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Why Is Antidepressant Withdrawal So Hard?

Antidepressant withdrawal symptoms were not recognized for decades. Now the FDA requires a warning about "discontinuation syndrome." Are patients warned about this devastating condition?

It is estimated that one out of every eight Americans takes an antidepressant medication (JAMA Internal Medicine, Feb. 2017). According to the New York Times, roughly 25 million Americans have been taking drugs such as sertraline, fluoxetine, citalopram, duloxetine, venlafaxine or paroxetine for at least two years. Some of these antidepressants are also prescribed for anxiety, panic, neuropathy, fibromyalgia, back pain, osteoarthritis, OCD and hot flashes. Are patients adequately warned that antidepressant withdrawal can be devastating?

Waking Up To Antidepressant Withdrawal Symptoms:

The mainstream media have suddenly discovered that stopping antidepressants can lead to disastrous symptoms. An article in the New York Times carried the headline, “Many People Taking Antidepressants Discover They Cannot Quit” (April 7, 2018).

A patient who had been on sertraline (Zoloft) described symptoms of antidepressant withdrawal: dizziness, confusion and fatigue. They persisted far longer than most health professionals would imagine. According to the NYT account:

“It took nine months to wean herself from the drug, Zoloft [sertraline], by taking increasingly smaller doses.

“‘I couldn’t finish my college degree,’ she said. ‘Only now am I feeling well enough to try to re-enter society and go back to work.’”

Antidepressant Withdrawal An Old Story:

Readers of this column have been reporting the same kind of problem for decades. In August, 1995, we heard from one person:

“I’m having trouble with rather severe withdrawal effects caused by abrupt discontinuation of paroxetine [Paxil] nearly two months ago. I took 20 mg daily for about two years for depression. When I felt less depressed and realized my inability to have orgasms was a side effect of the drug, I asked my shrink about discontinuation. He said to stop cold, so I did.

“Two days later, I saw sparkling zig-zag colored lights and had tunnel vision. Diarrhea, shakiness, horrible insomnia, wildly brittle emotions, and overwhelming crankiness set in. I was completely unable to concentrate or to do normal mental tasks, such as subtracting one four-digit number from another. I kept saying there was something wrong inside my head! I fell down, ran into things, and got covered with bruises. I was nauseated.

“I called the psychiatrist, who told me to take more Paxil. Instead, I asked him to do a literature search about withdrawal from Paxil, so he would know more about the drug he was prescribing. Two days later I received a letter from him, firing me as a patient.

“I am still emotionally volatile, really mad at the shrink and wondering if my depression is back. Was this doctor out of line, or was I?”

Our 1995 People’s Pharmacy Response:

In our answer, we pointed to a growing recognition that sudden discontinuation of antidepressants like paroxetine (Paxil) can sometimes cause withdrawal symptoms. The manufacturer told us that dizziness, sensory disturbances, nausea, agitation and anxiety had all been reported.

We were disappointed that the psychiatrist wasn’t more understanding and sympathetic about the symptoms this person was experiencing. We weren’t that surprised, however. In the mid 1990s, there still wasn’t widespread realization that stopping drugs like sertraline or paroxetine could lead to long-lasting and severe adverse reactions.

The Official Paxil (Paroxetine) Prescribing Information:

In our 1994 edition of the Physicians’ Desk Reference (PDR), the only mention we could locate about Paxil withdrawal was this:

Physical and Psychological Dependence

Paxil has not been systematically studied in animals or humans for its potential for abuse, tolerance, or physical dependence.”

Another SSRI-type antidepressant, sertraline (Zoloft) had equally reassuring prescribing information in 1994:

Physical and Psychological Dependence

“ZOLOFT has not been systematically studied in animals or humans for its potential for abuse, tolerance, or physical dependence. However, premarketing clinical experience with ZOLOFT did not reveal any tendency for a withdrawal syndrome or any drug-seeking behavior.”

It’s hardly any wonder that physicians did not think there was such a thing as antidepressant withdrawal symptoms. The official prescribing information for paroxetine and sertraline was reassuring. The FDA did not require studies and drug companies did not feel motivated to investigate this issue. See no evil, hear no evil, speak no evil.

Antidepressant Withdrawal Is Now “Discontinuation Syndrome”:

Fast-forward to 2018. There is much more awareness about antidepressant withdrawal symptoms. The FDA has given this kind of reaction a scientific name: “discontinuation syndrome.” It may seem less scary than antidepressant withdrawal.

Today, the official prescribing information for Zoloft is quite different from the 1994 PDR:

Discontinuation Syndrome

“Adverse reactions after discontinuation of serotonergic antidepressants, particularly after abrupt discontinuation, include: nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesia, such as electric shock sensations), tremor, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible.”

