce or eliminate the severity of antidepressant discontinuation syndrome.

Expert recommendations include:

• Eating fruits and vegetables
• Drinking plenty of water
• Getting adequate rest
• Keeping in touch with one's treatment team
• Seeking support from relatives and friends
• Limiting caffeine intake
• Restricting sugary foods
• Avoiding alcohol or substances

The healthier patients are, the less severe their withdrawals symptoms will be, and the greater the ability a psychiatrist has to provide them with support. Patients must take withdrawal effects seriously and restrict behavviors that could increase their risk for relapse.. 

Antidepressants are among the most helpful medications on the market, but patients wishing to cease use must remember the importance of caution and communication,. as these values are essential to maintaining stability and ensuring a healthy life.

Kevin Brown writes on mental health, addiction, and self-improvement. He lives and writes from Maryland.