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Antidepressant Tapering, Weaning, Titration Help

Last Updated on December 13, 2023 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

GPs are largely unfamiliar with effective antidepressant tapering, weaning, and titration methods. They are simply not educated on how to go about it, nor are they mental health specialists. The APA has noted a troubling trend of inappropriate prescribing, and many patients who want to stop, do not receive the help they need to do so safely. Never be afraid to ask for a second opinion when it comes to your health.1,3

Do Your Symptoms Require Antidepressants?

Tapering antidepressants gradually is one step in a series of actions to regain one’s full spectrum of mental well-being. Addressing root causes may be more effective than medication when depression is related to impaired hormonal states, nutrient deficiencies, and unresolved life situations, for example.14

successful antidepressant tapering
Alternative to Meds Center has been primarily invested in correct medication tapering. The center has helped clients with weaning off antidepressants and other prescription medication titration for close to 2 decades. Using holistic methods in the field of Environmental and Orthomolecular Medicine, we have published evidence demonstrating our client’s successes. We find that over 77% of people weaning off antidepressant medication and replacing them with strategies such as nutritional and lifestyle changes, do better in life, with fewer symptoms, better health, etc., than when they were still medicated.
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Antidepressant Discontinuation Syndrome

symptoms of antidepressant discontinuation syndromeAs Greenslit & Kaptchuk observe in their 2012 article published in the Yale Journal Of Biology & Medicine, “public controversies and medical uncertainties concerning antidepressants have become the norm.17

Antidepressant discontinuation syndrome was known about as early as 1959, a few years after antidepressants came on the market and clinical experience began observing and reporting on the problem of coming off antidepressant drugs.6

What is concerning to us at Alternative to Meds Center, is that despite physicians being encouraged and directed to inform their patients of the possibility of dependence and addiction, and inform them of the challenges of tapering antidepressants, we typically find that our clients received no such information or guidance, and were left more or less floundering on their own.8,9

We are here to help each person navigate successfully through the challenges of antidepressant discontinuation syndrome, and welcome referrals from prescribers where they felt unable to assist with an antidepressant tapering program for their patients.

Antidepressant Tapering Guidelines and Schedule

One of the challenges of tapering antidepressants is the number of variables that need to be managed during the process.

prepare for antidepressant taperingA schedule of how slow or how fast really needs to be individually tailored. Assessments and testing done prior will help determine the way forward. While math may certainly be involved, the process also has to take into consideration the length of time a person took antidepressants, whether failed attempts at tapering antidepressants have transpired, the client’s age and current health, including nutritional deficits that need correcting, and intensity of symptoms. While general guidelines are important, there is no “best” or cookie-cutter approach. The first thing to do is to gather enough information to design the tapering plan that will garner the best results for the individual, and closely monitor their process so that incremental changes can ease the process as it goes along.2

Example:  Some pills like Cymbalta require opening the capsules and counting beads. Others are time-released that will lose the time-release component once the pill is cut with a pill cutter. We suggest you speak to your prescriber about such issues, and we welcome you to go to our individual antidepressant tapering pages for more information about your particular drug. The list can be found on our medication tapering page.

Antidepressant Tapering Guidelines, Schedule
  • Generally, gradual antidepressant tapering is recommended over suddenly stopping.7,10
  • The exception to the above is serotonin syndrome (and some other medical emergencies) that require immediate cessation and hospitalization.19
  • If possible, your physician may be able to provide the smallest dose available in pill form.
  • A 10% reduction may be a good starting point, perhaps adjusted as much as 25% if that can be tolerated.
  • Research the drug’s half-life and that will be a likely indicator of when withdrawals will emerge.20
  • Longer half-life drugs are typically easier to taper from than those with a short half-life.20
  • Be alert to changes that may indicate the antidepressant tapering should be adjusted up or down.
  • Allow enough time to settle after one adjustment before the next adjustment.
  • Aim for 10 days to two weeks or more after each step-down to restabilize. Stability before the next cut is necessary.
  • The final adjustments during antidepressant tapering can be the most difficult and should not be rushed but initiated more slowly.

