Thinking of stopping antidepressants? Here’s what to think first

Summary: During the COVID-19 pandemic, there has been an increase in the use of antidepressants to combat symptoms of depression. Researchers discuss the impact of antidepressant use and provide guidelines for safe and effective withdrawal of antidepressant medications.

Source: The conversation

Mental health is essential to health and well-being. Yet two in five Australians aged 16-85 (44%) suffer from a mental illness in their lifetime, usually anxiety or depression. And more than 32 million antidepressant prescriptions are dispensed each year under the Pharmaceutical Benefits Scheme for these diagnoses.

The use of antidepressants has increased since the onset of the COVID pandemic at a faster rate than in recent decades. As we return to some semblance of normalcy, people may well be thinking about stopping their mental health medications, especially antidepressants.

But what are the risks of quitting or discontinuing these drugs? Here’s what to consider.

Is there a good time to stop antidepressants?

It may take several weeks after starting an antidepressant before symptoms begin to improve. During this time, the person may feel worse before they feel better, as side effects often occur before symptoms improve. Bothersome symptoms (nausea, diarrhea, or insomnia) usually improve once the body has adjusted to the new medication. So it’s important to give the antidepressant a “fair trial” and not stop too early in the process.

For people who have been diagnosed with first-episode anxiety or depression and are responding to their antidepressant, guidelines recommend a duration of use of six to 12 months, followed by a medical examination to assess whether taking medication is always indicated.

Of course, there are reasons you might consider stopping your antidepressant. They could include:

  • no longer experience symptoms of depression or anxiety
  • find other ways to cope
  • medicine that seems ineffective
  • long term use and want to take a break
  • a life event such as pregnancy, divorce, or job change
  • media influences, such as reports of treatments or depictions of people taking similar medications
  • side effects, stigma or pressure from family and friends.

go slow

In animal studies, restricted plasticity in specific parts of the brain (i.e. the brain’s ability to change connections or rewire itself) can cause features of depression or anxiety. How antidepressants work is not completely understood. However, recent evidence suggests that they protect or reverse some of these maladaptive neuroplastic changes.

Beneficial effects take time, and early withdrawal of antidepressants can thwart the neurophysiological adaptations of the drug. This can create a “shock to the system” and potentially lead to unwanted side effects such as withdrawal symptoms.

A slower reduction gives the brain time to readapt gradually.

What can go wrong when you abruptly stop antidepressants?

Stopping antidepressants abruptly, especially after a long period of use, will make most people – but not everyone – sick. It is impossible to tell in advance who will be affected, so it is advisable to reduce the dose slowly.

Stopping antidepressants (or reducing the dose) too quickly can cause antidepressant discontinuation syndrome in about 20% of people.

Withdrawal symptoms are variable but may include flu-like symptoms (lethargy, fatigue, headache, body aches, sweating), insomnia, nausea (sometimes vomiting), dizziness, sensory disturbances (such as burning or tingling), and hyperarousal ( anxiety, irritability, restlessness). , aggressiveness, mania, jerks).

Symptoms usually appear within ten days and usually disappear in two to three weeks. But occasionally, a prolonged withdrawal syndrome of several months may occur.

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The use of antidepressants has increased since the onset of the COVID pandemic at a faster rate than in recent decades. Image is in public domain

People who have had irregular doses, changed antidepressants, overlooked side effects, or had previous withdrawal symptoms are more likely to have prolonged symptoms and take longer to recover.

Is it withdrawal or relapse?

In mental illness, the cause of the symptoms can be difficult to differentiate. Side effects of antidepressants can mimic withdrawal symptoms or disease relapse, causing confusion for patients and prescribers.

Symptom overlap between antidepressant side effects, withdrawal, and relapse

Note: * indicates overlap.

Symptoms of anxiety or depression
difficulty concentrating
muscle aches
stomach ache
unexplained pain
difficulty controlling worrying feelings
Common side effects of antidepressants
drowsiness or insomnia*
weight gain/loss
sexual dysfunction
blurry vision
emotional numbness
Antidepressant withdrawal symptoms
sudden dizziness*
anxiety, restlessness*
electric shock sensations
flu-like symptoms (fever/chills)
nausea, stomach cramps
ringing in the ears
balance changes
disturbing dreams
feelings of detachment
blood pressure changes
irregular heartbeat
emotional symptoms
Source: provided by the author

Withdrawal symptoms tend to crop up irregularly like waves. This makes them different from a relapse of the original state, which has a more consistent pattern and takes longer to develop.

See also

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Stopping antidepressants is an important decision. Ask yourself if you are in the right frame of mind to make this change. Work with a trusted mental health professional to tailor a strategy to your personal situation to minimize the risk of withdrawal or relapse.

4 things to think about

Once you’ve thought about why you wanted to stop taking an antidepressant and if you’ve given it a chance to work, ask yourself if you feel physically and emotionally well and if you have people supporting you in your life. life.

If you still wish to engage in a process of withdrawal or discontinuation of medication:

1. approach your prescriber honestly with your reasons for quitting and work towards a shared decision to reduce the dose

2. plan dose reduction at a rate appropriate to your personal health condition and duration of antidepressant use (months versus years). Longer use requires a longer cone. The dose reduction can be as little as 10% or as much as 25% every one to two weeks, followed by two to four more weeks when you can observe how you feel and manage the reduced dose. If symptoms are tolerable, continue tapering as before. But be prepared to go back to the previous dose or a 10% dose increase if symptoms occur

3. watch for any symptoms and health using a daily diary that records drug dosage throughout the taper

4. maximize the chances of success with self-care: healthy eating, regular exercise and sleep.

Every drug we take should have a re-evaluation date. People taking antidepressants should have their medication reviewed no later than 12 months after starting.

This gives the patient the opportunity to discuss the risks versus the benefits of continuing to take their medication or to develop a common strategy for safe discontinuation.

About this psychology and psychopharmacology research news

Author: Treasure McGuire
Source: The conversation
Contact: Treasure McGuire – The Conversation
Picture: Image is in public domain

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