5 reasons why you might want to stop your antidepressant

First things first, please don’t abruptly stop your antidepressant. Unless you’ve only been taking it for a few days to weeks and were never on a similar medication before, you are likely to experience withdrawal and likely increase your risk of relapse of depression/anxiety/whatever reason you took it in the first place. That said, as long as you are game to decrease your antidepressant safely, there are plenty of good reasons to consider stopping your medication or least trying to decrease it. 

You don’t want to take the antidepressant

Patient preference matters. When considering de-prescribing psychiatric medications including antidepressants your values, ideas and opinions need to be included. Safety matters though, so having a discussion with your doctor about why you don’t want to take the medication, alternatives to the medication and reasonable expectations for how you can expect the process to go is important. At the end of the day your body is taking the medication, so if you don’t want to take the antidepressant, it’s an important consideration that should be addressed. 

You are taking so many psychiatric medications already  

In my practice I see many people on multiple psychiatric medications and sometimes even long supplement lists as well. In medicine, we call this polypharmacy (poly – many; pharmacy – medications). At a certain point, there really aren’t studies or research to tell us that this combination of (three, four, five plus) psychiatric medications is helpful or safe. There is no way to know for sure how all the medications are acting in your system. Polypharmacy has risks. For example, as you get older, polypharmacy (especially if you are taking benzodiazepines) puts you at risk for things like delirium. 

There is more risk to taking your antidepressant than not taking it

There are risks to taking antidepressants both in the short term and long term. Like any medication, antidepressants have a long list of possible side effects (although many side effects on the list are very rare or mild). In the short term, you can have side effects as your body and brain adjust to taking the antidepressant – things like headache and stomach upset. In the long term, you are at increased risk of side effects like sexual side effects (which in rare cases last even after you stop the medication) or as you age risks like falling of hyponatremia (low sodium levels).  Risks of taking the medication should be weighed against the risks of not taking them.

Your antidepressant isn’t helping

Many people don’t respond to their first trial of an antidepressant. There are strategies you can consider like switching antidepressants, augmenting with another medication (if you’ve had partial benefit), genetic testing, and medication alternatives (therapy, lifestyle changes, supplementation, interventional approaches etc). But at the end of the day it doesn’t make much sense to keep taking an antidepressant that isn’t helping. Keep in mind though that your antidepressant will take several weeks to have an effect and you want to make sure you’ve tried a therapeutic dose before you decide it doesn’t work. 

You feel better

This is the ideal scenario. You were struggling, you took your antidepressant, it helped, you feel better, and now you want to know what’s next. I typically suggest that people maintain several months of stability before we start discontinuing an antidepressant, especially if there is a prior history of depression/anxiety or your recent symptoms were severe. Many people stay on their antidepressants for years and years which isn’t always necessary. Continue to discuss with your doctors when it could be a good time to try stopping your antidepressant once you feel better.