Doctor's Answers (2)
It is not uncommon to develop discontinuation symptoms following cessation of antidepressant treatment. The term 'discontinuation symptoms' is preferred in your scenario as you describe symptoms experienced on stopping prescribed drugs that are not drugs of dependence. Discontinuations symptoms include irritability, headache, nausea, vomiting, sweating, pins and needles sensation, unsteady of gait, dizziness exacerbated by movement, insomnia, increased dreaming and flu-like symptoms.
The onset of symptoms is usually within 5 days of stopping antidepressant treatment. When taken continuously for 6 weeks or longer, antidepressants should not be stopped suddenly unless a serious side effect has developed.
Generally, antidepressant therapy should be discontinued over at least a 4-week period. This is not required with fluoxetine which has a long half life and is therefore likely to remain in the body over a long time. Discontinuation symptoms can occur after missed doses if the antidepressant prescribed has a short half -life. (e.g, paroxetine, venlafaxine).
In most cases, the symptoms are mild and will pass in a few days. If symptoms are severe, what I would do is to re-introduce the original antidepressant (or another with a longer half life from the same class) and taper gradually while monitoring for symptoms.
For persons suffering from a first episode of major depression, it is advisable to take the antidepressant for about 9 months or so. Do discuss with your doctor first before you stop the antidepressant. If the course of treatment is too short, there is a high chance that the depressive symptoms will come back.
Cheers! Take good care and work closely with a doctor whom you trust.
Dr Ng Beng Yeong
First of all, please go to see your psychiatrist if you've ran out of medications. Medications should always only be discontinued under the instructions of your doctor.
Another thing is - antidepressant treatments should usually be continued at the same dose for at least 4 months to 12 months for them to be the most effective.
When coming off them, antidepressants dosages should be slowly reduced, or "tapered":
Tapering helps your brain and body adjust to the changes. This is because antidepressants work by altering the levels of neurotransmitters in your body, which eventually adapt to the current level of neurotransmitters.
If the amount of neurotransmitters changes too much too fast — for example, because you've suddenly stopped taking your antidepressant, it's quite common to get "flu-like withdrawal symptoms", including nausea and headaches (like you've experienced due to abruptly stopping).
The onset of withdrawal symptoms is usually within 3 - 5 days of stopping the medicine, and will generally last for 2 - 6 weeks.
However, please don't mistake withdrawal symptoms with being "addicted" to a drug. Antidepressants are not "addictive" - you don't get cravings for them or need to keep increasing the dose to get the same effect.
As a final word, it's quite common for patients to want to stop taking anti-depressants for 2 reasons:
1. Afraid of "addiction" - doesn't happen, as explained above.
2. Adverse side effects of the anti-depressant.
If your reason for stopping is because of the side effects, there are many alternative anti-depressant medications that can help you - please discuss this wtih your doctor.
Never hesitate to reach out if you feel in despair. Help is just a phone call away.