Drugs like Prozac have a longer half-life than other short-acting antidepressants. As noted above, the half-life gives an indication of when to expect withdrawals to onset. Personal sensitivities can require these times to be extended, sometimes significantly.7,19,20

If protracted withdrawal should occur, we are here to help. Do not try to persist on your own.9 At the very least seek out a physician who is familiar with tapering antidepressants successfully, and with whom you feel you can work together as a team.

Four Challenges with Antidepressant Tapering Methods

The problems related to antidepressant tapering may seem complex and unwieldy, but can be simplified within the following 4 parameters:

1. Inadequately trained physicians, errors, and omitted steps in diagnoses

Physicians are licensed to prescribe, but not trained in antidepressant tapering. There is an absence of such training — it is just not given in medical school. Additionally, physicians are advised by NAMI, the National Alliance on Mental Illness, to ensure that an accurate diagnosis must include determining that there is no physical illness or other physical factors that may need attention BEFORE prescribing an antidepressant or other types of medications. Despite the advice so issued, doctors often hastily prescribe medications based on a short interview with their patients in the office, with no testing and no exhaustive physical examinations given to the patient. This could result in a misdiagnosis and incorrect treatment that will not resolve the person’s symptoms.1

2. Using band-aid solutions that only provide temporary relief

Physicians most often prescribe medications without any real effort to clarify and address root causes, Antidepressant drugs are not a cure, and can only dampen (suppress) the unwanted symptoms. In some extreme and rare cases, this temporary measure may be necessary. However, in the main, experience and studies show that there is actually little to no long-term therapeutic value inherent in prescribing antidepressant medication. The most common outcome will be that a person’s suppressed symptoms will eventually return and then intensify.2 This is the point where a physician may increase the dosage, not knowing what else to do. At some point when antidepressant tapering is introduced, without proper guidance, preparation, and support, the usual result is agonizing and unbearable. This could answer why many antidepressant weaning attempts may fail.

3. Antidepressant tapering and titration side effects

Another layer of confusion that occurs during a course of prescribed antidepressant meds is the extensive list of side effects that these drugs can throw into the mix. In fact, these antidepressant side effects commonly cause a person to decide to discontinue their medication. Each person presents a highly unique profile, often overlooked in the initial prescribing decision. It may be that a person was prescribed antidepressants to help with sadness after the loss of a spouse. However, their medication may now be causing insomnia or panic attacks that were not present before their prescription. A person may decide to abruptly stop the antidepressant to relieve these drug side effects. However, stopping medication all at once can result in disastrous consequences. A summary of the most common side effects connected to antidepressant medication can be found below.

4. Antidepressant weaning symptoms vs erroneous diagnoses

Quite separate from the return of original symptoms that may never have been properly diagnosed or given treatment, there are also symptoms connected with the process of antidepressant tapering itself. A list of some symptoms commonly experienced during antidepressant titration (especially when done too abruptly or without preparation and guidance during the process) is given below. There is perhaps no real way to articulate the amount of suffering and confusion that a person can face during such a crisis.

Antidepressant Tapering Symptoms

Titrating off antidepressants can generate a wide range of reactions, commonly including:
  • Brain “zaps” (paresthesia) 10
  • Tinnitus
  • Dizziness
  • Stroke-like paralysis 21
  • Anxiety
  • Confusion
  • Headache
  • Increased depression, including severe depression leading to suicidal thoughts
  • Panic attacks
  • Muscle pains
  • Muscular spasms
  • Emotional disturbances such as unusual spells of crying, hostility, deep despair, etc.
  • Vomiting, nausea
  • Insomnia and disturbed sleep, nightmares, or unusual dreams
  • Hypomania 11

