The Risks and Benefits of Going Off Antidepressant Medications

If you have been diagnosed with moderate and severe depression you may have been prescribed antidepressants to help in treating that condition. While these medications have been proven to help, they are not without their side effects. Some of the common side effects include reduced libido, indigestion, and loss of appetite. If you are currently taking antidepressants but want to stop, there are some things you need to be aware of. And, the most important step is to talk to your doctor before stopping your medication yourself.

If the primary reason you want to stop taking your medication is that it does not seem to be working or you are unhappy with the amount of improvement you've had, the first step is to talk to your doctor. You may need a different dosage or a different type of antidepressant.

Number of People Taking Antidepressants

Medication to treat depression and anxiety is prescribed to more than 20 million Americans. According to the Centers for Disease Control and Prevention, in 2004 one in 10 adult women and one in 20 men were taking antidepressants—a number that tripled over the previous decade. Yet 54% of patients on antidepressants stop following their prescription in the first six months of their treatment, according to a study of more than 100,000 patients published in a 2005 issue of Current Medical Research and Opinion.

Most of those who discontinue or switch antidepressants early on do so because of side effects, according to a 2002 Annals of Pharmacotherapy study. Fatigue or drowsiness was the most common complaint (10%), followed by anxiety, headache, and nausea (5% each).

Psychiatrist Matthew S. Keene, MD, executive director of Arizona's Scottsdale Center for the Advancement of Neuroscience and the leader of the CMRO study, says other common reasons people stop include an improvement in mood, a feeling the meds aren't helping, or concerns about becoming dependent.

After taking Zoloft for seven years, Sarah Pavsner, 38, a visual artist and teacher in Los Angeles, feared liver damage. However, Dr. Keene tells Health that the risk of [liver damage] from SSRIs is very low. "It's higher with Tylenol." Even more than that, Pavsner was concerned about becoming dependent on Zoloft to function. "I felt it was merely suppressing my feelings of depression," she says, "instead of helping me to find ways to deal with them."

Stop Using Antidepressants Responsibly

Do keep your doctor in the loop. Dr. Keene says that one-third of patients who quit antidepressants do so without telling their physicians. If you're experiencing side effects, your doctor can help you manage them by advising you how and when to take them. For instance, take the medication with food to minimize gastrointestinal side effects, or take them in the evening if you deal with fatigue.

The doctor can also change your dosage or switch your medication. Even if you're feeling better, treatment guidelines recommend staying on antidepressants for at least four to five months to prevent relapse of your previous symptoms.

Do take the meds as prescribed. Dr. Fuhrer observes that some people pop them occasionally like aspirin to deal with intermittent crises. But even after patients begin to feel markedly better, Dr. Fuhrer recommends that patients stay on them for at least a few months to minimize the chance of relapse.

How Not To Stop Your Medication

Don't confuse medication withdrawal with a relapse. Up to a third of patients who stop antidepressants experience "nausea, headache, dizziness, anxiety, irritability, fatigue, insomnia, and vivid dreams," says David Fassler, MD, clinical professor of psychiatry at the University of Vermont College of Medicine.

Collectively these symptoms are known as "antidepressant discontinuation syndrome," these symptoms can frequently be mistaken for a relapse. Dr. Fassler says that patients experiencing these symptoms should alert their physician.

During her first day off Zoloft, which Pavsner coordinated with her doctor, she experienced vertigo followed by a couple of weeks of light-headedness. "This has slowly gone away," she says. After stopping the medication, your mental health professional can continue to monitor your overall well-being and help treat your depression with talk therapy.

Don't quit cold turkey. To reduce the risk of withdrawal symptoms, it's best to work with your physician to taper the medication gradually. "This is especially true with medications with shorter half-lives, like Effexor or Paxil," says Shlomit Fuhrer, MD, a psychiatrist in private practice in New York City. "Prozac, which stays in your body longer, can be stopped more quickly."

Summary

There are valid reasons to want to stop taking prescription antidepressants. The first step to doing this should be a talk with your doctor. Explain your reason for wanting to stop and get their input. Don't quit cold turkey without talking to your provider.