How to Quit Antidepressants: Very Slowly, Doctors Say

Mustering solid evidence, two researchers have denounced the standard psychiatric guidelines for how best to wean patients from depression medications.

Comments: 109

  1. Paxil changed my world in the best possible way. I have since done lateral switches to other antidepressants. None has been equally effective, but remembering the severity of depression before SSRIs, it a place I never want to go again. Unfortunately, after a few years of use, you "break through," and the drugs just hold back the floodgates. Nevertheless, they have allowed me to live a very successful life- night and day.

  2. Since 2016 the FDA has required boxed warnings on coincident intake of opioids and certain anti-depressants. The longer the detoxification curve both classes of drugs have, the greater the chances for causing addiction. The role of the serotonin transporter is being identified here as a major factor, but it is likely that there are other interactions in background that are also critical and possibly determinative. The fact that doctors have always advocated people taking anti-depressives for an accumulative effect has been of concern. Now it is appearing that concern applies to many patients trying to return to their own "pre-Paxil" state. How ominous.

  3. @jwp-nyc, people get dependent on such meds, not addicted. There's a difference. You don't chase a high on these meds.

  4. This is such an important article about an epidemic of people having terrible difficulty when they want to stop taking SSRI’s because they no longer work, because the side effects are intolerable, or because they learn about the dangers of long-term use. These drugs are studied in trials for a matter of weeks. People who have been on them for years or decades are unwitting guinea pigs. There has been little help or advice from psychiatrists about weaning off properly, but I hope that is starting to change. I am glad to see the word “withdrawal” used in the article. The phenomenon has been called “antidepressant discontinuation syndrome,” but those who have done both say that going off antidepressants was unquestionably harder than going off heroin. Some have years of pain and disability. Let’s hope that psychiatrists who freely prescribe antidepressants will now also freely advise how to taper in a way that minimizes agony. And help patients recognize that what may look like the return of their initial symptoms may well be symptoms of withdrawal.

  5. Not only psychiatrists but GPs, as well. Most people I know who have been prescribed anti-depressants have never seen a psychiatrist, psychologist, etc.

  6. This is so good to see and so long overdue. I figured this out for myself 20 years ago trying to get off Effexor. I was experiencing the dreaded electric brain-bounce. My shrink did that doctor thing they do when they don't know the answer or simply don't believe you. He sat silent, offering no help or guidance. Glad the research is finally catching up.

  7. @Rob It took me three attempts before I successfully got off Effexor. My DO during the final attempt had me cut down over a 6 month period. For me, it finally worked. Up to that point, the doctors I talked to had the deer in the headlights look when I reported the problems coming off Effexor. This guy said right from the get-go that this was going to take an extended period of time with very small dosage reduction steps. He never questioned the reactions on past attempts, seemed to understand.

  8. When in ER for cancer treatment complications a couple years ago, a young resident told me flatly that Effexor is the hardest antidepressant to stop taking. I have postponed trying to do so, after 6 years of taking it, but your comments are encouraging. Thank you.

  9. @Rob I was on Effexor for three days and almost went to the ER because of the adverse effects. I had brain zaps for the following 15 years. Between the adverse effects of Effexor and statins I no longer use any perscription drugs.

  10. After almost 30 years on 20 mg daily of Prozac, which enabled me to live a fairly normal hectic life, I decided to get off of it now that my life is calmer. I took 6 months, decreasing very gradually. I decreased my weekly total one pill at a time, staying on the lower dosage for 3 weeks before reducing by another pill. (I did run my scheduled reduction by my GP who approved it.) Prozac stays in the system for a while, so handling this on a weekly basis worked for me. I eventually went down to 10 mg pills to taper at the end. I have had no withdrawal symptoms, and seem to be coping with my post-Prozac life. Good luck to all who want to get off anti-depressants.

  11. When my husband entered the end phase of early onset Alzheimer’s my internist prescribed a 20mg a day pill of Lexapro. After 3 years, with her guidance, I tried to taper off. 4 months in bed in a fetal position with indescribable migraine headaches. Full body pain 24/7. A visit to the ER. My doctor had not had a patient with this kind of withdrawal but did not discount me. I will go to my grave on Lexapro. This research is absolutely true.

  12. @Marina Beirne your experience sounds quite horrifying. I know more women on Lexapro than I can count. It seems to be the menopause drug. Scary stuff. I hope you are well.

  13. I'm far more concerned about taking a mood-altering drug for depression, anxiety, or concentration difficulties than taking an opiod for pain. This stuff is designed to work on--meaning change--the brain. I fail to understand why physicians are so quick to prescribe them without also issuing warnings about dependence, withdrawal, and permanent alterations to cognition.

  14. @H.L. Antidepressants saved me from my rages, suicidal feelings and high sex drive. Without them, I probably would not have been able to keep a job and stay independent. Try living without eyeglasses when your eyes weaken. For some of us, antidepressants are a necessity.

  15. I was put on Lexapro in 2002 while undergoing 48 weeks of treatment for HepC. After treatment, I developed several back problems leading to chronic pain. My doctor said to stay on the Lexapro because it helps with the anxiety of chronic pain. Last year I decided to take a new approach to pain management and discontinued all of my medicines, even my hormones, at the same time, with my doctor’s approval. Maybe it was because I was ready, or because I had tapered down on all of them in preparation, but the worst symptom I had was leg twitching for a few days. Every other time I tried to stop the Lexapro, the brain zaps were unbearable. It’s been a year of post medication living and I’m ok. Medications were definitely easier. Managing pain and the resulting emotions takes a lot of work without them. The biggest benefit is the ability to concentrate and remember things again.

