Antidepressant Discontinuation Syndrome(ADS)/Antidepressant Withdrawal Syndrome (AWS)
Updated: Dec 4, 2020
Lets start here :-
Types of antidepressants
Antidepressants can be grouped according to how they work. The different types are:
SSRIs: selective serotonin reuptake inhibitors: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
SNRIs: serotonin and noradrenaline reuptake inhibitors: duloxetine, venlafaxine, desvenlafaxine Serotonin modulator: vortioxetineNoradrenaline reuptake inhibitors: reboxetine TCAs (tricyclic antidepressants): amitriptyline, nortriptyline, clomipramine, dothiepin, doxepin, imiprimine, trimipramine*RIMAs (reversible inhibitors of monoamine oxidase A): moclobemide Tetracyclic antidepressants: mianserin Tetracyclic analogues of mianserin (sometimes called noradrenergic and specific serotonergic antidepressant [NaSSA]): mirtazapine MAOIs (monoamine oxidase inhibitors): phenelzine, tranylcypromine Melatonergic antidepressants: agomelatine*
During the 24 years I have been taking antidepressants I have been on 2 different types. For approx 18 years I was on Sertaline/zoloft, an SSRI and the last 6 I have been on Mirtazapine, a tetracyclic antidepressant.
Now don't worry about the scientific stuff. On a good day I get it on a bad day I don't give a sh*t!lol
I was changed over from one to the other over approx 48hrs...nightmare but have been happy on Mirtazapine as it helped me to sleep.
Today finds me starting to research ADS.
It hasn't been verified by my GP but having looked at the symptoms I an 99.9% sure this is what I have been experiencing this last week.
I have chosen not to reduce my meds anymore because I like to be prepared. I would rather settle back at 15mg and get through the winter. During which I will research ADS and check in with my GP to work out a plan for the spring.
The first place I have toddled off to on my search for guidance around ADS is the National Institute for Health and Care Excellence(NICE) website.
Here I find that at long last they are recognising the severity of ADS for some people. The pharmaceutical companies may want us to believe the opposite but they can go shove it as we know our own bodies and how we feel.
Having just said that I have read an article that claims that NICE is taking it too far and most people pop off their meds as easy as blinking.
Scoose me while I go scream obscenities, take a deep breath and come back totally Zen!
Right back to something helpful.
Antidepressant withdrawal can look like depression
Discontinuation symptoms can include anxiety and depression. Since these may be the reason you were prescribed antidepressants in the first place, their reappearance may suggest that you're having a relapse and need ongoing treatment. Here's how to distinguish discontinuation symptoms from relapse:
Discontinuation symptoms emerge within days to weeks of stopping the medication or lowering the dose, whereas relapse symptoms develop later and more gradually.
Discontinuation symptoms often include physical complaints that aren't commonly found in depression, such as dizziness, flulike symptoms, and abnormal sensations.
Discontinuation symptoms disappear quickly if you take a dose of the antidepressant, while drug treatment of depression itself takes weeks to work.
Discontinuation symptoms resolve as the body readjusts, while recurrent depression continues and may get worse.
If symptoms last more than a month and are worsening, it's worth considering whether you're having a relapse of depression.
Antidepressant withdrawal symptoms
Neurotransmitters act throughout the body, and you may experience physical as well as mental effects when you stop taking antidepressants or lower the dose too fast. Common complaints include the following:
Digestive. You may have nausea, vomiting, cramps, diarrhea, or loss of appetite.
Blood vessel control. You may sweat excessively, flush, or find hot weather difficult to tolerate.
Sleep changes. You may have trouble sleeping and unusual dreams or nightmares.
Balance. You may become dizzy or lightheaded or feel like you don't quite have your "sea legs" when walking.
Control of movements. You may experience tremors, restless legs, uneven gait, and difficulty coordinating speech and chewing movements.
Unwanted feelings. You may have mood swings or feel agitated, anxious, manic, depressed, irritable, or confused — even paranoid or suicidal.
Strange sensations. You may have pain or numbness; you may become hypersensitive to sound or sense a ringing in your ears; you may experience "brain-zaps" — a feeling that resembles an electric shock to your head — or a sensation that some people describe as "brain shivers."
As dire as some of these symptoms may sound, you shouldn't let them discourage you if you want to go off your antidepressant. Many of the symptoms of SRI discontinuation syndrome can be minimized or prevented by gradually lowering, or tapering, the dose over weeks to months, sometimes substituting longer-acting drugs such as fluoxetine (Prozac) for shorter-acting medications. The antidepressants most likely to cause troublesome symptoms are those that have a short half-life — that is, they break down and leave the body quickly. (See the chart "Antidepressant drugs and their half-lives.") Examples include venlafaxine (Effexor), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa). Extended-release versions of these drugs enter the body more slowly but leave it just as fast. Antidepressants with a longer half-life, chiefly fluoxetine, cause fewer problems on discontinuation.