Antidepressant Side Effects

Some side effects associated with antidepressant medications include:
  • Movement disorders such as akathisia, Parkinson-like disorders, tardive dyskinesia 12
  • A lowering of sodium levels in the blood results in seizure, coma, confusion, etc.
  • Suicidal thoughts or attempts
  • Life-threatening skin complications such as Stevens-Johnson Syndrome 15
  • Reduced blood-clotting capacity, abnormal bleeding 18
  • Sexual dysfunction in both males and females
  • Heightened risk of respiratory infections
  • Excessive perspiring
  • Mood swings
  • Emotional numbness, deadness
  • Risk of dehydration
  • Unusual weight loss or weight gain
  • Feeling nervous, shaky, increased anxiety 16

Inpatient Antidepressant Weaning

gentle, safe, managed antidepressant taperingIf one can imagine the difficulty of applying a plaster cast to one’s own broken leg, one may begin to understand the agonies of attempting unassisted antidepressant weaning. While suffering depression is obviously different than a broken limb, depression is a serious health issue that requires competent and attentive medical help to overcome safely and successfully. Adding the process of coming off these drugs can be simply too much to bear alone.

For persons with heightened sensitivity, even minute changes during antidepressant tapering can be difficult to endure. We are here to help even the most difficult of cases and have done so successfully in our inpatient treatment facility for many years.

Weaning off antidepressants is for some, best done in an inpatient facility that can deliver the needed level of clinical care. With competent and knowledgeable help and medical oversight, you can achieve a successful and health-restorative outcome.4

For well over 15 years, Alternative to Meds Center has specialized in providing gentle, safe, and properly managed antidepressant withdrawal.

Antidepressant Tapering at Alternative to Meds Center

multi-mode antidepressant tapering sedona drug rehabMethods used at Alternative to Meds Center include Amino therapy, stabilizing neurochemistry, toxin removal, therapeutic sauna, metabolic testing, allergy testing, targeted IV supplement therapy, and a clean organic diet.

Spiritual psychiatry, counseling of various genres, art and music therapy, equine-assisted therapy, yoga, Reiki, education components for sustained wellness, mineral baths, ionic foot baths, nebulized glutathione, classes on stress relief techniques, therapeutic massage, cranial-sacral therapy, trainer-led mild exercise classes, outdoor activities, guided peer support, are some of our protocols that provide real relief and healing.

A staff of over 40 amazing medical staff and caregivers provide care with compassion 24/7 for our clients. Many of the staff have had their own personal experience with medication tapering and recovery and authentically understand the processes and the challenges and sensitivities of our clients who are tapering from antidepressants.

Contact Alternative to Meds Center

Each client-assigned team of care staff programs the person for their unique needs and is based on testing done at the start. We investigate the underlying conditions and root causes as an integral part of developing the client’s specific step-by-step program. Antidepressant tapering treatment is delivered in a collaborative manner, with daily and weekly patient-care team meetings to track progress and be able to quickly make the micro-adjustments that are so essential to a successful antidepressant tapering program.

Alternative to Meds Center provides competent, attentive care for clients who wish to regain natural mental health without needing to rely on pharmaceutical drugs for the rest of their life. We invite you to contact us at the number listed on this page.

The programs offered at Alternative to Meds Center have helped thousands of clients with antidepressant titration in a comfortable, safe, and nurturing facility and could be the exact antidepressant tapering help that you or your loved one have been searching for.

1. NAMI “Understanding Your Diagnosis ” National Alliance on Mental Illness [online] N.D. [cited 2022 May 19]

2. Penn E, Tracy DK. The drugs don’t work? antidepressants and the current and future pharmacological management of depression. Ther Adv Psychopharmacol. 2012 Oct;2(5):179-88. doi: 10.1177/2045125312445469. PMID: 23983973; PMCID: PMC3736946. [cited 2022 May 19]

3. Samuel DB, Suzuki T, Griffin SA. Clinicians and clients disagree: Five implications for clinical science. J Abnorm Psychol. 2016 Oct;125(7):1001-1010. doi: 10.1037/abn0000201. Epub 2016 Aug 11. PMID: 27513578. [cited 2022 May 19]

4. Detoxification and Substance Abuse Treatment Book, “2 Settings, Levels of Care, and Patient Placement.” SAMHSA [excerpt online] Bookshelf ID: NBK64109] N.D. [cited 2022 May 19]