The FDA requires this for generic Zoloft (sertraline):

After a long list of antidepressant withdrawal symptoms comes:

“During marketing of sertraline and other SSRIs and SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs…While these events are generally self-limiting, there have been reports of serious discontinuation symptoms.

“Patients should be monitored for these symptoms when discontinuing treatment with sertraline. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate.”

The current prescribing information for paroxetine (Paxil) is quite similar and differs dramatically from the official line of the mid 1990s.

What Does “Gradual Reduction” in Dose Mean?

Neither the FDA nor the drug companies that make antidepressant medications spell out in detail what they mean by gradual reduction. For some physicians that could be interpreted as a week or two. For others it might be several weeks.

We suspect that many health professionals have very little idea what their patients go through when they try to stop antidepressant medications. Just listing symptoms such as brain zaps, dizzy spells, nausea, headaches, sweating, anxiety, fatigue, insomnia and digestive problems does not do antidepressant withdrawal justice.

Some of the other antidepressant drugs that can produce the discontinuation syndrome include citalopram (Celexa), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro) and venlafaxine (Effexor).

Stories from Readers:

You can find over 1,800 reader comments associated with this article:

Duloxetine (Cymbalta) Side Effects & Withdrawal

If you would prefer to just read just a few case reports, here are some:

Carl in Brisbee, Arizona, is going through hell:

“I was prescribed Cymbalta [duloxetine] and Provigil [modafinil] for PTSD (post-traumatic stress disorder) and narcolepsy.

“In the fall of 2017 my insurance company suddenly decided to not pay for my prescriptions. This lasted for 5 1/2 months. My Provigil alone is $4,500.00 a month! I could not afford to buy anything for 3 1/2 months.

“I had no idea about the side effects of stopping CYMBALTA suddenly! I was going crazy! I was suicidal. It was the most horrible I have ever felt in my life!

“It has been nearly seven months since the onset of withdrawal symptoms. I have been in bed for 3 3/4 months. Just a few steps make me exhausted. I am dizzy. I cannot walk a straight line. I bounce off the walls and hit the sides of doorways. It is as if I have very little control over my upright body.

“I know it is from the suddenly stopping Cymbalta! I took this drug for more than a decade. I just got used to it. I kept taking it for years, until insurance refused to pay in Sept. 2017. My life has been a wreck ever since. It still is going on. I am in a living hell and am unable to find a solution!”

Diane in Texas reduced her dose very gradually:

“I took Cymbalta for years and got off of it a few years ago. It was very difficult. I ended up opening the capsules and counting beads. I made very gradual adjustments and it took months to get off it. I felt withdrawal symptoms from the slightest decrease.”

Cindy in Seattle, Washington, offers an insider’s perspective:

“I worked in psych for 30 years (inpatient units), and one of the main reasons for an admission was to ‘wean’ the patient off SSRI’s. The withdrawal symptoms were that horrible and dangerous.”

Dagny offers an interesting taper tip:

“Antidepressants can quit working and result in withdrawal symptoms that are the same as they would be if the person quit the drug cold turkey. You might want to ask your doctor about switching to a different SSRI and see if that helps.

“I’ve gone through antidepressant withdrawal cold turkey. It was three and a half years of misery. The discomfort slowly decreased over that time period.
If you want to get off antidepressants, your doctor may be able to prescribe a liquid version. As you get close to reducing the dose in smaller increments this will make it easier to titrate the dose. You can taper very gradually during the last months. That is when it begins to get most difficult. A compounding pharmacy can make up the prescription for you.

“It will no doubt be more expensive than an ordinary prescription, but it would be well worth it. I wish I had known about this when I was suffering. Whatever you do, don’t just stop the drug. After a month or so of going off cold turkey, going back on the drug to stop withdrawal symptoms may not work. Take it slow and easy.”

How to Stop Duloxetine (Cymbalta) from “Hopeful” in Indiana:

Patients who have been through the hell of antidepressant withdrawal often try to help their fellow sufferers. Here is an article we wrote about a year ago with some thoughtful suggestions from “Hopeful” in Indiana. Remember to always check with a health professional about any withdrawal strategy:

How to Stop Duloxetine (Cymbalta) Without Withdrawal Symptoms

Why Is It So Hard to Stop Antidepressants?

To our surprise there has not been a large amount of research devoted to this crucial question. We now know that antidepressants affect a number of important neurochemicals: serotonin, norepinephrine and dopamine for starters. It is likely that other systems are also impacted, including GABA and “neurotrophic factors” (Frontiers in Pharmacology, April 16, 2013).

