Top three things you should know about stopping SSRIs?

Go slow  

Patients who stop their SSRIs cold turkey or even just quickly are at increased risk of experiencing withdrawal. A way to reduce withdrawal is to taper more slowly.  You also need to keep in mind the long term risks. A study in 2010 by Baldessarnini showed that a gradual reduction in the amount of SSRI over at least a couple weeks decreased the risk of future relapse in major depressive disorder compared to abruptly stopping the SSRI. Basically, current evidence suggests that a slower taper now increases your chances of not needing an SSRI again in the future.  It can be frustrating once you have made the decision that you want to stop your SSRIs to have to go slowly, but can also be a way of best setting yourself up for success in the short and long term.

Keep an eye out for withdrawal

Withdrawal symptoms can be sneaky.  For some patients, it’s very obvious – they stop their SSRI and one day later feel terrible. However, for others they can experience symptoms they didn’t realize could be related to stopping their SSRI and they experience them later on and for longer than they expected. Withdrawal symptoms can include but are not limited to irritability, anxiety, low mood, sleep troubles, electric zap sensations, dizziness, trouble thinking, headache, sweating, fatigue, nausea, diarrhea, and sexual symptoms. The time it takes for withdrawal to start can be anywhere from hours to (in some cases) months after stopping an SSRI. Withdrawal symptoms can also last anywhere from 5 days to (in rare cases) several years. This can all sound a little terrifying, but the good news is that there are proven strategies to help if you ever experience SSRI withdrawal (check out #3). And of course talking with your psychiatrist about your individual risk of withdrawal, any possible symptoms you are having, and next steps you can take is critical

Consider hyperbolic tapering if you are experiencing withdrawal 

Hyperbolic tapering is a method used to gradually discontinue medications, particularly psychiatric medications like antidepressants and benzodiazepines in order to reduce withdrawal symptoms. It is designed to reduce medication by a certain percentage of brain receptor occupancy (aka how much the medication is actually working in your brain) rather than a fixed dose of medication (aka the miligrams you see on your prescription bottle). This is important because SSRIs work differently at different doses. For example, a change of citalopram from 0 mg to 5mg increases brain percentage of receptor occupancy by 57% (a huge change in how much work is being done in your brain!). Increasing citalopram from 15mg to 20mg increases the brain percentage of receptor occupancy by 5% (much smaller). 5mg increase of citalopram at a lower dose range is doing much more work in your brain than 5mg increase of citalopram at a higher dose range. Because SSRI withdrawal symptoms are linked to large or fast changes in the brain receptor occupancy of SSRIs, it makes sense to use a tapering strategy that accounts for this like the hyperbolic taper.

If you are interested in SSRI deprescribing, please consider setting up a free 15-minute discovery call with me to learn more about my practice. 

Thanks for reading! 

Warmly,

Dr Amy

References:

Baldessarini RJ, Tondo L, Ghiani C, Lepri B. Illness risk following rapid versus gradual discontinuation of antidepressants. Am J Psychiatry. 2010 Aug;167(8):934-41. doi: 10.1176/appi.ajp.2010.09060880. Epub 2010 May 17. PMID: 20478876.

Fava, G. A. et al. (2015) ‘Withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation: A systematic review’, Psychotherapy and Psychosomatics, 84(2), pp. 72–81. doi: 10.1159/000370338. 

Horowitz, H., Taylor, D. (2024)  Maudsley Deprescribing Guidelines. Wiley Blackwell.

Sharp, T., Collins, H. (2023). Mechanisms of SSRI Therapy and Discontinuation. In: Current Topics in Behavioral Neurosciences. Springer, Berlin, Heidelberg. https://doi.org/10.1007/7854_2023_452

Psychosomatics, 84(2), pp. 72–81. doi: 10.1159/000370338.

Valuck RJ, Orton HD, Libby AM. Antidepressant discontinuation and risk of suicide attempt: a retrospective, nested case-control study. J Clin Psychiatry. 2009 Aug;70(8):1069-77. doi: 10.4088/JCP.08m04943. PMID: 19758520.

Short disclaimer: This information is for educational purposes only. It is not intended as medical advice, diagnosis, treatment or consultation.