  16. I was having problems with anxiety, including panic attacks, when I was living in Australia. I thought it might be related to peri menopause and went to a women’s health clinic. I saw an unsympathetic doctor who recommended Zoloft. I was skeptical and specifically asked if I would have problems withdrawing from it, because I had heard some news stories. She said it shouldn’t be a problem. I still waited a while before I started taking it. However, my work situation was becoming more stressful and causing more anxiety episodes so I filled the prescription. It always caused a little surge of anxiety an hour or so after taking the pill, which was not pleasant. I stayed on it a few months and then stopped taking it rather quickly. I went through several weeks of unpleasant withdrawal symptoms. I had brain zaps and sensitivity to sound and light. I still have an occasional brain zap 5 years later, which I had never experienced before Zoloft withdrawal. I am furious with that doctor who so casually prescribed Zoloft for anxiety (their are many other options) and dismissed my concerns about withdrawal issues. She lied to me. The effects were very real, completely physiological and long lasting.

  17. I quit Lexapro cold turkey when I found out it was making the fatigue from my CFS worse. First year was rough in terms of mood swings but then everything leveled off. And my hot flashes returned with a vengeance but I found something else that worked on them. I had tried other antidepressants and the side effects are too much to deal with. I took Lexapro for about 6-7 years and it dramatically helped my anxiety and depression, also prevented migraines, treated hot flashes and helped my chronic pain. Before that I had taken doxepin for 10 years. I miss being anxiety free and that state of bliss but the fatigue was a deal breaker.

  18. Why quit antidepressants if they're working? In 1993 a psychiatrist told me serotonin re-uptake was part of my genetic makeup, and for sertraline to remain effective I'd have to continue taking it indefinitely. I've never looked back. Now, I have no desire to be "weaned" from an inexpensive medication which has had such a profound and positive impact on my life.

  19. @BobMeinetz Thank you. I wonder why, too. Sertraline works, no apparent side effects after 15 years. Why stop? If I miss a dose, it's OK, but two doses and the emotional (usually rage) buildup begins. Sertraline has given me calm, patience, only good results.

  20. @BobMeinetz It's great that you're not having side effects, but many people have tremendous weight gain (e.g. 40 lbs or more) and overtime have more and more problems with short term memory loss on these medications. Btw, the idea that people need to remain on antidepressants "indefinitely" was heavily pushed by some drug companies. There's a lot of research showing that for the majority of people, they're only effective in the acute phase (1st 3-6 months) of a depressive episode.

  21. @D. Baker Sertraline, like most drugs, has a range of side effects. For me they've been minimal, but they should be a factor for anyone considering it for long-term use. Persistent depressive disorder (dysthymia) is a hereditary, biological serotonin imbalance in the brain - it doesn't come and go. Sertraline serves as a proactive check on slipping into severe depression, and yes - after a while it can almost feel like you don't need it anymore. In 1998 I was feeling pretty good so I tapered off. Then a personal crisis arose, and I promptly slipped back into the darkness that had been my home for 30 years. I resumed taking Sertraline, and within 2 days the crisis had somehow become manageable. I've taken it every day since. So excuse me if "a lot of research" doesn't hold a lot of weight with me.

  22. Suffering depression through the 1980's I was prescribed Prozac aka fluoxetine by a psychiatrist sometime soon after it became available. It was like a miracle for me--feeling so much better. But the idea at least then for this psychiatrist was that I was now cured, quit the drug. Surprise surprise back came the depression in spades. I also wonder at the haphazard weaning when changing anti-depressant drugs. Sometimes it has been an overnight switch, other times a slow weaning before switching drugs.

  23. These medications have withdrawal symptoms worse than opioids! This should be headlines in every newspaper in the world AND all doctors should be aware of this horrible problem. How do we get the word out to medical professionals?

  24. @Alan Burnham So you must believe we have an antidepressant epidemic where people who can't get prescriptions for antidepressants are buying them on the street. And I must have missed the stories about there being more antidepressant overdose deaths than the 70,000 occurring every year from opioids.

  25. People don't "Quit" antidepressants. You quit bad habits and addictive substances. You "discontinue" or "stop taking" prescribed, responsibly used medicines. "Quit" is great click-bait, but it stigmatizes mental illness. The information in this article is exceedingly valuable to those on antidepressants, but it's tone and word-choice suggests the choice to use psychiatric medicine is akin to addiction. Physical dependence is not addiction; addiction implies misuse, a fear of not being able to get your "fix," or a habit that impedes your ability to live your life and care for those you love. People on antidepressants experience none of things, in fact their medicine does the reverse! The article suggests a shocking lack of knowledge on the part of prescribing doctors and indicates that patients are denied information that they need to provide informed consent to starting and discontinuing medicine. But those with mental illness should not have to feel shamed to get the valuable information in this article. How many patients missed this important article because they wished to avoid the sigma of its headline?

  26. @Chris I agree - people "quit" bad habits. My Zoloft is not a bad habit, it's what allows me to function. Like many others, I am concerned about the long term effects of the drug down the road, but I don't wish at all that I hadn't gone on it because I need it. I think some of the people who are very anti-antidepressant have never experienced what it is like to have depression severe enough that it doesn't matter to you whether you will be able to stop taking the pills later on or not, you are just so glad to have some relief.

  27. @Why suffer one's llife away? Must people be stoic? It's all nonsense..Life is too, too short..

  28. I stopped taking Effexor nearly 10 years ago after taking 50mg daily for nearly 5 years. To this day, when extremely tired, I still experience the brain-zap sensation. The fact that some doctors ignore this in light of a lack of long-term available data on users of Effexor is disturbing.

