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How to stop taking antidepressants

Suppose a patient with depression that appeared for the first time has been treated with citalopram, for example, for twelve months. The symptoms improved after six weeks and the success continues. Now the woman asks if she could stop taking the drug. How do you proceed in this situation?

A very short text in BMJ from the "10-minute consultation" section brings the answer to the point: In the event of a successful reduction in symptoms, you should first take the antidepressant medication after one year at the earliestTaper off (over a period of at least four weeks) - depending on history and review of other risk factors for relapse. Figure 1 shows what the exact procedure looks like.

What are the risks if you don't follow these recommendations?

If antidepressants have been taken for at least four weeks and are then stopped abruptly, around 20% of patients develop what is known as an antidepressant withdrawal syndrome within two to four days (antidepressant discontinuation syndrome), which lasts for around a week, but rarely for many months.

The symptoms (flu-like symptoms, sleep disorders, nausea, dizziness, sensory hypersensitivity, fear / irritability) are summarized in English with the abbreviation FINISH:

F.lu-like symptoms (lethargy, fatigue, headache, achiness, sweating),

I.nsomnia (with vivid dreams or nightmares),

Nausea (sometimes vomiting),

I.mbalance (dizziness, vertigo, light-headedness),

S.ensory disturbances (“burning,” “tingling,” “electric-like” or “shock-like” sensations),

Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness).

If the drug in question or a similar drug is started again, the symptoms will disappear in a maximum of three days. Among the SSRIs, paroxetine is assigned the highest and fluoxetine the lowest potential for causing withdrawal syndrome.

If the treatment lasts less than four weeks, the risk of withdrawal is extremely low. In an emergency, you can either start the drug again or switch to fluoxetine.

Pringsheim T, Kelly M, Barbui C. Stopping antidepressants following depression. BMJ 2016; 352: i220

Gabriel M, Sharma V. Antidepressant discontinuation syndrome. CMAJ 2017; 189: E747


(As of: 01/26/2018)