If you’re one of the millions of Americans living with depression, you may be wondering whether it’s safe to come off antidepressants on your own. Taking antidepressants puts you in a pretty sizable club: When asked, 13 percent of Americans aged 12 and over reported taking antidepressants in the past month, according to a 2017 CDC analysis of data from 2011 to 2014.
But antidepressants aren’t a one-size-fits-all solution for everyone with depression. For some, regular therapy is just as effective (or more effective) than medication. Others may just want to see if they’re OK without medication, Jesse Wright, M.D., Ph.D., author of Breaking Free From Depression: Pathways to Wellness, professor of psychiatry and director of the Depression Center at the University of Louisville, tells SELF. Still others may start to feel better and think they don’t need the medication anymore. And sometimes, the undeserved stigma around antidepressants is at play: “People may think of taking antidepressants as a weakness,” Dr. Wright says. (It’s not.)
If you’re debating coming off antidepressants, here’s what you should know.
Stopping antidepressants cold turkey, without talking to your doctor, is a really bad idea.
Experts aren’t 100 percent sure why antidepressants work, but they have some ideas. “Antidepressants increase the levels of neurotransmitters such as serotonin, noradrenaline [also called norepinephrine], and dopamine, mostly by blocking their ‘reuptake,'” Paolo Cassano, M.D., Ph.D., a psychiatrist at Massachusetts General Hospital, tells SELF. This means antidepressants change the cycle in which neurotransmitters are released from one cell and bind to the receptors in other cells, Dr. Wright says. Ultimately, this allows higher levels of these neurotransmitters to exist in the brain, which can alter your mood.
Just like the decision to start antidepressants was one you made with your doctor, the decision to stop them should be, too. “It’s not a good idea to stop abruptly,” Dr. Wright says. Instead, you should talk to your doctor about a strategy for tapering off. This usually involves cutting back in increments over a course of weeks or months so that you won’t experience any ill effects. Transitioning off depression medication with a doctor’s help is typically “very smooth,” Dr. Wright says, because they figure out the timeline most likely to work for you.
If you suddenly deprive your body of the depression medication it’s accustomed to, you can throw your system for an unpleasant loop.
Without the right tapering strategy, you can experience antidepressant discontinuation syndrome, aka some pretty troubling side effects. While experts haven’t identified the exact mechanism behind this, Dr. Cassano says “it is understood as primarily the consequence of the sudden decrease in levels of [neurotransmitters].” Neurotransmitters don’t just affect your brain—serotonin, for example, has influence on a bunch of systems in your body—so antidepressant discontinuation syndrome can cause all sorts of symptoms.
These symptoms can include dizziness, insomnia, irritability, headaches, excessive sweating, electric shock sensations, and paranoia or suicidal thoughts, according to Dr. Cassano. “Patients can really feel the lack of the medication,” he says.
And, unfortunately, it’s not always as easy as just starting the medication up again if symptoms return, as it can take as long as eight weeks for them to kick in, Dr. Cassano says.
OK, but what about if the side effects are unbearable?
“The only case where I can think someone might want to stop their medication on their own is if there is a sudden, unpredicted, and intense side effect,” Dr. Cassano says. Even then, you shouldn’t just stop taking the medication and eventually mention it to your doctor at some point—you need to get in touch with a medical professional ASAP, even if that means going to the emergency room, Dr. Cassano says. The possibility of severe side effects will vary based on the drug (so you should talk to your doctor about what exactly to look for with your specific medication), but these could include things like numbness, tremors, a high heart rate, and suicidal thoughts.
Other side effects—like sleep issues or sexual problems—are worth bringing up to your doctor, too. They can discuss other possible brands or formulations that may be a better fit, Dr. Wright says. (And if you feel like your doctor isn’t taking any of your concerns seriously enough, or like you’re just not gelling, it may be time for a second opinion.)
Stopping antidepressants before you’re ready also makes it more likely that you’ll experience a relapse of depression.
Doctors weigh various factors when deciding if it’s right for you to stop taking antidepressants, like whether you’re at risk of becoming depressed again and whether you have major events coming up for which you could use the extra emotional stability. If your doctor signs off on you stopping antidepressants, it’s because they have faith in your ability to maintain your improved mental health.
For example, if you started taking antidepressants because of persistent grief after a loss, you may have learned coping mechanisms that enable you to heal. Or if you were experiencing depression due to negative thoughts, perhaps you engaged in cognitive behavioral therapy to help change your thinking. Or maybe being on antidepressants made it more feasible for you to change your lifestyle in ways that can sometimes help, in part, to ward off depression, like staying physically active.
If you feel like you’ve made real strides in managing your depression, like your life circumstances have changed to the point where you no longer need them, or like the side effects mean it’s time to discuss other options, come prepared with examples to make your case to your doctor. If they decide it’s a good idea for you to come off antidepressants, they’ll likely schedule a follow-up appointment once you’ve tapered off to make sure it was the right choice for you (or, if you got the prescription from a therapist and will still be seeing them, this discussion will happen on a more ongoing basis).
No matter what, you should ask how to know whether depression symptoms are creeping back and how best to reach your doctor if that starts to happen.
Ultimately, deciding when to go off antidepressants is up to you, but how you do it should be mediated by a doctor, psychologist, or psychiatrist.
Seeking a doctor’s advice first makes it much more likely that you can either taper off slowly enough to avoid antidepressant discontinuation syndrome, or that you can find an antidepressant without whichever side effect you’re concerned about.
“Depression can take a big toll on people’s lives,” Dr. Wright says. “Treatment is really important.” And, whether you’re using antidepressants or other methods to manage your depression, listening to your body and communicating openly and often with your doctor are key.