You and your healthcare provider have decided it’s time to wean off your antidepressant and now you wonder: what is the best way to stop? Cold turkey or a slow wean? Well, the answer is we don’t really know the easiest way to get you off of your antidepressant.
Most antidepressants have been associated with adverse effects when abruptly discontinued. While discontinuation symptoms are usually mild and self-limited, this is not always the case, and when discontinuation symptoms persist, it can be difficult to distinguish those symptoms from the underlying depression.
When antidepressants are discontinued, it is common practice to taper them over two to four weeks to minimize the symptoms associated with abrupt discontinuation. However, the evidence on the effectiveness of slow medication tapers didn’t really point us one way or another.
Now we have some new information: A study comparing tapering over three days with tapering over two weeks found no difference in discontinuation and depressive symptoms. What was different, however, was that the time to recurrence of depression in patients who discontinued their antidepressant over one to seven days was shorter compared with patients who discontinued their antidepressant over 14 or more days. So the longer the taper the less likely the recurrence of depression.
The worst withdrawal symptoms tend to happen in the antidepressants with the shortest half-life-- namely Venlafaxine (Effexor) and Paroxetine (Paxil)-- while the mildest symptoms occur with Fluoxetine which has a long half- life. As many of you know, the "discontinuation syndrome" is worse when you stop your antidepressant abruptly and may include dizziness, nausea, fatigue, muscle aches, chills, anxiety, and irritability. These symptoms are not dangerous and usually lessen over one to two weeks, but they can be quite distressing and uncomfortable.
How do the antidepressants compare?
• Fluoxetine (Prozac) produces less severe withdrawal symptoms than paroxetine (Paxil) or sertraline (Zoloft) cessation.
• Sertraline cessation produces less symptoms than paroxetine cessation.
• Patients who have difficulty tapering off of paroxetine may benefit from being switched to an equivalent dose of fluoxetine then tapering off of that.
• Abrupt discontinuation of Venlafaxine (Effexor) commonly causes withdrawal symptoms including dizziness, flu-like symptoms, and anxiety.
• Stopping Citalopram (Celexa) generally produces only mild symptoms less severe than with paroxetine cessation.
• Evidence suggests that fluoxetine (Prozac) causes the least withdrawal symptoms, and paroxetine (Paxil) causes the most discontinuation symptoms.
So how should you stop them? Not abruptly! Experience suggests that discontinuation symptoms can be reduced by a slow tapering of the drug. When you are stopping your antidepressant taper the dose 25 percent per week so as to minimize the occurrence of discontinuation side effects.
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