Doctors are finally learning to manage antidepressant withdrawal

I went cold turkey off of citalopram when I was a teenager and it was a pretty unpleasant two weeks of heart palpitations, but the immediate benefit of no longer experiencing emotional blunting made me avoid taking any more antidepressants for 10 years. I was prescribed it by a GP and never given any real support in my mental health or in coming off of it. It was a real black pill for me on the UK's treatment of mental health issues.

Last year I started taking buproprion (Wellbutrin) after seeing a private psychiatrist in Romania, and I found it beneficial, but ended up losing more than 10kg, and becoming malnourished to the point of my hair falling out. Again I stopped of my own accord, and buproprion has basically no cessation symptoms.

This spring I saw a psychiatrist through Romania's public health service who prescribed me vortioxetine (Brintellix/Trintellix) after I shared my history and it's been a game changer. I experience basically no side effects besides a slight reduction in libido, with no other effects on sexual function. It's really helped me to find my balance again. And I see a psychiatrist once a month paid for by my public health insurance with the medication fully comped. Vortioxetine has a half-life of 66 hours so the one time I did have to skip a day and a half, the withdrawal was not noticeable.

Just sharing this to say that there are good doctors and good meds out there, and that having low tolerance for one medication doesn't mean that you shouldn't t […]

This is an absolute failure on the part of medical science. SSRIs went mainstream in 1988.

By 1992! We knew about withdrawal issues: https://www.wikidoc.org/index.php/SSRI_discontinuation_syndr...

Let's be generous and give it until the 2000s for the knowledge to spread and science to validate; and we're still left with 26 years of blundering around without IMO sufficient warning to patients about withdrawal risks.

I would wager some of the doctors who prescribe today were well past a glint in their father's eye when we started to know about this.

To provide one additional anecdote: I came off escitalopram with no taper after taking it for about five years (10mg). I got brain zaps for a while, got very irritated at times, but largely was fine after a few weeks. Not downplaying the withdrawal effects for some people, but they’re not as catastrophic as this article suggests for many (perhaps most).

And overall I’m very glad I took it! It got me through a rough patch, and seems (in combination with therapy, and some life changes) to have rewired me a little. Symptoms I had for a decade prior have not returned. And I’m not sure I could have made those life changes without it.

Sadly my arachnophobia came back though. Oh well.

I’ve been on a SSRI for 5 years and not once have I thought about getting off of it. It literally saved my life.

I remember a while life of depression and constant churn of recursive emotions destroying me.

I’m worried that too many people are downplaying the benefits that this drug for those of us that it has helped immensely. And it’s extra risky to be downplaying it while RFK jr is actively working to remove the drugs from the market.

Going cold turkey is always the worse way to wean off a SSRI, but the half-life of the drug is also a good indicator of the intensity of the withdrawal. Also, some people might eliminate a drug faster than others, so the result is surely harder on some that others.

Doctors that tells you how to reduce the SSRI/SNRI are following what's available on the market, and generally the gap between doses is always huge and gives a big gap and so bigger withdrawal. Once I asked to a pharmacist if he could make smaller doses and he answered me to be like a good junky and open the capsules and cut them myself. I was a bit shocked at the moment, but at least it costs me less that him having to do it a that helped me greatly to reduce a SNRI without feeling too much symptoms.

So a good advice, is look at the half-life of the drug you are taking, and be a good junky and split the capsules or have liquid form to reduce by small amount.

Half-Life of Specific SSRIs

- Fluoxetine (Prozac): 4 to 6 days, with its active metabolite norfluoxetine lasting 7 to 16 days.

- Sertraline (Zoloft): Roughly 22 to 36 hours.

- Citalopram (Celexa): About 36 hours.

- Escitalopram (Lexapro): About 27 to 32 hours.

- Fluvoxamine (Luvox): 17 to 22 hours.

- Paroxetine (Paxil): About 21 to 24 hours.

Half-Lives of Common SNRIs

- Venlafaxine (Effexor): About 5 hours for immediate-release (extended-release has an effective transit/clearance profile, though parent half-life remains short); its active metabolite (desvenlaf […]

Though this article concentrates on the SSRIs, other meds like the SNRIs can have a similar or even worse withdrawal effect. We didn't call it "Side Effexor" for nothing.

People legitimately need these drugs, including in the short term. The problem for acute stressors once they resolve is how to get them back off.

SSRI's saved my life with no side effects that I can discern, yet I still have the urge to try and get off of them from time and so do friends and family of mine that also benefit from them. Maybe that urge needs more study because it is not taking us in a good direction. I'm not saying that because of the difficulty of weaning off, but because of the benefits of staying on. For those of us that need them, trying to wean off of them is like trying to wean off of I don't know, vitamin C or something else essential. Don't do it! Be glad you found something that helps! Keep taking it!

There’s a lot of focus on negatives in comments. I will say ssris probably saved my life and I have had zero side effects to date. It’s easy to say “just suck it up and power through it”. That advice can kill people

I am by no means advocating against taking anti-depressants, I am just sharing my own experience. I have to say this because I have seen people with severe depression make night and day transformations off of these medications and know they can work.

For me, it wasn't an SSRI, but a norepinephrine-dopamine reuptake inhibitor - often prescribed for treatment-resistant depression. In my early 20's, I had tried everything, nothing seemed to work, then these treated the physical symptoms pretty well - I got my energy and motivation back, sleep normalized.

After several years though they stopped working. We upped the dose until there was nowhere left to go. At the dose I was taking, it was very important to take it at the precise right time or you could spiral into some very bad symptoms. Drink at all, or just a little too much, could spiral you into an episode. I finally decided that it was worth being depressed than what I was dealing with physically and emotionally on the drug, so I stopped it.

It was a rough month or two but I entered a new treatment program, the doctor found I was severely D3 deficient. We worked on my sleep habits, nutrition, diet - finally discovering what I had was seasonal affective disorder. So we have a plan for those months, and honestly, it's been 2 years off of them and I have never felt better.

Depression is a complicated condition, there's no one treatment in my mind, it's a lot of contributing factors. I won't take them again, especially since the […]