  29. My psychiatrist, on being asked when I could stop Paxil, asked me what would You answer to a Type One diabetic who asked when to stop insulin! Was his reasoning correct? Other physicians have since tried to help me taper off. Doesn’t work. What happens now?

  30. This nails it. I’ve never taken antidepressants, but my withdrawal from the anticonvulsant Lamictal was hell on wheels. Lamictal has a notorious withdrawal that is completely denied by the medical community, and side effects while on Lamictal were the worst of any drug I was on. Benedict, please do an investigative piece on Lamictal. There’s an army of people struggling to get off that drug.

  31. @Beth, Lamictal isn't all bad. It keeps me from having epileptic seizures.

  32. As a master's level behavioral health therapist I thought I knew how to taper 50 mg Zoloft I had taken for years. I Spoke with psychiatrists with whom I worked etc., and did a taper so over 3 months decreasing the dose every week until it was a crumb. The first month off the taper I was fine. The second month I went into a very deep depression where I couldn't eat sleep or function. At first I didn't connect being off the antidepressant with the way I felt because I had followed directions. The only time the depression lifted a bit was when working out. A psychiatrist put me back on the Zoloft at 50mgs and slowly over about 5 months I was back. I was lucky. I joke that in the Zombie Apocalypse I will be breaking into every pharmacy to hoard Zoloft. I will never go off it again. I has given me great empathy for clients who are depressed. I now to have been there and know how awful it truly is.

  33. I was diagnosed with Major Depression about 15 years ago. I started on Paxil, some things changed and had a seamless transition to Effexor. The point of therapy was to change thinking habits. As that worked, after less than 5 years, I got off Effexor in about 6 weeks with no problems. I've been off SSRIs ever since. I say this here because I want people to know that SSRIs are NOT necessarily a lifetime thing. And they are not necessarily hard to stop in a matter of months. At least in this one case, no withdrawal issues. Your mileage may NOT vary. Although it might.

  34. Thank you for this story, which validates my experience coming off of Paxil years ago after taking this drug seven years for panic attacks. After one failed attempt at short-term weaning, I was fortunate enough to discover the site Paxil Progress and learned that I would need to taper off at a much slower rate. It ended up taking me a year and a half, reducing my dose very gradually every few weeks after the still-extremely uncomfortable withdrawal symptoms--headaches, insomnia, increased anxiety, mood swings, brain zaps, etc.--faded. I know that these drugs are life-savers for many people. However, I think it's important for prescribing doctors to warn their patients about this significant down-side to these drugs. I definitely wish I'd known about it beforehand.

  35. I tapered off effexor this summer after about 15 years taking the drug. Effexor no longer worked for me. My taper was about two months and supervised by a psychiatrist. When I began the taper, she commented that it would likely be “unpleasant, but not dangerous.” It was unpleasant...unless one enjoys hot flashes...but dangerous only to anyone who had to deal with me. Having information and a compassionate clinician who empowered me to slow my taper by a few weeks when it was too unpleasant made all the difference. Unfortunately too many patients don’t have information and support - and while I can only draw on my experience, I have to wonder if lack of support creates new anxiety in already anxious patients exacerbating withdrawal effects and the decision to extend withdrawal by months or years.

  36. I've been on a low dose of Effexor (but in generic form) for a long time. I feel very good, (probably as a result of the daily pill). The drug is, indeed, hard to quit. I haven't felt depressed when I cut the dose--I have had very odd physical sensations and a definite feeling of malaise. 35 years ago I found it was easy to taper off of imipramine. So was tapering off benzodiazepines. But Effexor has been tough to even slightly reduce. I'm OK with that, but if I decide to taper off Effexor (or Venlafaxine) I'll do it by a tiny speck a week, not by the half or quarter of a pill.

  37. I took various SSRIs for about 20 years. During the last 5 of those 20 years, I wanted to get off the drugs, but had to curtail several attempts because of side effects that included dizziness, hot flashes, and emotional lability (which I feared would result in getting me fired). I was finally able to quit after I retired. Now, five years later, I have noticed that, at any sign of emotion, certain relatives who still take SSRIs are quick to suggest that I need to go back on them again myself. Given how hard it was to get off, I think not. I do think it shows more about how uncomfortable some people are with even honest, appropriate emotion than it does my mental health.

  38. @JR Being retired allowed me to pace myself, avoid triggers and stress (to some greater extent than when I was in the work place). Those relatives you mention should be ignored and also should not be in on your personal treatment plan. I hope you find places to express emotion where you will not be so quickly judged.

  39. The best way to get off of psychiatric medications is to not take them in the first place. Many psychotherapists and psychoanalysts increase the number of sessions per week with beneficial effect. A dependence on other people and learning to choose new dependencies (literature, art, knowledge) is a much better way to live rather than relying on government or corporate sponsored addictions to one or another substance.

  40. @Dr. Diane hello, Dr. Khandai here. So I'd say "dependence" in any form is bad. Patients should be offered a choice, just know that not everyone- especially economically disadvantaged patients and rural patients- can access weekly psychotherapy, due to insurance not covering it (whole separate and important problem!) or lack of therapists in their area. Also, for many patients- ex. single working moms- it's not feasible to be able to take off several hours a week for therapy. Also, some patients prefer medications to doing therapy; and for bipolar disorder or schizophrenia, evidence clearly supports medication over psychoanalysis. I also take issue with the idea that psychiatric medications are "an addiction." Would we tell people with diabetes to give up their "addiction" to insulin, and just eat healthier? In depression, especially in moderate to severe depression, antidepressants can be lifesaving. I'd urge anyone to not be knee-jerk anti-medication, nor have a simplistic view of the realities of being able to even get into, much less intensify psychotherapy. Just speaking as a psychiatrist in the US who deals with this on a daily basis with patients.

