Antidepressant Discontinuation Syndrome

What is antidepressant discontinuation syndrome?

Antidepressant discontinuation syndrome (ADS) can happen if you stop taking your antidepressant if you’ve taken it for at least six weeks. It’s more likely to happen if you suddenly stop taking the medication instead of slowly tapering off under the guidance of your healthcare provider.

ADS causes several symptoms, including insomnia, nausea and flu-like symptoms. They typically last less than two months. Some people refer to antidepressant discontinuation syndrome as “antidepressant withdrawal.”

The syndrome usually isn’t physically harmful, but it can be very unpleasant. In addition, stopping an antidepressant can make the condition it was treating (like depression or anxiety) come back.

It’s important to talk to your healthcare provider if you’re considering stopping an antidepressant to try to prevent ADS.

How common is antidepressant discontinuation syndrome?

Studies show that 27% to 86% of people who attempt to stop antidepressants, whether on their own or under the supervision of a healthcare provider, experience ADS.

What are the symptoms of antidepressant discontinuation syndrome?

Symptoms of antidepressant discontinuation syndrome typically begin within two to four days of stopping an antidepressant. Symptoms include:

• Flu-like symptoms, including fatigue, headache, achiness and sweating.
• You may also have vivid dreams or nightmares.
• Nausea (sometimes vomiting).
• Dizziness and light-headedness.
• Burning, tingling or shock-like sensations (paresthesia).
• Mood changes, like anxiety, irritability, agitation and aggression.

See your healthcare provider if you’re experiencing these symptoms.

The symptoms can range in severity but are usually mild. One study revealed that of people experiencing discontinuation symptoms:

• 7% had ongoing symptoms at two months.
• 6% had ongoing symptoms at one year.
• 2% had symptoms beyond three years.

What causes antidepressant discontinuation syndrome?

Researchers don’t know the exact cause of discontinuation syndrome. But they think it’s related to a sudden decrease in serotonin levels if you stop taking an SSRI (selective serotonin reuptake inhibitor) or SNRI (serotonin and norepinephrine reuptake inhibitors). Your body responds with physical and mood-related symptoms due to this sudden lack of serotonin.

What are the risk factors for antidepressant discontinuation syndrome?

You’re more likely to develop ADS if you stop taking an antidepressant and you:

• Suddenly stop taking it (as opposed to slowly tapering off it).
• Have taken the antidepressant for a long time (years).
• Take a high dosage of an antidepressant (this varies based on the type).
• Have had discontinuation syndrome symptoms when you’ve missed a dose (but resumed taking the medication).

The type of antidepressant you take can also increase or lower your risk of ADS. This mainly has to do with how long the medication lasts in your body. Antidepressants that your body breaks down (metabolizes) quickly are more likely to cause ADS if you stop taking them than those that last longer in your system.

SSRI risk profiles:

• High risk of ADS: Paroxetine (Paxil®, Pexeva®) and fluvoxamine.
• Moderate risk of ADS: Citalopram (Celexa®), escitalopram (Lexapro®) and sertraline (Zoloft®).
• Low risk of ADS: Fluoxetine (Prozac®).

SNRI risk profiles:

• High risk of ADS: Venlafaxine (Effexor®) and desvenlafaxine (Khedezla®, Pristiq®).
• Moderate risk of ADS: Duloxetine (Cymbalta®, Drizalma®, Irenka®).
• Low risk of ADS: Milnacipran (Savella®) and levomilnacipran (Fetzima®).

MAOIs (monoamine oxidase inhibitors), tricyclic antidepressants and tetracyclic antidepressants also typically carry a relatively high risk for ADS.

What are the complications of antidepressant discontinuation syndrome?

In some cases, discontinuation of antidepressants can carry significant risks, including:

• Suicidal ideation.
• Suicide.
• Mania.

If you or your child have suicidal thoughts or behavior, dial 988 on your phone to reach the Suicide and Crisis Lifeline. Someone is available to help you 24/7.

How is antidepressant discontinuation syndrome diagnosed?

There aren’t any medical tests that can diagnose antidepressant discontinuation syndrome. Instead, your healthcare provider will ask questions about your symptoms and medical history. They’ll ask when you stopped taking your antidepressant.

The symptoms of ADS can look like the symptoms of other conditions, including depression and anxiety. So, it helps to provide as much detail as possible about your symptoms and how they started.

How is antidepressant discontinuation syndrome treated?

The most effective treatment for ADS is to resume taking the antidepressant at the previously prescribed dose. This usually makes your symptoms go away within 24 hours. If you still want to go off of the antidepressant, your healthcare provider will give you specific instructions on how to slowly taper off it.

Depending on the severity of your symptoms and how long they last, your provider may recommend medications to manage them. Examples include:

• Pain relievers like Ibuprofen or acetaminophen for headaches.
• An antiemetic like ondansetron (Zofran®) for nausea.
• Hydroxyzine or benzodiazepines for anxiety and insomnia.

How can I prevent antidepressant discontinuation syndrome?

Unfortunately, antidepressant discontinuation syndrome (ADS) isn’t always preventable. But the main action you can take to try to prevent it is to talk to your healthcare provider before stopping your antidepressant. Going off antidepressants safely can be a long process — you have to slowly reduce the dose over time.

Each type of antidepressant is different, so your provider will be the best guide to help you go off of the medication.

What is the outlook for antidepressant discontinuation syndrome?

The outlook for ADS varies from person to person. Most cases are mild and last no more than eight weeks. But some cases can be severe, and symptoms can last for a year or more.

A note from Cleveland Clinic

Antidepressant discontinuation syndrome (ADS) can be unpleasant. The best way to try to prevent it is to slowly go off of your antidepressant under the guidance of your healthcare provider. If you have any questions or concerns about your medications, talk to your provider. They’re available to help.