Published: 7 September 2023

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Antidepressant withdrawal: taper antidepressants slowly

Published: 7 September 2023
Prescriber Update 44(3): 52–53
September 2023

This article reminds prescribers about the risk of antidepressant withdrawal (also known as discontinuation syndrome).¹ It is important to inform patients about this risk, and some resources are highlighted below.

What is antidepressant withdrawal?

Antidepressant withdrawal comprises one or more adverse effects that can occur when people discontinue antidepressants. In some people, withdrawal symptoms can be severe and protracted.²

Symptoms of antidepressant withdrawal

Antidepressant withdrawal can be associated with a wide range of symptoms. Table 1 provides some examples (list not exhaustive).

Table 1: Symptoms of antidepressant withdrawal

Most common	Common	Less common
Dizziness	Sleep difficulties	Suicidal thoughts
Fatigue	Anxiety	Sexual dysfunction
Headache	Irritability	Cognitive dysfunction
Nausea	Tremor	Loss of coordination

Source: Hirsch M and Birnbaum RJ. 2022. Discontinuing antidepressant medications in adults. In: UpToDate 21 October 2022. URL: uptodate.com/contents/discontinuing-antidepressant-medications-in-adults (accessed 21 June 2023).

Risk factors for antidepressant withdrawal

Antidepressant withdrawal can happen any time an antidepressant is reduced or stopped, but is more likely when:²

• antidepressants are stopped abruptly
• antidepressants are tapered too quickly
• someone has been taking a high dose of antidepressants
• someone has been on antidepressants for a long time.

All antidepressants can cause withdrawal symptoms, but some are associated with a higher risk (eg, venlafaxine and paroxetine).³

Dose tapering

To reduce the risk of antidepressant withdrawal, slowly taper the patient’s dose before stopping it completely.² Provide the patient with information on antidepressant withdrawal (see below) and monitor them for withdrawal symptoms.

Refer to the sponsor's data sheet and local clinical guidelines for further information on stopping antidepressants.

Patient information

• Advise patients to speak to their healthcare provider if they are thinking about stopping or reducing their antidepressant, or if they are having withdrawal symptoms.
• For more information on a specific antidepressant, patients can refer to the sponsor’s consumer medicine information (CMI): Search for a CMI.
• A Medsafe information leaflet is also available: Stopping antidepressants: be cautious and go slow.
• See also the Healthify information: Antidepressants.

References

1. Davies J and Read J. 2019. A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addictive Behaviors 97: 111-21. DOI: https://doi.org/10.1016/j.addbeh.2018.08.027 (accessed 21 June 2023).
2. Hirsch M and Birnbaum RJ. 2022. Discontinuing antidepressant medications in adults. In: UpToDate 21 October 2022. URL: www.uptodate.com/contents/discontinuing-antidepressant-medications-in-adults (accessed 21 June 2023).
3. Royal College of Psychiatrists. 2020. Stopping antidepressants November 2020. URL: www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/stopping-antidepressants (accessed: 21 June 2023).