  41. @Dr. Diane Your glib advice to "not take them in the first place" is useless to anyone who is already using these medications. And who will pay for me to "increase the number of sessions per week?" That would be awesome but I don't think I know a single person who would be able to afford it, no matter how willing they might be. I say this as someone whose life has literally been saved by years of therapy, ALL of which I've paid for out-of-pocket because even with pretty good insurance through my jobs over the years, I've never had access to coverage for much in the way of mental health care, with the exception of anti-depressant drugs. Three calls to the EAP, then you're on your own. When meds are a covered expense and therapy is not, is it any wonder that people who are suffering go for the pills? Literature, art, and knowledge are great healers as well but I have to say, your advice to basically stop taking drugs and get a life is not kind or helpful to anyone.

  42. @Dr. Diane. I don't take antidepressants because my initial experience trying to do so was so horrific that I didn't want to keep trying (I had terrible, terrible, intense and frightening side effects, such as hallucinations and vomiting - a sibling of mine also had these side effects so we are maybe predisposed to a rare reaction). That being said, and even as someone for whom art and and literature make up a large portion of my life (even my professional life) and are in a way life saving for me, I have never found a way out of my depression. I have found counseling and psychotherapists to be particularly useless. Maybe I've never found the right "fit" but I've seen four different ones over the years, each equally unhelpful. I figure out my own coping strategies that I have to modify with time and the season, but I would never begrudge someone theirs, especially given that psychotherapy alone can really be a dud for some.

  43. I took Paxil for almost 20 years, and if I forgot to take it for two days, I started getting the brain-zaps. It was like I could feel the electric impulses going across my brain. It wasn't unpleasant, just very annoying. I finally got fed up with the weight issue and my psychiatrist and I decided to switch to Prozac. It was to be about a month long transition: first lowering the Paxil dose, then taking a lower dose of each, and then dropping it and upping the Prozac. I cut short the transition phase after having mild brain zaps for a few days. It's been a year since I switched and if I miss a day or two, I'm just a little sad, without the zaps. I know that I will be on anti-depressants for the rest of my life (unless the new nasal ketamine is really as good as it is). I know that no matter where I go or who I work for, I will need a psychiatrist more than a GP. And I know that if I ever want to stop, it's going to be a long, hard journey.

  44. Those of us who suffer from depression and suicidal thoughts when not on medication should feel supported in continuing to take them. Those who are able to handle their depression and suicidal thoughts in other ways should be supported in those endeavors.

  45. @Hope wish this comment could be pinned to the top of this thread. Sigh.

  46. @Hope In college, I self-medicated with sex. It seems, for me, the biochemical interactions during intercourse calmed me. Of course, I needed another dose within three days and wasn't always able to get it! So when I got Wellbturin at 34, I was delighted that it killed my sex drive. I wished it had been available when I was 19, but it hadn't been invented back then.

  47. As a physician, I find that tapering the antidepressant slowly to the lowest dose available, then switching to Prozac 10 mg for 7 days and stop, works very well for most people. Prozac of course has the longest half -life (9 days).

  48. It took me 1.5 years 10 mg 6 mo, 5 mg 6 mo 2.5 3 mo then every other day to every 2 days, 3 days etc.

  49. I was given Cymbalta for facial pain by my neurologist. I was on it for one month and the pain stopped so I stopped. The brain zaps started and I had no idea what was going on. My pharmacist told me how to reduce and the nurologist who prescribed it refused to believe it. I could not believe one month of cymbalta could create such a bad reaction.

  50. It should be pointed out that the post-meds person will not be the 'same' person as the pre-meds person. I have had relationships with two women who were severely depressed and highly medicated. I'll talk about one them. She very nearly succeeded in taking her own life about a year before I met her. Medicated, she was a fairly calm, non-confrontational, etc girlfriend. After about two years together, she and her therapist slowly (over many months), weaned her off her meds. She progressively became more irritable, confrontational, and unpredictable. I did not like the 'new' person and we only lasted another six months or so. Now, I suspect, the later version of herself, was more her 'true' self, and the version that I loved was probably inhibited in some ways. I'm not going to judge either version, as good or bad. I have no expertise to know if this is a common dynamic, but it makes sense.

  51. No surprise here. We treat doctors like omniscient Gods and patients like children. How else can one justify giving doctors the power to dismiss patients relief from pain complaints in the current opioid hysteria? To ignore a patient's testimony is to ignore the patient's relationship to his body and ultimately his God. This unequal power dynamic only adds fuels the resurgence of religious fundamentalism in this country and discontent with our democratic institutions.

  52. I didn't wean myself off celexa slowly enough and had a meltdown. My healthcare provider wasn't as helpful as I would have liked at the time. Now I'm afraid to try again.

  53. In 2013, after careful consideration and talking with my doctor, I discontinued Paxil over a period of 6 weeks, longer than the recommended time. The following 18 months were the most agonizing and painful of my 60 years. I have had breast cancer and CFS; those experiences paled in comparison. Why are these medications still being prescribed? Where is the class action suit?

  54. @Diane, you went too fast. Paxil/paroxetine has the shortest half-life of the SSRIs, so it must be discontinued slowly and carefully. These drugs are still prescribed because there aren't better replacements for them yet. Best wishes to you.

  55. Not having been depressed for a minute my entire life I had no idea how horribly serious depression is until I heard Rogan interview Mikhaila Peterson, who got herself off antidepressants and cured it. Google it.

  56. This comment of yours could do a lot of damage if people acted on it without thinking and/or not consulting with a psychiatrist who really knows what they’re doing. Readers beware!

  57. Too many patients are casually prescribed anti-depressants by their General Practitioners who are ignorant of the dangers of dependency and withdrawal. Patients beware!