When drug-induced modifications occur within the body, there are frequently cellular adaptations. Receptor sites on neurons change. This is the way the body attempts to deal with changes in neurochemistry. Because neuroscientists have not devoted a lot of research to this issue, we do not yet have a good explanation for the underlying causes of discontinuation syndrome.

We suspect that withdrawal symptoms occur as the body tries to reestablish homeostasis. Some people are super sensitive to this challenge. It may take them months or years to achieve balance. Others may overcome the challenge over several weeks.

People’s Pharmacy Perspective:

We are glad to learn that the media is starting to wake up to the seriousness of antidepressant withdrawal. This is not the depression returning. That has sometimes been used as an explanation for why people suffer symptoms after stopping an antidepressant. It is much easier to blame the patient than the drug.

We believe this because people report the discontinuation syndrome even when they were taking the medication for other reasons than depression:

Jan was taking duloxetine for the pain of fibromyalgia:

“I was on Cymbalta for over 10 years for fibromyalgia. I just didn’t feel good on the medication. I asked myself, why I am I taking it? My symptoms were actually worse.

“I decided I need to get off this drug. At my annual checkup my doctor said fine, but let me give you 30 mg for a month (I was on 60 mg.) Then you should be fine.

“NO. I am on my 3rd day and as everyone else has said on this website, I am going a bit crazy. I threw up the first day. I had the brain zaps, crying and the shakes to name a few! I have been drinking tons of water and trying to eat lots of fruits and veggies. I took a long Epson Salt bath with peppermint oil to try and sooth my pain.

“Thank You so much for sharing the idea of opening the capsule and removing the small white balls and weaning that way…who knew?”

Occasionally, patients may need to stay on antidepressant medication for many years. Others may need to be on such drugs indefinitely. But for those who wish to get off their medicine, there are no good guidelines for gradual tapering.

It is long past time for the FDA to require drug makers to develop evidence-based strategies to help people discontinue antidepressants safely.

Share Your Own Antidepressant Withdrawal Story

If you needed to stop an antidepressant medication for any reason, please share your experience in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I had a horrible experience with Zoloft. I took it for 6 weeks. I stopped it because it was making me more depressed. When I stopped it for over a month I passed out dizzy and was more severely depressed. I had pains all over my body, flu symptoms, and a heart attack feeling!!!! Could not get out of bed. If I didnt know what was going on from my research I could have wanted to die!!!!! Awful medication. I wish I could give this information to someone. It needs to be taken off the market!!! I am traumitized and lost my memory!!!!

In January of 2013 my doctor took me off 8 mg of lorazapam in 6 weeks! 63 months later I am still getting worse ,not better! I have been unable to walk more than to the next room,head pressure is horrible,tinnitus too and this year I lost all my long term memory (short term is OK) so now I can’t daydream, I can’t talk to friends I have known for most of my life because I don’t know them anymore!

My neurologist told me he can’t help and even my wife who sees my uncontrollable muscle movements ans sees me cry out in agony can’t take me anymore and because my doctor said withdrawal can’t last over 3 years she believes him and tells me to ” GET OVER IT” and I am ready to give up! I don’t know what to do!

Anybody tried coming off metrazapine 30?

In Feb of 1996 I had an accident resulting in a large loss of blood and a compound fracture of the tib/fib of the left leg. I became very depressed. Prior to this I was an active adult, never having a psychiatric diagnosis. I worked out in the gym five days a week.

I was mis-managed (in the Washington, DC area) on psychiatric medication for 12 years, (1996 to 2008) resulting in a diagnosis of serotonin syndrome. I was put on antidepressants less than two months after the accident in 1996. In 2000 I was hospitalized for my first suicide attempt. Had a total of three suicide attempts requiring hospitalization. I was diagnosed bipolar after the first suicide attempt after being prescribed Prozac. Thereafter, I was prescribed Depakote with an antidepressant. I was given Xanax and then later Clonozepam to alleviate horrible anxiety symptoms from the antidepressants. My life was drastically altered because of Iatrogenic Depression (definitely relating to illness caused by medical examination or treatment).

Diagnosed with Serotonin Syndrome in December of 2008 by a GW University professor who is a neuro-pyscho pharmacologist. This was not the doctor that prescribed and managed my diagnosis of depression.
At this point I was hallucinating. I threatened suicide once again and my mother found the neuro-psycho-pharmacologist. It was suggested that I go into the hospital and be placed in a coma to detox. I refused.

I walked away from doctors that day.
It took me 8 months to detox off of antidepressants and 4 (four) YEARS to detox off of the benzodiazepines.
I detoxed on my own with the help of a doctor who prescribed medication as I tapered off the medication.

