In April of 2018, the New York Times released an article entitled, “Many People Taking Antidepressants Discover They Cannot Quit.” (1) They interviewed a number of people with severe antidepressant withdrawal symptoms and found that there is a growing number of consumers and physicians alike who are alarmed at the dependency formed by antidepressants — and how incredibly hard it is to stop taking these powerful psychotropic drugs.
These stories echo the truth known by many of us who have studied natural health for years: Antidepressants (and many other psychoactive drugs) are far too dangerous — read my piece on antidepressant side effects — and not nearly effective enough to justify their vast prescriptions in this modern world.
If you take an antidepressant (or know someone who does), this information is vital to your decisions advocating for your mental and physical health. Read more to discover the most common antidepressant withdrawal symptoms and ways you can minimize these effects if you choose to wean from your prescription.
What Are Antidepressants?
Antidepressants are one class of brain-altering medications intended to reduce the signs of depression. Unfortunately, they were formulated based on a false premise known as the chemical imbalance myth, which assumes that simple chemical imbalances cause mood disorders. (2)
As time goes on, it becomes more apparent that antidepressants aren’t actually as effective as the public may assume them to be. Experienced physicians and researchers have become concerned that the benefits of these drugs are outweighed by their major side effects, including antidepressant withdrawal symptoms. (3, 4, 5)
In fact, one review of many clinical trials determined that the “true drug effect” of antidepressants is only about 10–20 percent, meaning that 80–90 percent of patients in these trials either responded to a placebo effect or did not respond at all. (6)
Antidepressants fall into a few categories, the most popular being SSRIs or “selective serotonin reuptake inhibitors.” These, along with SNRIs (serotonin and norepinephrine reuptake inhibitors), are the more modern drugs most doctors choose rather than more “outdated” tricyclic antidepressants (TCAs).
Some drugs used for depression don’t fit into these categories and are often used as secondary treatments when “preferable” options don’t work or to increase the impact of the main prescribed antidepressant. They may also be used “off-label,” which happens when your doctor can legally prescribe a drug for depression that hasn’t been FDA-approved for the condition.
- Fluoxetine (Prozac)
- Citalopram (Celexa)
- Sertraline (Zoloft)
- Paroxetine (Paxil, Pexeva, Brisdelle)
- Escitalopram (Lexapro)
- Vortioxetine (Trintellix)
- Venlafaxine (Effexor XR)
- Duloxetine (Cymbalta, Irenka)
- Reboxetine (Edronax)
- Cyclics (tricyclic or tetracyclic, also referred to as TCAs)
- Amitriptyline (Elavil)
- Amoxapine (Asendin)
- Desipramine (Norpramin, Pertofrane)
- Doxepin (Silenor, Zonalon, Prudoxin)
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
- Protriptyline (Vivactil)
- Trimipramine (Surmontil)
- Maprotiline (Ludiomil)
- Rasagiline (Azilect)
- Selegiline (Eldepryl, Zelapar, Emsam)
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
- Bupropion (Zyban, Aplenzin, Wellbutrin XL)
- Trazadone (Desyrel)
- Brexpiprazole (Rixulti) (antipsychotic used as an adjunctive therapy for major depressive disorder)
Many people consider antidepressants to be designed for short-term use only — supported by the American Psychological Association’s very own practice guideline published back in 1993. (10)
However, when these drugs were first developed and studied, the length of use wasn’t a concern — and no research was made available explaining what happens when you go off an antidepressant. Studies on these have rarely gone beyond a two-year observational period. (11) Plus… it’s not very profitable for the pharmaceutical companies selling these products to figure out how short-term they can make their products.
So, what does happen when you stop taking an antidepressant?
