Patients who abruptly discontinue antidepressants after taking them for years often face unpleasant and even dangerous symptoms due to a physical dependence. The best process is to follow a tapering schedule while consulting with a physician, according to a clinical review in The Journal of the American Osteopathic Association.
Patients with antidepressant discontinuation syndrome (ADS) often have flulike symptoms, insomnia, nausea, imbalance, sensory disturbances often described as electric shocks or “brain zaps” and hyperarousal, according to Mireille Rizkalla, PhD, Assistant Professor, Department of Clinical Integration at Midwestern University Chicago College of Osteopathic Medicine, and lead author on this review.
When patients stop taking older, first-generation antidepressants, they may also have more severe symptoms, including aggressiveness, catatonia, cognitive impairment and psychosis. Discontinuing any antidepressant also carries a risk of gradual worsening or relapsing of depression and anxiety as well as suicidal thoughts.
Dr. Rizkalla and her coauthors included the following recommended tapering schedules for different classes of antidepressants. However, she insists patients consult their physician before and throughout the process to monitor their symptoms and progress.
Symptoms of antidepressant discontinuation syndrome and recommendations for taper rates
|Drug||Recommended taper rate||Withdrawal effect|
|Monoamine oxidase inhibitor|
|Phenelzine||Reduction of 15 mg every 2 wk or 10% per wk||Headache, insomnia, myoclonic jerks, agitation, catatonia, delirium, delusions, hallucinations|
||Gradually taper over 3 mo||Influenza-like symptoms, headache, lethargy, insomnia, dizziness, nausea, akathisia, Parkinsonism, tremor, agitation, anxiety, low mood|
|Selective serotonin reuptake inhibitors|
|Gradual taper generally unnecessary due to long half-life and active metabolite||Influenza-like symptoms, headache, lethargy, abdominal pain, diarrhea, insomnia, dizziness, nausea, imbalance, electric shock, irritability, anxiety, low mood|
|Reduction of 10 mg every 5-7 d with a final dosage of 5-10 mg/d before discontinuation.|
|Sertraline||Reduction of 50 mg every 5-7 d with a final dose of 25-50 mg/d before discontinuation|
|Serotonin-norepinephrine reuptake inhibitor|
|Venlafaxine||Reduction of 25 mg every 5-7 d with a final dosage of 25-50 mg/d before discontinuation||Influenza-like symptoms, headache, lethargy, nausea, insomnia, dizziness, electric shock, anxiety, low mood|