I can honestly say that I lost everything that I loved because of anti-depressant medications. I did not function normally, never leaving the house and had horrible body pain. In the year 2000 I separated from my husband because my personality completely changed and in 2001 divorced. All medications and doctor’s visits were self pay except for the time that I was married, from Feb 1996 until 2001 when I had insurance. The last two years that I was on the medication the cost of Cymbalta and Effexor was nearly $500.00 a month. It was the Cymbalta/Effexor combination that caused the Serotonin Syndrome.

I vowed to make my story known. I have been healing for the last ten years after detoxing off of all medication. I now try to do my best to eat good quality food, drink good quality water, eat very little meat, and take as few pills as possible.

I will do anything I can to help bring to light the devastating effects of psychiatric medication, specifically antidepressants, mood stabilizers and anti-anxiety medication.

Today I’m doing well, still with depression, but much happier than I ever was while on medication.

I recommend to everyone to look up SSRI Stories | Antidepressant Nightmares.

I am taking Trazadone, and trying to wean myself off…but I can’t sleep…I had gotten down to 1/2 a tablet every 3rd night, but after several nights of not sleeping, had to go back to every other night…will try again, after I get some rest…if someone has a suggestion, I would appreciate all help…I also take clonazapam each night…been taking both, for several years…I am 77, and would like to get off at least the Trazadone…

I have been on Celexa for about 15 years. About 10 years ago I tried to wean myself off of it and turned into a person I didn’t know. Words would come out of my mouth that I had no control over and usually they were not nice. I was appalled and embarrassed that a mean streak had developed while weaning off this drug. I also had brain zaps. I went right back on the drug and refuse to wean off again because I am scared of becoming a raging b**** again.

I’ve been taking 50 MG Sertraline and 300 MG Buproprion HCL XL for years. With my doctor’s assistance I tried to get off first the Buproprion. She reduced it to 150 MG for a period then I went off it completely, still taking the Sertraline. EVERYTHING irritated me, and I became Super Bitch, biting off people’s heads for the smallest of irritants. I told my doctor I needed to get back on it because I must be a very angry person who needs the drug.

She never once told me it may be a side effect of getting off a drug. A year later I tried to get off the Sertraline, which she had me stop cold turkey. I had the same reaction, and Super Bitch reappeared. I again told her I needed to get back on that one too because, again, I believed I must be a very angry person. Now after reading this I realize these were withdrawal symptoms, that I am not just an angry person (what a relief).

However, it sounds like I need to keep taking these drugs for the rest of my life to avoid years of withdrawal temper tantrums. Is there any harm in taking these drugs for all of your life???? These are solid tablets so I don’t see how I can gradually get off of them.

I had a nightmare getting of Effexor when I developed light and sound induced seizures from 7 months trial of the drug for migraine anxiety…never before having had seizures in my 56 years…
MY Israeli Doc prescribed them describing them as the best in his arsenal here in NZ.
I still have an involuntary body jolt triggered by certain triggers…and stopped the drug 7 months ago after a tapering program was devised by another Dr including treatments with Russian Scenar treatment and other suggestions…
If it had been spelled out to me this possibility of discontinuation syndrome …what that means … i would never have agreed and with my history of sensitivity to meds clearly documented in my medical notes feel it should not have been recommended…
WHY DO THE PHARMA COMPANIES ENJOY PROTECTION FROM THE FULL DISCLOSURE OF SIDE EFFECTS…IF fully informed consent is the bench mark for patient rights …they are corrupted at the outset.
I feel ripped off…and yet also lucky to be back with the loving support of a best friend I made it back from zombieland as my granddaughter described…to me…u turned into a zombie her words at 7 years
How can these drug companies get away with it? how come no one is made responsible…humans are being poisoned by the drug companies.

What upset me was that, when you tried to go off one of these meds and had problems, they would use that to say “you see, you really need this”.
I feel so angry that all of these years these drugs were marketed as non-addictive and that doesn’t seem quite true.

Now they are bringing in these antipsychotic drugs (Abilify, Seroquel) which wreak havoc with the metabolism, causing insulin resistance, diabetes, weight gain and high cholesterol. Hmmm…. I wonder why they suddenly started prescribing anti-psychotics for depression? Sounds to me like the drug company’s needed to create a new market as they didn’t have enough people experiencing psychosis to pad their pockets.

I have took different antidepressants off and on for yrs. some are better than others but that is an individual thing which works best.a earlier post the shrink “fired” the patient for question her.if a dr thinks they know best and you can question them when you have side effects he is dr at low end of the scale. they suppose work with you. you pay them, so they work for you.

My decease dad once “fired” a dr at hospital.they put him in physo ward two days. My dad explain I am not paying you to peek your head in the door 2 mins just so you can get paid for $200 visit. Makes sense to me.

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