Antidepressant Withdrawal Symptoms, Timeline & Detox
Major Classes of Antidepressant Medications
There are several major classes of antidepressant medications:1,2
- Selective serotonin reuptake inhibitors (SSRIs): These work selectively on serotonin and include well-known drugs such as Prozac, Zoloft, Paxil, and others.
- Tricyclic antidepressants: These are medications that have a very broad mechanism of action to work on several different neurotransmitters, including dopamine, serotonin, and norepinephrine. These medications include Elavil, Anafranil, and Pamelor. While they are generally as effective as SSRIs in the treatment of depression, they may have a much more severe side effect profile and, therefore, are not commonly prescribed for depression. They still have their utility in other areas, like treating chronic pain.
- Monoamine oxidase inhibitors (MAOIs): This is an older group of medications that is rarely used today, as it has the potential for a number of serious side effects. The medications prohibit the breakdown of certain neurotransmitters by inhibiting an enzyme. Nardil and Parnate are examples of medications in this class.
- Atypical antidepressants: This group consists of several different medications that have a different mode of action from the other three groups. Cymbalta, Wellbutrin, Remeron, and Effexor are examples of different medications in this class.
Antidepressant Withdrawal Symptoms
People who use antidepressants for a significant period will likely develop physiological dependence and experience antidepressant discontinuation syndrome (ADS) if they abruptly cease taking their medication. It appears that ADS is most prevalent in individuals who abruptly stop using antidepressant medications that work on the neurotransmitter serotonin (hence, it is sometimes referred to as serotonin discontinuation syndrome or SSRI discontinuation syndrome even though other medications besides SSRIs can induce it). However, ADS is noted to occur across all classes of antidepressant medications.3
ADS is also more likely to occur if the individual has used the medication for a period of longer than 6-8 weeks; it is extremely rare for it to occur if the person has taken the drug for less than 6 weeks. It appears that 20% of individuals who abruptly stop using antidepressant medications develop ADS.4
Common antidepressant withdrawal symptoms include:5
- Restlessness.
- Insomnia.
- Perspiration.
- Upset stomach.
- “Brain zap” (i.e., feeling an electric jolt in your head).
- Irritability.
- Anxiety and low mood.
Antidepressant Discontinuation Syndrome (ADS) Timeline
Symptoms typically begin within 2-4 days following cessation and last 1-2 weeks. However, in rare cases, they may last up to a year. Symptoms can be relieved within 1-3 days by restarting the medication or taking a similar antidepressant.6
ADS is sometimes mistaken for physical illness, presenting as a mild flu-like condition that may also present with some mild psychological symptoms, particularly depression and anxiety.5
Can You Get Addicted to Antidepressants?
While individuals may develop a physical dependence on antidepressant medications, this dependence is not characterized as a severe substance use disorder (SUD), which is the clinical term for addiction.7
The difference between having an addiction to a drug and developing a physical dependence on a drug is that addiction is a behavioral health condition that represents the nonmedical use of a drug that results in several clinically significant adverse consequences in various aspects of one’s life.7
Physical dependence is simply when someone experiences withdrawal as a result of either discontinuing the drug or drastically cutting down the dosage. While dependence is often a consequence of an addiction, it is not indicative of addiction when someone is taking medication as prescribed.7
Just as people can be physically dependent on a drug and not be addicted, it is possible to be addicted to a drug and not have developed physical dependence on it.7
Antidepressant Withdrawal Treatment & Medications
The symptoms associated with ADS are rarely life-threatening. However, whenever an individual experiences withdrawal symptoms that include psychological symptoms like depression, there is the potential for self-harm or unintentional harm due to poor judgment or accidents. It is strongly recommended that individuals discontinue antidepressant medications under the supervision of a physician.
Since withdrawal often occurs as a result of abrupt discontinuation, a tapering strategy where the prescribing physician slowly tapers down the dosage of the antidepressant medication in successive intervals can be an effective method of avoiding or mitigating these symptoms.8
Some sources recommend that if the above tapering process still produces symptoms, using a different antidepressant with a longer half-life and then tapering down slowly with that medication should avoid the symptoms of ADS.8
