You have been taking antidepressant medicines for over six months, and you suddenly stop taking the medication without consulting your doctor. You then develop flu-like symptoms, have trouble sleeping, feel dizzy or get nervous. Many of these symptoms are collectively called antidepressant discontinuation syndrome. This is not life threatening, but you must consult your doctor to decide the course of action to be taken.
About antidepressant discontinuation syndrome
Antidepressant discontinuation syndrome occurs when a person, who had been taking antidepressants regularly, stops taking antidepressant medication suddenly. This syndrome occurs with all classes of antidepressants, but a well-described one occurs with selective serotinin reuptake inhibitors (most commonly Paxil and Zoloft). A number of unpleasant withdrawal symptoms are experienced on abruptly stopping medication. Instead, tapering the dose gradually, with at least 1 to 2 weeks gap between each dosage reduction, under the doctor’s supervision is advisable. Approximately 20 percent of patients experience this syndrome after abruptly discontinuing antidepressant medication for at least six weeks. However, the syndrome subsides within a week on resuming medication.
Symptoms
Symptoms are usually mild, lasting for one or two weeks and disappear on starting antidepressant medication again. These include flu-like symptoms, insomnia, sensory disturbances, imbalance, anxiety, irritability, depression, fatigue, headaches, nausea, and vomiting. Depression and anxiety are common symptoms, and most often depression experienced on stopping medication is worse than the original depression that needed treatment. Many times, patients fail to recognize this as a withdrawal symptom and think the depression has returned, thus resuming the medication again.
Diagnosis
Recognizing the syndrome is very important and is based on three factors. Firstly, though the symptoms are mild in nature, associated signs include significant discomfort, work absenteeism, other psychological issues and at times there is the need for hospitalization. Secondly, the failure in recognizing the symptoms may result in misdiagnosis, thus exposing the patient to unnecessary diagnostic investigations and other medial examinations. Lastly, the patients might become unwilling to use psychotropic medications in future, thereby, increasing the risk of relapses of depressive disorders. Certain observations will also help facilitate diagnosis; abrupt onset of symptoms within days of stopping the medication, lasts for a short duration when untreated, and rapid resolution of symptoms once medication is reinstated.
It should also not be inferred that one is addicted to antidepressants by having withdrawal symptoms. Antidepressants do not cause such issues.
Course of action
It is always best to talk to the doctor before taking one’s own decision to stop the medication. Issues like missing a dose, stopping medication on purpose or running out of stock, should always prompt a discussion with the doctor. In the cases of unpleasant side effects, there maybe changes made in dosage or alternate drug suggestion by the doctor. It maybe recommended to gradually reducing the dosage for several weeks till the brain adapts itself to the absence of the drug. Hence, the physician should always keep a high degree of suspicion for the emergence of the discontinuation syndrome in lieu of accidental or purposeful self-discontinuation of medication.
Creating Awareness
Clinicians need to be familiar with measures to tackle the prevention and management of antidepressant discontinuation syndrome. A time was there when health professionals themselves were unfamiliar with the existence of such a syndrome. Increased awareness is required to help professionals adopt correct strategies to prevent and to effectively treat when discontinuation symptoms arise. Patients should be educated about the possibility of developing symptoms, adhering to medication and tapering the dosage prior to stopping medication. They should be informed that antidepressants do not cause craving, tolerance and loss of control, implying addictive qualities like in the case of drugs or alcohol. Being aware of this will lessen the likelihood of symptoms appearing and also their misdiagnosis. Prior to starting a course on antidepressants, patients should be informed that the treatment period would be at least for six weeks, assuming the medication is effective and well tolerated. Communication between the patient and health practitioner is very important and any intention to stop taking the medication should be done under the supervision of a well-informed clinician.
