More than 37 million adults in America are currently taking antidepressants. These rates have more than tripled since 2000, an astoundingly high number for any drug to be taken in society.

Given the scope of the number of antidepressants being prescribed and used in the U.S. and abroad, it would seem a matter of utmost importance that psychiatry should develop clinical guidelines for safe antidepressant discontinuation.

And yet, the literature on antidepressant withdrawal is sparse and—at best—confusing.

Psychiatry continues to adhere to a largely symptoms-based medication model of treatment.

It remains steadfast in minimizing and effectively denying responsibility for teaching physicians how to safely stop prescribed medications.

Why is this the case?

There simply isn’t enough incentive for the pharmaceutical industry to fund studies proving their drugs have negative consequences. Unfortunately, for the most part, government funding hasn’t stepped in to help create robust studies of antidepressant withdrawal, either.

In a recent study of 180 long-term antidepressant users, over 130 people reported withdrawal symptoms after cessation, and 45% of the participants felt addicted to the drugs.

As the authors of the study noted, “some patients were also critical of the lack of information given by prescribers with regard to adverse effects, including withdrawal symptoms. Some also expressed disappointment or frustration with the perceived lack of support available to them in managing withdrawal.”

What Withdrawal Treatment Plans Exist for SSRI Antidepressants?

While psychiatry lacks official, comprehensive guidelines for managing withdrawal from SSRI antidepressants, several strategies do exist.

However, these strategies are not formalized, do not reflect a field-wide consensus, and are based largely on the clinical experiences and personal preferences of individual physicians.

Proposed strategies for treating patients struggling with antidepressant discontinuation include: 

  1. Tapering based on symptoms: If side effects are concerning, temporarily increase the medication dose and then resume the taper more slowly.
  2. Switch to another SSRI or SNRI antidepressant with a longer half-life: Drugs with longer half-lives may produce fewer acute withdrawal symptoms because their levels decrease more slowly over time. Switching to Prozac is often utilized as a withdrawal treatment strategy, as Prozac has a relatively long half-life.
  3. Prescribe an adjunctive atypical antipsychotic: While atypical antipsychotic medications might help with symptoms, they come with their own concerning side effects. Antipsychotics are known to cause weight gain, increased cholesterol, and tardive dyskinesia — a potentially permanent movement disorder.
  4. Psychotherapy: Cognitive behavioral therapy, classic psychoanalysis, and mindfulness are often suggested as strategies to help ameliorate withdrawal symptoms.
  5. Exercise: Known to be helpful for depression, physical exercise is often recommended to try and decrease withdrawal symptoms.
  6. Phototherapy: Phototherapy utilizes artificial light exposure as a means to synchronize patients’ circadian rhythms, normalizing the sleep-wake cycle and helping to balance mood.
  7. Give up: Traditional psychiatry often recommends that patients who find it too difficult to come off medications ultimately stay on their medications indefinitely, even if the drugs are no longer providing any therapeutic benefits.

Reviewing these suggestions, I am struck by how little they offer the patient suffering from antidepressant withdrawal. Replacing a patient’s antidepressant with an SSRI with a longer half-life may lessen the severity of withdrawal symptoms to some unknown degree, but this is not always successful. Employing a slow taper is critical, but on its own, a taper is insufficient to effectively address withdrawal.

To effectively treat patients experiencing withdrawal from antidepressant medications, doctors must help patients manage their withdrawal symptoms as well as implement strategies to prevent depression relapse.

Lack of Clinical Trials for Antidepressant Withdrawal

Although all of the above-listed suggestions can be found in published medical and psychiatric literature, none have been verified by clinical trials. Psychiatrists are not taught these techniques and are not trained in them. These recommendations are not supported by research.

Instead, they represent the common practices that mental health clinicians have used in the past to treat patients struggling with medication discontinuation.

Recommendations for drug tapering protocols abound in the research literature, reflecting a stunning lack of professional consensus as to best practices.

  • Some studies suggest reducing a patient’s antidepressant dosage by 25% each week to ameliorate symptoms of withdrawal.
  • Other studies advise a longer taper of between six and eight weeks.
  • Still, other researchers have concluded that a four-month taper is best.
  • We even find studies claiming there is no distinct advantage to be gained through tapering as opposed to abrupt discontinuation.34,35

But how can psychiatry teach doctors to prescribe medications when the field does not know how to safely stop the medications?

Lacking research-based protocols for safely tapering patients off SSRI antidepressants, many psychiatrists and patients simply give up. If there is any consensus to be found in traditional psychiatry regarding antidepressant tapering, it is one of cynicism and defeat.

As one recent study puts it, since “. . . depression is a chronic disorder, we recommend continued, potentially indefinite, treatment to reduce the risk of relapse or recurrence . . .”1

In other words, some of the leading researchers in the field claim the only method proven to mitigate withdrawal from stopping antidepressants is to not stop in the first place!

While in the past psychiatrists could perhaps claim a certain level of ignorance about the risks and side effects of antidepressant medications, today’s psychiatrists cannot. Recommending permanent treatment with antidepressants as a way to prevent withdrawal is simply unacceptable.

After decades of treating patients taking antidepressants, I have curated a methodology to help patients successfully cease SSRI medication with a minimal amount of side effects. If you or a loved one are trying to stop taking antidepressant medication, please check out my ebook guide on antidepressant withdrawal.

If you are a physician and interested in learning about an effective method to help patients effectively wean off of antidepressants, please check out our course on Managing Medication Side Effects, or read my latest book, Functional Medicine for Antidepressant Withdrawal.

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References

  1. Jha MK, Rush AJ, Trivedi MH. When discontinuing SSRI antidepressants is a challenge: management tips. Am J Psychiatry. 2018;175(12):1176-1184.