Short answer: do not stop an antidepressant abruptly. Plan a gradual taper with your psychiatrist at a stable time in your life, ideally after you have felt well for six to twelve months. A slow taper reduces discontinuation symptoms and makes it easier to tell them apart from a return of depression.
Good times and bad times to stop
Better: you have been well for months, life is fairly stable, and you have support and coping skills in place. Harder: during a move, new job, breakup, pregnancy planning without medical input, or the start of a New England winter if you have seasonal depression.
Discontinuation symptoms
- Dizziness or “brain zaps”
- Flu-like aches and fatigue
- Irritability, anxiety or tearfulness
- Vivid dreams or trouble sleeping
- Nausea
These usually begin within days of a dose reduction and settle within one to two weeks. Medications with a short half-life (for example paroxetine or venlafaxine) tend to cause more symptoms than longer-acting ones.
How tapering usually works
- Reduce the dose in steps, often every two to four weeks
- Smaller steps near the end, when symptoms are most common
- Pause or go back a step if symptoms are hard to manage
- Keep follow-up visits through the taper and for a few months after
Relapse or withdrawal?
Withdrawal symptoms appear quickly and improve over days. Relapse usually builds slowly over weeks, with returning low mood, loss of interest or anxiety. If depression comes back, restarting treatment works for most people.
Questions to discuss before you start a taper
- How many episodes of depression or anxiety have I had? (More episodes may mean longer treatment is wise.)
- What early warning signs should I watch for?
- Who will I contact if symptoms return?
- Should I time the taper around seasons, work deadlines or family events?
Liquid forms and small steps
For some medications, the last steps of a taper are the hardest. Liquid formulations or smaller-strength tablets can allow very gradual reductions, which helps people who have had strong discontinuation symptoms in the past. Your psychiatrist can tailor the schedule to the specific medication you take.
Keeping what you learned
Treatment is more than medication. Before tapering, write down what helped you get well: routines, people, therapy skills, exercise, sleep habits. Keeping these in place during and after the taper is one of the most effective ways to stay well.
Frequently asked questions
Are antidepressants addictive?
They do not cause craving or the compulsive use seen with addictive substances, but the body adapts to them, which is why tapering matters.
Should therapy continue during a taper?
Yes, if possible. Therapy skills lower relapse risk.
Plan your taper with a Psych Boston psychiatrist through medication management visits in Lexington or by telehealth. Request an appointment.
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This article is general information, not medical advice. If you are in crisis, call or text 988 or call 911. Psych Boston is an outpatient psychiatry practice at 35 Bedford St #17, Lexington, MA781-218-9550).