  58. This article fails to ask a basic question: If you suffer from depression and medication treats it effectively, why stop taking it? I'm guessing the answer has something to do with a lingering cultural bias against mental illness of any kind, a belief that it's a character flaw rather than a disease. As someone who has been taking antidepressants successfully for almost 30 years, I find such thinking dangerous and offensive. It's like telling diabetics to buck up and stop taking insulin. If your depression responds well to the miracle of modern psychopharmacology, stick with it.

  59. @JG There are many reasons one might choose to stop. Side effects, pregnancy, success in CBT, etc. You are correct that no one should be stigmatized for taking it their whole life long--just as you should not shame those who choose to seek other options for treatment, or feel they are well enough to cease medical intervention. As someone who has suffered from debilitating withdrawal symptoms AND debilitating side effects of several different medications tried, I do appreciate this article on its merits.

  60. @JG After many years, I went off Effexor for the simple reason that it gradually stopped working, at any dose. The body adjusted, and the old demons could no longer be subdued. I guess that's why people get off the medication.

  61. @SV Multiple studies have shown that untreated depression is far more likely to have a major negative impact on the health of both the mother and fetus that is taking an antidepressant. And JG is right. In fact, when people go on and off antidepressants, each episode of depression is likely to be worse and more difficulty to treat.

  62. So why is the NYT publishing 2 different and potentially conflicting articles on medications for depression? One about how to get a person slowly off from taking medication and then an article of a fast acting nasal spray.

  63. @MDCooks8 Because they're both relevant--and not "potentially conflicting." This one is about withdrawing from SSRI medications in pill form; the other is about a brand-new type of treatment with a nasal spray, not a pill and not an SSRI. Other than the goal of lessening depression, one has nothing to do with the other.

  64. 99% of Psychiatrists are completely familiar with withdrawal symptoms that people may experience when stopping or tapering medication, and are able to help patients through that process, either through a very slow taper, or through substituting the typically short half antidepressant (eg. paxil or effexor) for a longer half life one (eg. prozac), and then tapering off that medication. I don't find this to be much of a problem in my clinical practice.

  65. @A psychiatrist It's quite possible you find it "not much of a problem" because your patients, being experienced with psychiatrists dismissing their problems, don't tell you.

  66. I was placed on Cymbalta when I was diagnosed with MS ten years ago. It did nothing for my nerve pain, or my depression. I continue to take it, because coming off of it is unbearable. No one warned me that I would become physically dependent on the Cymbalta. I'm also on morphine - missing a dose of that only makes my pain worse. Missing a dose of Cymbalta makes me very ill, with such extreme brain zaps that I have to lie in bed with my eyes closed, making sure not to move my head. IME, SSRI/SNRIS are far more dangerous than opioids.

  67. @Broce Same here...going off Cymbalta is agony...ive tried to 3 or 4 times. The anxiety and dizziness it causes is far, far worse than the original depression it was prescribed for. Guess Im on it for life...because Im not going though the withdrawal again.

  68. I could not agree more having been in the same situation. For better or worse I have not been able to take any anti-depressants for long because they make me so damn sad - every single class of them, to the point of suicidal thoughts. Despite this long and well-documented reaction history, as a chronic pain patient with an incurable genetic disease these are still being pushed (there is no better word) on me in place of painkillers that work pretty well and have, for me, no side effects, and which I taper down from very high post-surgical levels to maintenance levels very easily.

  69. Four years ago I tapered off antidepressants over an eight month period pretty much on my own since my therapist didn’t have any information about how to accomplish it. It was two years before I stopped having withdrawal symptoms like sleeplessness and brain zaps. I'm glad doctors are finally paying attention to this issue.

  70. I'd suggest people talk to a pharmacist for support, if a psychiatrist or internist is not sympathetic or knowledgeable. In my experience the pharmacist will know a lot more about the drug and will have some real-world advice for you, as a result of hearing many people's experiences with the drug.

  71. First and foremost, I suffered for a long time, went to therapy, took pharmaceuticals that did nothing. ONLY when I took naturopathic herbs did change begin to happen. People labor in therapy while taking really ineffective drugs. Spread the word: naturopathic herbs work for anxiety and depression. REALLY work.

  72. You. Got. Extremely. Lucky.

  73. Because they work for you doesn’t mean they work for everyone.

  74. As a psychiatrist I can report that this almost never becomes an ongoing problem when patients (very rarely) complain of discontinuation symptoms and they are addressed properly. One pearl for some patients is to switch to Prozac for 7-10 days then stop it. Prozac is incredibly slowly metabolized. Typically, 25% of the Prozac that was there the day you stop is in your bloodstream SEVENTY days after your last dose. Half of the remaining amount takes another 35 days to exit your body. I have never seen this fail in more than 20 years. Sadly psychiatrist prescribe some 15% of the psychiatric medication that Americans take. Most of the other medications are prescribed by general practitioners on the strength of a pamphlet and a free lunch from the drug company.

  75. Clinical judgement is a fine and necessary thing, but only if one pays close attention to it's limitations. Why might it be that you find "complaints" to be "very rare," whereas other psychiatrists (like the one whose comment is directly above yours) find the problem to be common? Might it be that there are different perceptions, sensitivities, metrics, and biases at play? Might it be that it's useful to pay attention to such differences and consider that one's clinical judgement is not the end of the story? Might this also be the reason why we need the sort of formal research reported in this article?

