The New Science That Ends the ‘Terror and Panic’ of Quitting Long-Term Antidepressant Use

In 2006, Anna King was involved in family law proceedings that caused severe stress and trauma. When she was prescribed antidepressants to help her cope, she was initially unsure.

“I was hesitant to take an antidepressant and sought information from my psychiatrist about its safety,” she says. “I was told they were safe and could be stopped at any time.”

But King, who lives in Adelaide, says the advice was wrong. She’s still coming off a type of antidepressant known as a selective serotonin reuptake inhibitor, or SSRI, more than eight years after starting the medication.

The process has left her with severe withdrawal symptoms, she says, which have caused “profound suffering, disability and loss” in her life.

While some people will experience days or weeks of withdrawal symptoms as they taper off their antidepressants, and others may experience no withdrawal symptoms at all, King experiences a phenomenon known as “prolonged withdrawal symptoms” – sometimes called “post-acute withdrawal symptoms.” ”.

People who suffer from long-term withdrawal suffer from symptoms that can last for months or even years, long after the antidepressant has left their system.

In 2022-2023, 1,269 antidepressants were prescribed for every 1000 Australians. The country has one of the highest rates of antidepressant use per capita among OECD countries. There is particularly high and long-term use among women and growing use among young teens and adolescents.

But as prescribing increases, there are also concerns about the lack of evidence-based advice on when and how to come off the drugs safely.

King and health professionals – including Dr Mark Horowitz, a doctor who co-authored guidelines for tapering off antidepressants – say Australian healthcare professionals need to take the issue of long-term abstinence more seriously. These guidelines were approved by the Royal Australia College of General Practitioners in July, but they say more education is needed for doctors across the country.

While persistent and severe withdrawal symptoms from medications like opioids or benzodiazepines are well known, “severe and persistent withdrawal symptoms from antidepressants have long been neglected or minimized,” according to a study. article published in the journal Therapeutic Advances in Psychopharmacology.

In Britain, the National Health Service’s clinical record system added “long-term withdrawal” to the official medical terms in its database in 2023. It means that patients who experience it can be recorded and better data collected on how they are affected. The NHS also has one clinic to help patients come off their antidepressants more safely.

In October a study co-authored by Horowitz and published in the journal Molecular Psychiatry examined all existing, high-quality studies on the frequency of antidepressant withdrawal symptoms and the risk factors for experiencing those symptoms. The study, led by China’s National Institute for Drug Addiction, found that 43% of patients surveyed experienced withdrawal symptoms when stopping their antidepressant.

The longer patients took antidepressants, the more likely they were to experience long-term withdrawal symptoms and the more severe these effects would be.

Although the exact neurobiology underlying long-term withdrawal is not known, Horowitz says that antidepressants – especially SSRIs and serotonin and norepinephrine reuptake inhibitors – reduce the number and sensitivity of serotonin receptors in the brain. These medications work by increasing the availability of serotonin, a chemical that affects memory, hunger, sleep, mood, and other functions.

Horowitz says the brain adapts to this increase by reducing the number and sensitivity of serotonin receptors in the brain as it begins to expect serotonin from the medication and tries to maintain balance.

Antidepressants can also affect other neurotransmitter systems, such as dopamine and norepinephrine, and it takes some time for these complex interactions to regain balance after stopping the antidepressant.

It’s thought that long-term use can lead to structural or functional changes in the brain, which can take months or years to fully recover — much longer than antidepressants take to clear the system, Horowitz says. The recovery of receptor density and sensitivity in the brain can be slow, leaving the brain in a dysregulated state.

When long-term antidepressant users come off the drugs too quickly without evidence-based guidance, the side effects “are often severe and can sometimes take months or years for people to recover,” Horowitz says.

“It can be life-threatening or disabling.”

This was the case with Koning. She is a registered nurse and no longer practices due to the illnesses and symptoms she suffered for years when she tried to stop taking her antidepressants and other psychiatric medications. She says her experience is an example of what can go wrong when an antidepressant is stopped abruptly and when withdrawal symptoms are misdiagnosed as a relapse.

