One of the most prevalent and influential medications prescribed in the modern medical age is the selective serotonin reuptake inhibitor (SSRI) antidepressant. Since 1987, SSRI antidepressants have provided many individuals with a tangible solution to their severe depression-based symptoms. Over the years, many other effective antidepressants have also been developed to assist with a variety of conditions beyond just depression, including anxiety, panic disorders, obsessive-compulsive disorders, trauma disorders, and even the treatment of chronic pain.
The use of antidepressants in the treatment of co-occurring substance use disorders is common and has provided benefits for many individuals in early recovery. Depending on a variety of criteria, antidepressant medications may be prescribed for short-term (6-12 months), long-term (1+ years), or lifelong, if appropriate.
Even with all the benefits of modern antidepressants, there are a variety of unwanted side effects that cause people to become wary of long-term use. This has resulted in the need to find safe ways to wean off prescriptions; however, it generally requires medical supervision to prevent the occurrence of unwanted withdrawal symptoms.
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What Is Antidepressant Discontinuation Syndrome?
Before SSRIs were developed, antidepressants existed as less sophisticated medications that had more side effects than most could tolerate. In fact, many of those medications made such significant restrictions on a person’s lifestyle many people decided to stop taking their medication altogether. This resulted in many experiencing uncomfortable withdrawal symptoms, often referred to as “antidepressant discontinuation syndrome.”
Antidepressant discontinuation syndrome occurs with all forms of antidepressants, even SSRIs; however, the symptoms experienced can differ depending on the medication being used and the length of use. Antidepressants are often prescribed because of a noticeable decrease in the brain’s ability to regulate serotonin levels. With proper use, antidepressants can assist with helping the brain regulate these chemicals to healthy levels again.
It’s important to note that experiencing withdrawal symptoms when discontinuing an antidepressant regimen is not a sign of addiction. Addiction and substance use withdrawal symptoms are related to maladaptive or unhealthy patterns of behavior that have resulted in unnatural biological changes in the body. Withdrawal symptoms for addiction-based conditions is the body trying to find a way to get back to its “normal” state of functioning without the unhealthy doses of chemicals provided by substances getting in the way.
Even with these differences, the withdrawal symptoms from both addiction and discontinued use can be similar to one another. Symptoms of antidepressant withdrawal include:
- Sleep difficulty
- Body aches
Stopping Antidepressant Use
The decision to end the use of antidepressant medications depends on a person’s situation and overall medical needs. Most people who start a medication do so with the intention of ending their medication use at some point. Many people do not prefer to rely on medication daily if they can find alternative solutions such as psychotherapy, lifestyle changes, or other mindfulness-based strategies such as acupuncture or yoga.
Whatever the reason may be to discontinue antidepressant medications, it should be done under medical supervision to reduce the risk of withdrawal symptoms from developing or reducing the severity of the symptoms if present. Abruptly ending antidepressant use can result in many uncomfortable withdrawal symptoms developing. In many instances, a rebound, or return, of depressive symptoms may occur after abruptly stopping antidepressant use.
The process of ending most long-term medications, like antidepressants, is usually planned at the start of the treatment process. The prescribing healthcare provider will generally discuss the benefits and risks of starting any new medication and review the plan to discontinue them safely. Since antidepressant medications generally take 4-8 weeks to become fully effective, it can often take a similar amount of time to slowly discontinue the medication.
This process is often referred to as “tapering” and will be reviewed at each step of the process with your provider to ensure withdrawal symptoms are either not present or are safely managed if they do appear. The tapering process utilizes the current medication’s half-life, which is the amount of time it takes for half of the drug to be processed from the body, and follows a standardized practice that slowly reduces the medication in the body.
Approximate half-life of popular antidepressants:
- Effexor – 6 hours
- Zoloft – 24 hours
- Paxil – 29 hours
- Lexapro – 30 hours
- Celexa – 36 hours
- Prozac – 5 days
The tapering process to stop antidepressant use is typically an outpatient procedure that can be done safely so long as the benefit of ending the medication outweighs the risks. Risks that may arise include uncontrolled depressive symptoms that continue to occur even after resuming the medication, especially any symptoms that include suicidal ideations or self-harming behaviors. When co-occurring substance use is also involved in this conversation, it makes the decision to end antidepressants, or other medications, even more risky without a solid plan for aftercare.
Preventing relapse of mental health conditions, like depression, is a key part of anyone’s aftercare plan, with or without substance use concerns. Having a strategy to manage the stress of life is part of ensuring a solid aftercare plan for preventing relapse and safely managing triggers.
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Having a strong support system is essential in early recovery and often throughout life itself. Surrounding oneself with positive and supportive people helps make it that much easier to make it through the difficult periods that naturally occur. Friends, family, medical, spiritual, and peer support programs like 12-step models can be beneficial.
Sleep plays a major role in our overall mood management. Poor sleep tends to result in feeling poorly, which, when left unchecked, can result in a relapse of mental health symptoms. Engaging in healthy sleep hygiene can reduce unhealthy behaviors before bed and help establish a stable sleep routine.
Psychotherapy, or talk therapy, has helped many people overcome a variety of conditions and concerns. Having a supportive professional to assist in the early stages of recovery after ending long-term antidepressants can be instrumental and is almost always recommended for those who have a history of mental health conditions. It can also be helpful to have someone trained in recognizing the symptoms of depression or other mental health conditions so that in the event of a relapse, they can help prevents any serious concerns from arising.
Primary Medical Care
Maintaining physical health is an essential part of maintaining mental health. It’s also important to ensure proper care is provided for other medical conditions that may be connected to depression, such as diabetes, chronic pain, or obesity, among many others. Having a medical provider who is aware of your history and can formulate treatment plans to ensure proper care is invaluable.
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Depending on what you or your loved one’s relationship with antidepressants looks like, recommended treatment options vary. If there are active withdrawal symptoms, it is highly encouraged that you seek medical attention with your local healthcare provider or treatment center. If there are no significant withdrawal symptoms, you may find benefits in outpatient services to help you on the first step of the recovery journey.
No matter what your condition is, the first step in recovery is to ask for help. If you’re ready to take that step for yourself or your loved ones, contact a treatment provider today.