Symptoms of discontinuation
Symptoms of discontinuation
Understanding about antidepressant discontinuation symptoms has grown recently, and recommendations have changed. Half of patients will experience withdrawal symptoms on reducing or stopping their antidepressant. These can be severe in 50 per cent of cases and can last months or sometimes years.
For others, withdrawal symptoms are short and self-limiting. Patients on long-term antidepressants (> six months) are more likely to experience withdrawal effects.
Patients should be warned not to stop taking their antidepressant abruptly as this can give rise to severe and long-standing withdrawal symptoms and increase the risk of relapse. Tapering over a few months seems to reduce the risk of withdrawal symptom severity. On average it takes three to 24 months for a patient to come off an antidepressant.
| Physical Symptoms | Sleep and emotional symptoms |
| Nausea and loss of appetite | Insomnia |
| Headache | Increased dreaming |
| Dizziness | Vivid dreams |
| Abdominal cramps and diarrhoea | Nightmares |
| Visual disturbances (double vision) | Anxiety |
| Flu-like symptoms | Depression |
| Electric-shock sensations | Panic |
| Fatigue | Agitation |
| Sweating and flushing | Irritability |
| Palpitations and missed beats | Mood changes |
| Tremor | |
| Tinnitus | |
| A feeling of inner restlessness and an inability to stay still (akathisia) |
While reducing and tapering antidepressant doses gradually can minimise the risk of developing discontinuation symptoms, actual guidance on how to do this is limited. Many of the manufacturers of antidepressants advise against abrupt cessation in their summary of product characteristics but offer little practical advice on how to gradually taper and stop.
Previously the general advice was to reduce antidepressant doses over a two- to four-week period with linear reductions in dose until stopped. There is now growing research to indicate that this method may not be the most effective way to prevent discontinuation symptoms. Reducing antidepressant medications over a period of 14 days does not significantly reduce discontinuation symptoms comparative to abrupt discontinuation. One study, for instance, found that 60 per cent of participants were not able to taper their antidepressants to stop over a four-week period and much longer reduction periods were needed (up to four months).