  76. As a psychiatrist, I deal with this problem all the time. There is wide individual variation in how rapidly or slowly individual people can taper antidepressants. The worst culprits for extended withdrawal syndromes are those with short half-lives — those that are metabolized rapidly — particularly paroxetine (Paxil) and venlafaxine (Effexor). Those especially may have to be tapered over weeks or months. The slower-metabolized antidepressants like sertraline (Zoloft) and especially fluoxetine (Prozac) can usually be tapered and stopped more without much problem. Also, when switching from one antidepressant to another in the same class, you can often overlap them, tapering down on the old one and up on the new one simultaneously. This rarely causes problems. Some people seem especially vulnerable to the SSRI discontinuation syndrome and others not at all. There are genetic variations in the activity of the liver enzymes that metabolize drugs, which play a big role in this, and only genetic testing will give advance knowledge of who is more likely to have problems. Someone who is a rapid metabolizer of a particular antidepressant will be more likely to have problems with discontinuation. The most important thing is to stay in touch with your doctor and tailor your dosage changes depending on your individual reaction.

  77. Another problem that happens and is not talked about is the times when the pharmacy itself will run out of the medication or there is some hassle with insurance so that the script goes unfilled and you have none left, and are thrown into an unintentional period of withdrawal. I ended up in the Dr's office once as my Celexa prescription was slow to be signed off by him, so the insurance had questions, and it was not filled for 2 weeks. I was in the full brain-zap, seizure like reactions, not being able to think straight without lightning bolts disrupting the thoughts. The doc could not believe that it was really that bad until I was all but on the floor of his office flopping around. He gave me an injection of the Celexa, and in about 20 minutes I was back to near normal. At that point I was not at all sure I wanted to be on a medication like that, quitting morphine or cigs, which I have done both, as well as lesser antidepressants, but the full on brain-zapping, tearing one apart from the inside when it is supposed to Help, makes me wonder if these drugs were actually tested well enough, and whether some recompense should be paid to those of us who have suffered so at the hands of Big Pharma's little mistakes.

  78. Perhaps US physicians should borrow from Germany where St. John’s wort is the first line of treatment for mild to moderate depression. The upset of withdrawal is negligible. Unfortunately, it does not make super-profits for big pharma.

  79. It also mixes badly with many other medications, and has its own set of possible side effects.

  80. @Pelasgus Repeated studies have shown that St. John's wort has no benefit for depression. Of course, why believe actual science.

  81. I tapered off 200 + mg venlaxafine 2017-2018 over 8 months and it was very difficult, in truth, disabling, w all the side effects people have said. At the end was counting the beads and my psychiatrist added in a 20 mg Fluoxetine to "soften the landing." I'm still on the 20 mg. These days intermittent brain zaps and vertigo waves happen but 10 months later my mood and cognitive abilities are stabilizing and strengthening. It was so worth it. The reason I tapered was brain fog and constipation. I'm a writer so fog was really noticeable. The stomach has improved a lot along w increased Magnesium intake. These meds plus age (Im 62) do a number on us. Tapering has been a huge disruptive process that has included a whole lifestyle do over essentially simplifying everything from food to schedule to priorities to relationships, and yes, also upping the faith part of my life. I feel grateful to my husband and friends and family and doctors who supported me through it. I see how it can be impossible for many. My point is consent. When we get on, the prescribing doctor has a duty also to inform the patient of getting off issues known and unknown. Thanks so much for writing the article.

  82. How is this even controversial? I thought it was common knowledge. In my talks with my psychiatrist, tapering off was always discussed as a long, drawn-out affair. And it was never reducing by half, which doesn't even make sense since the half-life of many medications is shorter than a day... It was always reducing the dosage slowly, combining different dosage pills if needed. E.g. 20 mg -> a few weeks at 10mg+5mg (15mg total) -> a few weeks at 10mg -> a few weeks at 5 mg -> done. The reasons were two-fold: 1) Reduce the side effects, so the body slowly adjusts to the reduced dosage 2) Monitor the psychological effects of tapering off, to ensure that depression/anxiety does not come back. If it does, we can quickly and easily readjust the dosage (e.g. if at 5mg the problems come back, go back up to 10mg. That is already half the dosage I was taking initially, and it's not a defeat - it's actually great progress!). Ending medication in just four weeks, especially if someone has been taking it for years, sounds absolutely crazy... and I'm dismayed that any medical professional would suggest it :(

  83. It seems that each person responds to medications (and lots of other things) in his or her unique way. In 1990 I took Prozac for about six months. It was tremendously helpful. I didn't plan to stop taking it, or even tapering off. But after those six months I kept forgetting to take it, and after two more months it seemed I no longer needed it (and my psychiatrist agreed). Maybe I was just lucky, but there were no adverse side effects from taking Prozac or from stopping taking it.

  84. @johnb Maybe more people should try that -take it briefly, long enough to get a boost, then quit before the dependency sets in. Just a thought. I'm feeling like maybe the advice to take them for years, if not decades, is a bit of a con.

  85. I learned this the hard way. Glad the awareness is catching up to reality.

  86. I've been using mostly Wellbutrin, (Prozac when I couldn't get Wellbutrin in South Korea) since 1984. Tired of being on Wellbutrin in 1990, I tapered off. Only to transform myself from a healthy 40 year old into a 90 year old - my muscles refused to work and caused much pain. In frustration one night, I drank two beers. I woke up the next day feeling fine. I've used this technique to go off antidepressants since then. It is dangerous. Too much alcohol can cause death or other horrendous side-effects. I keep the alcohol intake minimal for this reason. To advise me not to do this is an insult. Not everyone on antidepressants can't be trusted to self-medicate in a healthy manner. Yes, I am suicidal. Wellbutrin stops that. But when I need to go off it, I can. Easily. Safely. Pain-free. No lingering side-effects. Has any research been done on this use of low dosages of alcohol to go off antidepressants? It has worked well for me.