Antidepressant Withdrawal Symptoms
The accepted medical term for the phenomenon of withdrawal symptoms of antibiotics is “discontinuation syndrome.” (12)
A 2017 survey of patients coming off antidepressants found that only a little over half of the respondents were able to completely discontinue antidepressant use. Nearly three quarters of the people who answered wanted to stop taking these medications due to the long-term side effects of the drugs, and 54 percent of them rated their withdrawal symptoms as “severe.” (13)
It’s important to note that these symptoms, particularly when discontinuing SSRIs, tend to come on in the first one to four days off the drugs and last a little less than a month for many people. However, as stated in the New York Times, some patients find that it takes many months, sometimes even two years, to taper off the medications entirely. (1)
Others, like in the 2017 survey I just mentioned, give up and decide to stay on their medications, despite the consequences, because antidepressant withdrawal symptoms are simply too difficult to manage. (13)
As Carey and Gebeloff share: (1)
The medical profession has no good answer for people struggling to stop taking the drugs — no scientifically backed guidelines, no means to determine who’s at highest risk, no way to tailor appropriate strategies to individuals.
“Some people are essentially being parked on these drugs for convenience’s sake because it’s difficult to tackle the issue of taking them off,” said Dr. Anthony Kendrick, a professor of primary care at the University of Southampton in Britain.
Medical literature is undecided on a comprehensive list of these symptoms; however, I’ve outlined below the most frequently reported in research and anecdotal reports. (14, 15, 16, 17, 18, 19, 20, 21, 22)
1. Fatigue and Sleep Disturbances
Chronic fatigue is repeatedly a common withdrawal symptom of antidepressant discontinuation, even when medication is very slowly tapered off. Another sleep-related symptom of antidepressant withdrawal is having vivid dreams, nightmares or other types of sleep disturbances, which likely contribute to daytime fatigue and drowsiness. Some reports define insomnia specifically as an antidepressant withdrawal symptom.
2. Brain Zaps and Paresthesia
Sometimes used interchangeably, brain zaps and/or paresthesia are concerning neurological antidepressant withdrawal symptoms.
Paresthesia is described as “ a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body. The sensation, which happens without warning, is usually painless and described as tingling or numbness, skin crawling, or itching.” Withdrawal from various SSRIs is reportedly associated with paresthesia.
On the other hand, the phenomenon of brain zaps is a different but related type of sensation. They are connected most closely with SSRIs and one MAOI, phenelzine, and are also known as “brain shocks,” “brain shivers,” “electric brain thingies,” “brain flips,” “head shocks” or “cranial zings.” (23, 24)
Brain zaps are described as the feeling of electricity in the brain that results in a loss of some awareness and physical movements. Two case reports explain patients who thought they had experienced stroke and whose symptoms went away after discontinuing the antidepressants. (25)
These “zaps” have not been thoroughly explained or defined in medical literature yet; however, one doctor describes his theory of where they come from as “some kind of random discharge of nerve impulses in the brain.” (24) There is no treatment known to eliminate brain zaps, although most conventional medical practitioners recommend starting back on the medication that caused this withdrawal symptom. (23)
Two doctors, Dr. Tom Stockman of East London (a psychiatrist) and Deacon Shoenberger, PhD, have published personal accounts of their own experience withdrawing from antidepressants — and both experienced brain zaps and paresthesia. Both accounts are fascinating, as they have each seen patients and recommended antidepressants as treatment. Stockmann says to the New York Times, “I knew some people experienced withdrawal reactions, but I had no idea how hard it would be.” (27, 1)
3. Cognitive Impairment
Closely tied with movement disorders, mood issues and anxiety, there are several forms of cognitive impairment linked to antidepressant withdrawal. These include hallucinations, delusions, delirium, impaired memory, poor stress tolerance, impaired concentration/memory, disorientation and cataplexy.
The last on that list is an uncontrollable paralysis and/or weakness of the muscles brought on by emotional highs, often including laughter, but is thought of as a neurological issue, as it originates in the brain.
4. Suicidal Thoughts
Increased chance of suicidal thoughts is a well-known side effect of antidepressants. (28) Did you know suicidal thoughts often increase in frequency for people withdrawing from antidepressants? This is another challenging symptom, as recurring suicidal thoughts can also be a sign of a relapse back into depression.
5. Irritability and Mood Problems
It’s not abnormal to experience increased irritability and mood problems as you detox from antidepressants. Some of the literature describes these as “mood fluctuations,” “agitations” and “restlessness.”