Besides easing the transition, tapering the dose decreases the risk that depression will recur. In a Harvard Medical School study, nearly 400 patients (two-thirds of them women) were followed for more than a year after they stopped taking antidepressants prescribed for mood and anxiety disorders. Participants who discontinued rapidly (over one to seven days) were more likely to relapse within a few months than those who reduced the dose gradually over two or more weeks.
Antidepressant drugs and their half-lives*
Half out of body in
99% out of body in
Serotonin reuptake inhibitors
27 to 32 hours
Four to six days
Serotonin and norepinephrine reuptake inhibitors
Dopamine and norepinephrine reuptake inhibitor
*Discontinuation symptoms typically start when 90% or more of the drug has left your system.
Source: Adapted from Joseph Glenmullen, M.D., The Antidepressant Solution: A Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and "Addiction" (Free Press, 2006).
How to go off antidepressants
If you're thinking about stopping antidepressants, you should go step-by-step, and consider the following:
Take your time. You may be tempted to stop taking antidepressants as soon as your symptoms ease, but depression can return if you quit too soon. Clinicians generally recommend staying on the medication for six to nine months before considering going off antidepressants. If you've had three or more recurrences of depression, make that at least two years.
Talk to your clinician about the benefits and risks of antidepressants in your particular situation, and work with her or him in deciding whether (and when) to stop using them. Before discontinuing, you should feel confident that you're functioning well, that your life circumstances are stable, and that you can cope with any negative thoughts that might emerge. Don't try to quit while you're under stress or undergoing a significant change in your life, such as a new job or an illness.
Make a plan. Going off an antidepressant usually involves reducing your dose in increments, allowing two to six weeks between dose reductions. Your clinician can instruct you in tapering your dose and prescribe the appropriate dosage pills for making the change. The schedule will depend on which antidepressant you're taking, how long you've been on it, your current dose, and any symptoms you had during previous medication changes. It's also a good idea to keep a "mood calendar" on which you record your mood (on a scale of one to 10) on a daily basis.(I do this with my joy diary.)
Consider psychotherapy. Fewer than 20% of people on antidepressants undergo psychotherapy, although it's often important in recovering from depression and avoiding recurrence. In a meta-analysis of controlled studies, investigators at Harvard Medical School and other universities found that people who undergo psychotherapy while discontinuing an antidepressant are less likely to have a relapse.
Stay active. Bolster your internal resources with good nutrition, stress-reduction techniques, regular sleep — and especially physical activity. Exercise has a powerful antidepressant effect. It's been shown that people are far less likely to relapse after recovering from depression if they exercise three times a week or more. Exercise makes serotonin more available for binding to receptor sites on nerve cells, so it can compensate for changes in serotonin levels as you taper off SRIs and other medications that target the serotonin system.
Seek support. Stay in touch with your clinician as you go through the process. Let her or him know about any physical or emotional symptoms that could be related to discontinuation. If the symptoms are mild, you'll probably be reassured that they're just temporary, the result of the medication clearing your system. (A short course of a non-antidepressant medication such as an antihistamine, anti-anxiety medication, or sleeping aid can sometimes ease these symptoms.) If symptoms are severe, you might need to go back to a previous dose and reduce the levels more slowly. If you're taking an SRI with a short half-life, switching to a longer-acting drug like fluoxetine may help.
You may want to involve a relative or close friend in your planning. If people around you realize that you're discontinuing antidepressants and may occasionally be irritable or tearful, they'll be less likely to take it personally. A close friend or family member may also be able to recognize signs of recurring depression that you might not perceive.
Complete the taper. By the time you stop taking the medication, your dose will be tiny. (You may already have been cutting your pills in half or using a liquid formula to achieve progressively smaller doses.) Some psychiatrists prescribe a single 20-milligram tablet of fluoxetine the day after the last dose of a shorter-acting antidepressant in order to ease its final washout from the body, although this approach hasn't been tested in a clinical trial.
Check in with your clinician one month after you've stopped the medication altogether. At this follow-up appointment, she or he will check to make sure discontinuation symptoms have eased and there are no signs of returning depression. Ongoing monthly check-ins may be advised.
Something that keeps coming up is the drug's half life -heres what Mind say about it:
What is a drug's half-life?
The half-life of a drug is the time it takes for the amount of it in your body to be reduced by half. This depends on how the body processes and gets rid of the drug, and can vary from a few hours to a few days.
No matter what dosage of a particular drug you're on or how long you've been taking it for, its half-life is always the same.
Why does my medication's half-life matter?
A drug's half-life matters because usually:
a short half-life = more withdrawal problems, a long half-life = fewer withdrawal problems
So if you're taking a drug with a short half-life and having problems with withdrawal, it might be possible for you to switch to a related drug with a longer half-life, which could be easier to come off.
So this will give me something to think over before I speak to my GP this week.
I always feel better when I have something to focus my attention on especially something as important as this.
I took last night would've been a 7.5mg but I took 15mg so am not feeling as unwell as I have been.
Updates to follow.