  87. As a physician I can empathize with those who experience the horrible symptoms that can come with stopping antidepressants. There are many classes of these medications and each one must be treated differently. Some can be stopped faster than others. Of course, not all patients are created equal and each one will react differently when stopping the medications. it is best to err on the side of caution and slowly taper over a period of months. There are many ways to do this. In addition, my impression and that of many other physicians is that psychiatry is one of the least scientific of the specialties. The simple fact that many patients do not respond to antidepressants in a helpful way shows that many of these medications have a low success rate. They are often prescribed in a hit or miss fashion, try this, if it doesn't work we will try something else, and without much understanding of whether the emotional state alteration is due to biological or non-biological reasons also plays a part. Too many patients are put on antidepressants without much prior thought. This is simply bad medicine.

  88. I wish more doctors thought like you. Antidepressants don’t work for me, period. A few years ago I found the courage to tell my new doc that I am not going to try a new one which she swears will work for me because this one is really different from the 6 or 8 that I’ve already tried. I am no longer going to pretend that they make me feel any better. No more antidepressants for me!

  89. After reading these comments I am so glad I weaned myself off 15 years of Effexor last June/July. I am only now realizing that since then, the irritability I've been experiencing is withdrawal. A two week trial of Zoloft last month was a horrible mistake and again, I took myself off over 7 days. No more antidepressants for me. I'll just have to learn to live with being "blue."

  90. There are natural solutions that help anxiety, depression and insomnia with zero side effects. add while you are withdrawing very slowly and continue with the natural solutions to feel good without harmful side effects

  91. Yes, I've tried to come off Citilapram. Terrible brain shocks. Insomnia. It was awful so I'm just going to stay on the things till I die

  92. One lesson I will take here is to show more empathy to people having public or workplace meltdowns. They might not be spoiled babies or throwing out white tears or suffering from affluenza or showing lack of impulse control. They could be having a serious episode of medication withdrawal. Good to know!

  93. I have had care by countless psychiatrists and have perhaps the broadest and most personal view of the mental healthcare system in America. Thoughts: 1). You have to advocate your yourself relentlessly. You know you better than anyone. 2). Psychiatric diagnoses are incredibly imprecise and often wildly inaccurate and often based on incomplete information and faulty assumptions and suppositions and internal biases by the psychiatrist. How can any reasonable psychiatrist come to a conclusion as to the medical diagnosis regarding a new patient simply from a one-hour initial intake session? Yet this is what happens every day in America. 3). Many psychiatric drugs have significant side-effects, which few psychiatrists properly disclose. See the wonderful Youtube Series by board-certified and Harvard-educated psychiatrist Peter Breggin, MD. 4). Modern psychiatry has moved away from its roots, which are in talk therapy, also known as psychotherapy. As Peter Breggin MD notes, talk therapy has minimal to zero negative side effects, which cannot be said of drugs. 5). It takes a long time to find not only the right medication, but the right combination of medications and dosages for your condition. 6). Stay patient, be strong, and always advocate your yourself, without apology. Find a doctor in private practice and find a way a to pay for it. It is worth it. 7). If you are succeeding more in life, and are more at peace in mind and body, that means care is working.

  94. I did my own tapering off. I also recommend upping your personal (non-social media) interactions, whether family or organizations. I'm a fairly busy church lady. Sometimes a meaningful distraction that forces communication is a great blessing.

  95. I’ve just come off of Effexor in the last two months, and it was pretty brutal. I would have liked to have more information from my doctor on the way in and more empathy from my doctor on the way out. However, I don’t question for a moment the value of the drug and its impact on my ability to stay alive.

  96. Why Quit? Isn't it possible that an individual can only thrive while taking an antidepressant? Couldn't it thought of as meeting some biological deficiency in an individual similar to a vitamin, mineral, or hormonal deficiency? Why must people be made to suffer needlessly?..

  97. They don’t work forever for everyone - tolerance occurs and you can quickly go up to the maximum effective dose. After that, there is nothing to do but wean off one anti-depressant and try another. Having seen this multiple times with a close family member, I think the reality of the severe physical withdrawal symptoms associated with anti-depressants is grossly under-reported

  98. More than 25 years ago, my psychiatrist put me on Effexor for anxiety and depression. It worked, but over the years it became less effective, so the dose was increased. I got up to 150mg XR. Last year, when it wasn't working and I didn't want a higher dose, I decided to see if I could do without it. I knew from having missed doses that it would be tough, due to the drug's short half-life, so I did a lot of research on how to taper successfully. The process took several months and it was really rough. I'd alerted my friends and cut out all non-essential activities. Because I'm retired, I could do that. I cannot imagine being able to go through that process if I was still working. When I was finally off, I felt great -- optimistic, lots of energy, etc. -- for about four months. Then depression, anxiety and panic came back -- big-time. I tried CBD oil, mindfulness meditation, regular walks, CBT reading, a host of vitamins and minerals. Nothing worked. I was a mess and my life was close to unbearable. My doctor said ``Enough of this'' and put me on Wellbutrin, which is helping, but I'm still very shaky physically and emotionally -- and I am a strong person. I feel for anyone who's trying to withdraw from an anti-depressant and is finding the process a nightmare. Thank heaven the medical profession is finally paying attention to what we've been telling them. Our experiences are real and compelling.