One online patient survey study discussed the differences between an “immediate withdrawal phase,” which lasts up to six weeks, and a “postwithdrawal phase,” which begins after drug withdrawal and may persist for years. The authors define these postwithdrawal symptoms as “symptoms that persist after actual withdrawal has been completed and may last for years and occur after 6 weeks of drug withdrawal, rarely disappear spontaneously, and are sufficiently severe and disabling to have patients returned to previous drug treatment.” (29)
In this survey, many patients reported developing depressive disorders, including manic depression and mood swings, after the drug had been cleared of their system. This is particularly difficult to treat, as it’s hard to recognize the difference between relapses and depression as a postwithdrawal symptom.
Many people coming off antidepressants experience headaches. These may range from mild to very severe.
7. Sexual Dysfunction
According to one symptom survey, a case report shared about a man who “experienced hypersensitivity of the genitals and premature ejaculation” when coming off citalopram. (21)
8. Gastrointestinal Issues
In addition to nausea and vomiting, cessation of antidepressants can lead to other gastrointestinal issues, including stomach pain and loose stools/diarrhea.
9. Movement Disorders
Tardive dyskinesia is a movement disorder most frequently associated with antipsychotic drugs, as it is a very common side effect of these medications. However, variations of this may also occur during antidepressant withdrawal. Different sources describe similar occurrences to this as akathisia, movement disorders, unstable gait and dystonic reactions.
These may not go away within just a few weeks — there is some evidence that movement disorders may be a postwithdrawal symptom that persists for a long time. (29)
10. Mania and/or Anxiety
While anxiety and/or mania may happy when withdrawing from a number of antidepressants, they are more severe when observed in patients ceasing MAOIs. These may also be postwithdrawal symptoms and last longer than the drug’s actual half-life. (29)
Other antidepressant withdrawal symptoms include:
11. Anorexia Nervosa
12. Runny Nose
13. Excessive Sweating (Diaphoresis)
14. Speech Changes
15. Nausea and Vomiting
17. Problems with Sensory Input (like Tinnitus)
18. Aggressive or Impulsive Behavior
19. Bedwetting (Nocturnal Enuresis)
20. Drop in Blood Pressure
21. Muscle Pain or Weakness (Myalgia)
Natural Ways to Help Improve Antidepressant Withdrawal
The best ways to come off antidepressants safely include: (13, 14)
- Contact with friends and support system, particularly those with experience withdrawing from antidepressants
- Staying in contact with your prescribing doctor
- Slowly tapering off dosages
There are certain antidepressants associated with worse or longer withdrawal symptoms, particularly drugs with shorter half-lives like fluvoxamine, paroxetine and clomipramine, so it’s also important to consider that when choosing to start one of these prescriptions in the first place, should your doctor recommend it.
Coming off antidepressants can be an extremely challenging experience. This process should never be done cold turkey, and should always be supervised by a qualified professional.
One surveyed patient astounded at the lack of information they were given, a realization that echoes through many accounts of this process: (30)
I was never fully informed of all side effects, short or long-term. I have kept the information I receive when prescribed … I am now only finding out the permanent damage from medication that the prescriber knew about but didn’t tell me. If I had been more fully informed I would not have taken the medication for a long time or at all.
Common antidepressant withdrawal symptoms include:
- Fatigue and sleep disturbances
- Brain zaps and paresthesia
- Cognitive impairment
- Suicidal thoughts
- Irritability and mood problems
- Sexual dysfunction
- Gastrointestinal issues
- Movement disorders
- Mania and/or anxiety
- Anorexia nervosa
- Runny nose
- Excessive sweating (diaphoresis)
- Speech changes
- Nausea and vomiting
- Problems with sensory input (like tinnitus)
- Aggressive or impulsive behavior
- Bedwetting (nocturnal enuresis)
- Drop in blood pressure
- Muscle pain or weakness (myalgia)
Being informed, in contact with your prescriber and part of a healthy support system are great ways to deal with antidepressant withdrawal symptoms in a safe, natural way.
The post Antidepressant Withdrawal Symptoms to Watch Out For appeared first on Dr. Axe.
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