By 2015, the stressors in her life that caused her to prescribe the medication had subsided, but King felt her mental and physical health continued to deteriorate as she suffered from fatigue, loss of libido and weight gain. She began to wonder if her medication was the cause and asked her psychiatrist to come off the medication.

Under medical supervision, she was told to gradually reduce the medication over the course of ten days. She now realizes that this advice was bad. Because she had been taking the drug for almost ten years, she required a much longer, more gradual withdrawal from the medication.

“The resulting symptoms were devastating and I was unable to function, let alone return to work as a nurse,” says King.

“In the months that followed, I developed debilitating physical, cognitive and psychological withdrawal symptoms, some of which included pressure and pain in the head, dizziness, nausea, fatigue, sensitivity to light and sound, irritability, cognitive problems, agitation, suicidal thoughts and anxiety . and panic, which was so debilitating that I was afraid to leave my house.

Before taking antidepressants, she had never experienced these symptoms.

Her psychiatrist attributed the symptoms to a recurrence of psychiatric illness and this misdiagnosis “resulted in a cascade of prescriptions,” she says, with her being prescribed other antidepressants and benzodiazepines. She ended up taking 14 different medications at different times and in different combinations, switching between them as she experienced side effects and withdrawal symptoms from each.

“The fear I experienced during these years was so deep that I felt like I was being suffocated by my own skin,” says King. “I had severe akathisia (restlessness), tremors, burning skin, aching bones, intolerance to light, sound and touch.

“I barely slept and was housebound with no quality of life.”

By the end of 2017, she was “unwell, terribly scared and desperate” for answers that she said she was not getting from specialist doctors. King turned to online forums and found thousands of people talking about their experiences with taking antidepressants – specifically about the worsening of symptoms when they tried to stop taking their medications, even when following standard medical advice.

It has now been shown that the usual guidelines for tapering off the medications are too rapid and can cause serious symptoms, especially in those who have been taking antidepressants for a long time. These people need a much slower, more careful, non-linear taper that sometimes takes place over years, known as “hyperbolic taper.”

“So I began the painfully slow journey of recovery by implementing hyperbolic tapering through online support from strangers,” says King. She is still in the process of tapering off her SSRI medications.

“I have come a long way, but it is a slow process. My health is getting better and better. I’m not plagued by panic attacks and anxiety where I don’t feel safe, so I can leave the house and talk to people and have started socializing again. I can open the curtains and enjoy the sun on my face, I can listen to music and watch movies, my husband can hold me – because I no longer experience intolerance to light, sound and touch.

“I often think about how different the past nine years of my life would have been if this (hyperbolic tapering) had been implemented in the first place by my psychiatrist… So much pain and suffering would have been avoided.”

King wants to educate healthcare professionals about long-term abstinence and hyperbolic tapering and the importance of informing patients at the time of prescribing about the possibility of abstinence. In July, she was invited to share her story at an event organized by the New South Wales chapter of the Royal Australian College of General Practitioners and the NSW Mental Health Commission.

Dr. Elizabeth Moore, president of the Royal Australian and New Zealand College of Psychiatrists, says antidepressants can be beneficial for many people with moderate to severe depression and anxiety.

“They are not a quick fix, but part of a broader, compassionate strategy to help people regain control of their lives,” she says.

“RANZCP guidelines emphasize the need for an individualized, patient-centered plan of care to manage depression and other mood disorders, prioritizing overall well-being and minimizing harm to the individual.”

For those who feel ready to stop taking their antidepressants but are concerned about doing so because of the potential for withdrawal symptoms and because of the time it may take to taper off safely, Horowitz says, “Not all long-term users will need to do this . it will take years to complete, some can do it in a few months and some will have no problems at all – there is a lot of variability.

“I tell people, ‘go as fast as you can and as slow as you need to’.”