SSRI Withdrawal Symptoms

If are taking a selective serotonin reuptake inhibitor (SSRI) antidepressant, it is important to talk to a doctor before you stop taking your medication. If you stop taking your antidepressant suddenly, you may experience withdrawal symptoms known as SSRI discontinuation syndrome. 

"SSRI withdrawal symptoms are not uncommon. They can start when people abruptly stop taking antidepressants. People can have flu-like symptoms, trouble sleeping, nausea, imbalance, electric shock sensations, and restlessness," says Rehan Aziz, MD, a psychiatrist at Hackensack Meridian Health and associate professor of psychiatry and neurology at the Hackensack Meridian School of Medicine.

Learn more about what happens if you quit taking an SSRI abruptly, some withdrawal symptoms you might experience, and how to prevent SSRI discontinuation syndrome.

What Is SSRI Discontinuation Syndrome?

Selective serotonin reuptake inhibitors (SSRIs) are a class of drug commonly used to treat depression and some forms of anxiety. The drugs help normalize brain function in people with certain mood disorders by increasing the amount of serotonin in the brain.

While beneficial, one of the downsides is that some people may experience a form of withdrawal called SSRI discontinuation syndrome when treatment is stopped.

This syndrome most commonly occurs when the medication is stopped abruptly and can manifest with symptoms that seem very much like the depression and anxiety the SSRI was being taken to treat.

Why SSRI Withdrawal Symptoms Occur

Serotonin is a type of chemical called a neurotransmitter whose purpose is to deliver messages to and from brain cells. By modifying this process, the chemistry in the brain can be regulated in a way that typically improves depression or anxiety.

The various SSRI drugs used to treat mood disorders have similar mechanisms of action but varying degrees of drug half-life. This term describes how long an active drug molecule stays in the bloodstream before being expelled from the body.

Most SSRIs have short half-lives. Common SSRI medications used to treat depression include:

• Celexa (citalopram)
• Lexapro (escitalopram)
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Zoloft (sertraline)

Of these, Prozac has the longest half-life and, when stopped, will gradually clear from the bloodstream. The others, by contrast, have a short half-life and, when stopped, will drop off abruptly. When this happens, the person taking them may experience disconcerting or even profound withdrawal symptoms.

Changes in the Brain

Drug half-life is only part of the reason for SSRI discontinuation syndrome symptoms. When used over a period of time, SSRIs can cause changes in the brain that affect serotonin receptors.

When treatment is eventually stopped, there will be fewer receptors than before and a short-term deficiency of serotonin activity. The body will typically correct this, but there will be a period of adjustment until the system normalizes.

Common SSRI Withdrawal Symptoms

The most common symptoms of SSRI discontinuation syndrome are described as either being flu-like, or feeling like a sudden return of anxiety or depression. They can include:

• Chills
  
• Diarrhea
• Difficulty walking
• Dizziness
• Fatigue
• Headaches
• Impaired concentration
• Insomnia
• Irritability
• Lightheadedness
  
• Nausea/vomiting
• Paresthesia (burning, prickly, or skin-crawling sensations)
  
• Shock-like sensations (sometimes called brain zaps)
  
• Vertigo
  
• Visual disturbances
  
• Vivid dreams
  

Symptoms typically begin two to four days after abruptly stopping an SSRI that has been taken regularly for at least one month. In some cases, people can experience withdrawal symptoms after missing a dose of an SSRI with a short half-life. Research suggests that around 70% of people taking SSRIs skip doses occasionally, so it is not uncommon for people to experience some withdrawal symptoms from time to time.

Severe Symptoms

In some cases, people may experience more severe symptoms such as:

• Catatonia (a state of unresponsiveness)
• Depersonalization (a detached, out-of-body experience)
• Psychosis
• Suicidal thoughts
  

How to Prevent SSRI Withdrawal Symptoms

Research suggests that around 50% of people experience SSRI withdrawal symptoms when they stop taking a selective serotonin reuptake inhibitor. These symptoms typically last around two weeks, but may persist for longer for those who have been on SSRIs for many years.

Taking your medication at the same time each day can help minimize the risk of experiencing withdrawal symptoms. If you do miss a dose of your medicine, take it as soon as you remember unless it is almost time for your next dose. Don't take a double dose to make up for your missed dose.

If you've missed a dose or stopped your medication and begin having withdrawal symptoms, Dr, Aziz recommends resuming your regular dose and talking to your doctor.

Tapering Your Dose

If want to stop taking your antidepressant or lower your dose, always talk to your doctor first. SSRI discontinuation syndrome can be unpleasant, so gradually tapering your dose can help minimize the chances of severe symptoms. 

Typically, tapering off over one to two weeks would be reasonable if treatment has lasted less than eight weeks. After six to eight months of treatment, you may need to taper off over six to eight weeks.

Your tapering schedule will depend on the medication you are taking and how long you have been taking it. Your doctor may also adjust your schedule as needed depending on your symptoms.

It is also a good idea to check in with a doctor a few weeks after completely stopping your antidepressant. You should also reach out to a doctor if you notice the return of any symptoms of anxiety and depression in the weeks and months after you have stopped taking your antidepressant medication.