  99. Tapering off of Paxil 13 years ago took me a solid 7 months. I was cutting pills into little mounds of powder, but I had to. If I didn’t, I would get brain zaps (such an awful experience), and start vomiting. It was the 8th drug they tried for my postpartum, and at one point I was on no less than 4 meds at one point. I ended up doing 5 years of intense behavioral therapy (with a stint of anxiety meds and sleeping pills) to address quite a mess of issues. It was difficult, slow, very uncomfortable- even intolerable at times, but I’m a completely different thinker and human being now. We did CBT, ACT, exposure therapy and sleep therapy. I never thought it would work... but, I slowly learned it is all about the relationship you have to your depression, thoughts, panic attacks, OCD etc. I was a mess, and while I am not perfect by any means, I can cope with my emotions on my own now, and I truly know they are temporary (could be anxiety for an hour, or 4 weeks, but still- it’s not forever). Nothing is permanent, no matter what your brain tells you.

  100. I want to support all of those out there who are trying to withdraw from anti depressants and anxiety medications. I was able to do it with the help of from three remedies that my husband created . The hardest part is the insomnia, so he developed a sleep remedy. And then one for anxiety and one for depression. In terms of detoxing: 1. You have to lower your dosage very gradually. I would feel withdrawal symptoms each time I lowered the dosage by a fraction of the pill. 2.You need to drink lots of water and light cardio exercise everyday to help detox easier. 3. Take Natural Solutions for anxiety, depression and sleep while withdrawing and then replace the pharmaceuticals with the natural ones and feel happy, relaxed and sleep well without any side effects. They have changed my life and countless others. 4. Have a good support system to guide you through the withdrawal as the symptoms are uncomfortable but fortunately only temporary and far less uncomfortable with the natural solutions to help you through.

  101. Well it's about time. I went through this years ago, when it was still mostly unrecognized. I ran into an acquaintance who is an addiction counselor and, with trepidation, told him what I was experiencing. He said, without missing a beat, "Yeah, it's actually worse than heroin because it just goes on and on and on--everyone in my business knows that. And what makes it worse is that there's no socially acceptable narrative. If you get off heroin, everyone knows that's incredibly hard and that you've done something heroic. With this stuff, people think you're making it up, because it's supposed to be a nice medicine that some smart doctor gave you." Those words helped me get through it and I'm glad people now can find more support. What I especially love is the last line of this article. Why in the world would a doctor believe the experience of patients when it's not in the textbooks?!

  102. I've tried coming off Citalipram. I had terrible brain shocks. A lot of insomnia. And felt generally awful. I'm staying on it in the meantime.

  103. Bravo for these two researchers. Interesting to see that they were motivated by their own direct experience with anti-depressants. Now that they've published, maybe some of those disbelieving psychs in the UK will now trust what their patients have been telling them for years. I'm blessed with a doc who listens to his patients. We learned together about the pure hell known as Effexor withdrawal, 10 or 12 years ago. I described the "zaps" as the feeling you get when you have a high fever, when you turn your body it feels like it takes a "whoosh" for all of you to catch up. That, and feeling like I had the flu for weeks. Were I a conspiracy theorist I would point out the interesting financial advantages for drug companies to create drugs that don't cure, but treat; and therefore much be continuously taken, while also being pure hell to stop taking. As tempting as it is to cast Big Pharma in a Machiavellian role (and often for very good reasons), I have to remind myself that they're not 100% certain how the drugs work (when they do). Oh, we know they're SSRI's, but read the literature and you'll find many hedged bets in the form of "It is thought that the mechanism is..." and "It is believed that this is achieved by..." Anti-depressants have been a wonderful tool for me, but over time you can hit diminished returns & wonder if they're doing anything at all. The only way to know is to remove the variable, and stop taking them.

  104. I am a professional woman who had never taken a psychotropic medication until I was widowed and asked my family doctor for something to help me sleep. I am now in my 3rd year of tapering off Lexapro, with one more year to go. It has been hell. I was treated as if I were a fussy, crazy middle-aged woman. Visual and vestibular rehab therapy - which I had to find and pay for on my own - helped me more than anything else. Both therapists told me my symptoms were exactly like those of their traumatic brain injury patients.

  105. *****There’s real danger in expecting people who are already psychologically anguished or debilitated to tolerate further mental anguish. It’s beyond negligence, it’s exploitative. Who’s counting the suicides triggered by botched discontinuations? Oh wait, we can’t count them. These patients are dead.*****

  106. "Doctors have in mind that these drugs act in a linear way, that when you reduce dosage by half, it reduces the effect in the brain by a half,” Dr. Horowitz said. “It doesn’t work that way" This tells me that we have to work harder to teach pre-med students physics and math. Most solutions to physical problems are nonlinear and can only be approximated as linear over a sufficiently small interval.

  107. I have been taking Prozac for 7 years. I have tried to stop several times and pretty quickly experience symptoms as mentioned here that were difficult to control. Thank-you for reporting this, NYT. I will be talking to my doctor and try taking the very slow approach and maybe include some CBT as well.

  108. I bare-knuckled it and went cold turkey from Prozac. It wasn’t easy, though easier than quitting smoking, and I lost the 30lbs the Prozac packed on.

  109. The anti-depressants I took many years ago—Zoloft, and then Paxil—both gave me such bad side effects that I was happy to rid myself of them. The first was prescribed by a psychologist, and the second was prescribed by a psychopharmacologist. The Zoloft gave me chronic but relatively mild symptoms—farting, dry mouth (although that led to tooth decay)—and I took it for about two years before switching from the psychologist to the psychopharmacologist. So I switched abruptly from one to the other when I switched doctors. The Paxil was horrible because it made my affect completely flat. I didn't care about anything, didn't feel anything, and as far as I know I didn't have any other side effects. So I told this to the doctor, and because he wasn't a talk therapist, he just shrugged. I chose not to see him again, and just quit cold-turkey because I wan't in pain—or joy, or fear, or anything. I wish I could go back in time to do it right—and report both the doctors—but I quit the pills and the therapy and never looked back.