Antidepressants are valuable tools when you’re experiencing depression or anxiety, but if you’ve felt stable and happy for a while, you may wonder if you still need yours.
Before you stop taking your medication, talk to your healthcare provider.
“Sometimes you’re not having symptoms of depression because your antidepressant is working and helping to keep your depression in remission,” says UNC Health psychiatrist Jennifer Gates, MD. “That’s why it helps if you’ve worked with a provider who has helped track your symptoms over the long term.”
You might be ready to use coping strategies you’ve learned in therapy to handle your mental health symptoms without medication. But even if you’ve gained new tools, you might still need your medication to avoid experiencing the worst symptoms of depression and anxiety again.
“These medications are generally well-tolerated for the long term, so don’t feel like you have to come off of an antidepressant if it’s helpful,” Dr. Gates says. “These medications can be life-changing and lifesaving.”
Considerations Before Stopping an Antidepressant
Here are some of the topics you and your provider might discuss if you’re wanting to stop your medication:
Your medical history and history of depression and anxiety.
Before stopping an antidepressant, you and your provider should discuss why you started taking one.
“We consider whether you have had one isolated depressive episode and now things have resolved, or whether you’ve had multiple depressive episodes throughout your life,” Dr. Gates said. “We also consider the severity of your depressive episodes—whether you were hospitalized, experienced psychotic symptoms, had suicidal ideation or attempted suicide.”
If you’ve had multiple episodes or severe episodes, you’re at much greater risk of a relapse of symptoms if you stop taking the medication. You may need to take a medication for the rest of your life.
Your provider will want to know your plan for dealing with triggers for depression or anxiety, so they’ll ask questions about other treatments, such as psychotherapy, your support network and coping strategies.
It’s also important to remember that one medication can be treating multiple concerns. Your depression may have improved, but you could still need it for anxiety, for example.
The side effects you experience.
Some people want to stop taking an antidepressant because they don’t like the side effects, which can include problems with sexual function, gastrointestinal changes and sleep issues.
“Communicate with your provider about what you’re experiencing, because we may be able to treat your side effects if the medication is otherwise effective,” Dr. Gates says. “It may also be that there’s an alternative that works and won’t cause those side effects.”
Whether the medication is working.
You may want to stop your medication because it’s not making you feel better.
“If the medication isn’t treating your symptoms, we can consider augmenting with another medication or switching to a different one,” Dr. Gates says.
If you’ve been on the medication for a long time, your body may be responding to it differently; if you’re new to the medication, it may need more time to work.
Again, this is where having a good relationship with a trusted provider can help, as they’ll know the history of your symptoms, what you’ve tried and how the side effects impact your life.
Your plans for pregnancy and breastfeeding.
If you’re contemplating pregnancy, you may want to stop all medications because of worries about how they could affect your baby. Your mental health provider and your OB-GYN can help you understand the specific risks. It may be that your antidepressant is considered generally safe for pregnancy and breastfeeding, or you may be able to switch to an option that is considered safer.
“A lot of people only think about the risks of the medication, but there’s risk in untreated psychiatric illness in pregnancy as well,” Dr. Gates says. “The risks of untreated depression and anxiety might outweigh the risks of the medication, which is why this is such an important conversation to have if you’re of reproductive age.”
Risks of Abruptly Stopping Your Antidepressant
Even if you and your provider agree that you’re ready to stop taking your antidepressant, that change can’t happen overnight.
“The longer you’ve been on your medication and the higher the dose, the more likely your provider will recommend tapering off gradually,” Dr. Gates says. “To abruptly discontinue an antidepressant puts you at increased risk of relapse of your depression as well as an increased risk of antidepressant discontinuation syndrome.”
Antidepressant discontinuation syndrome is a cluster of symptoms that includes dizziness, headache, nausea, sleep disturbances, anxiety and fatigue. Some people experience brain zaps, which feel like an electric shock in the brain; Dr. Gates says they’re not dangerous, but they can be uncomfortable.
The severity of these symptoms can vary based on each person and the type of antidepressant you take. This syndrome is likely due to your brain adjusting to the absence of the medication.
Your provider can create a plan to gradually decrease the amount of medication you take so that you don’t experience severe symptoms.
Work with Your Doctor to Taper Off an Antidepressant
As you take lower doses of your antidepressant, you may need to see your provider more often.
“You may need to meet with your provider more regularly so we can check in on your mood and any symptoms like dizziness, nausea and sleep changes,” Dr. Gates says.
It’s often difficult to notice your own depressive symptoms. If you feel comfortable, tell someone in your life that you’re tapering off an antidepressant so they can flag any concerning symptoms. Be sure to build in lots of time for self-care, including good nutrition, sleep, exercise, meditation, therapy and hobbies that bring you joy.
If you start to experience depression or anxiety symptoms or discontinuation symptoms, there are options.
“We can slow down the taper and keep you at a certain dose for longer before decreasing the dose again, or we can temporarily increase the dose,” Dr. Gates says. “If you’re on a medication that’s short-acting and leaves your body quickly, it may help to replace it with one that’s longer acting for the taper. There’s not one timeline you have to stick to.”
If you stop the medication and you’re struggling, don’t be afraid to ask for help.
“Don’t let your symptoms get worse without talking to your provider, because we can help,” Dr. Gates says. “Many people can restart the same medication and feel better, while for other people, we might need to choose something different. You’re not out of options, and you don’t have to suffer alone.”
[cta] If you have questions about your medications, talk to your doctor. If you need a doctor, find one near you.The post Read This Before You Stop Your Antidepressant first appeared on UNC Health Talk.