5. Patient Health Info, ” Antidepressants – Side Effects.” NHS [online] 2018 Aug [cited 2022 May 19]

6. Mann, A.M. & MacPherson, A.S. (1959). “Clinical experience with imipramine
(G22355) in the treatment of depression. Canadian Psychiatric Association Journal, 4, 38-47 [cited 2022 May 19]

7. Rosenbaum JF, Zajecka J. “Clinical management of antidepressant discontinuation. J Clin Psychiatry. 1997;58 Suppl 7:37-40. PMID: 9219493. [cited 2022 May 19]

8. “Informed Consent AMA Principles of Medical Ethics: I, II, V, VIII [cited 2022 May 19]

9. Ostrow L. et al., “Discontinuing Psychiatric Medications: A Survey of Long-term Users.” Abstract published July 2017 in Psychiatric Services [online] [cited 2022 May 19]

10. “FDA Label Information Paxil (paroxetine) see page 6 (593-616) [online] [cited 2022 May 19]

11. Dilsaver SC, Greden JF. “Antidepressant withdrawal-induced activation (hypomania and mania): mechanism and theoretical significance. Brain Res. 1984 Mar;319(1):29-48. doi: 10.1016/0165-0173(84)90028-6. PMID: 6143595. [cited 2022 May 19]

12. Leo R, “Movement Disorders Associated With SSRIs” Psychiatric Times May 1 2001 [online] [cited 2022 May 19]

13. Smith B, “Inappropriate prescribing.” APA June 2012 Vol 43 No.6 [print version Page 36] [cited 2022 May 19]

14. DeRubeis RJ, Siegle GJ, Hollon SD. Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms. Nat Rev Neurosci. 2008;9(10):788-796. doi:10.1038/nrn2345 [cited 2022 May 19]

15. Herstowska M, Komorowska O, Cubała WJ, Jakuszkowiak-Wojten K, Gałuszko-Węgielnik M, Landowski J. “Severe skin complications in patients treated with antidepressants: a literature review. Postepy Dermatol Alergol. 2014;31(2):92-97. doi:10.5114/pdia.2014.40930 [cited 2022 May 19]

16. Shelton RC. Serotonin and Norepinephrine Reuptake Inhibitors. Handb Exp Pharmacol. 2019;250:145-180. doi: 10.1007/164_2018_164. PMID: 30838456. [cited 2022 May 19]

17. Greenslit N, Kaptchuk T, “Antidepressants and Advertising: Psychopharmaceuticals in Crisis.” Yale J Biol Med. 2012 Mar; 85(1); 2012 Mar PMC3313530 [online] 2012 Mar 29 PMID 22461754 [cited 2022 May 19]

18. Halperin D, Reber G. Influence of antidepressants on hemostasis. Dialogues Clin Neurosci. 2007;9(1):47-59. doi: 10.31887/DCNS.2007.9.1/dhalperin. PMID: 17506225; PMCID: PMC3181838. [cited 2022 May 19]

19. Scotton WJ, Hill LJ, Williams AC, Barnes NM. “Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions. Int J Tryptophan Res. 2019;12:1178646919873925. Published 2019 Sep 9. doi:10.1177/1178646919873925 [cited 2022 May 19]

20. “Antidepressants by generic name and characteristics.” published by [online] [cited 2022 May 19]

21. Haddad PM, Devarajan S, Dursun SM. “Antidepressant discontinuation (withdrawal) symptoms presenting as ‘stroke’. J Psychopharmacol. 2001 Jun;15(2):139-41. doi: 10.1177/026988110101500210. PMID: 11448088. [cited 2022 May 19]

22. Tint A, Haddad PM, Anderson IM. The effect of rate of antidepressant tapering on the incidence of discontinuation symptoms: a randomised study. J Psychopharmacol. 2008 May;22(3):330-2. doi: 10.1177/0269881107081550. Erratum in: J Psychopharmacol. 2009 Nov;23(8):1006. PMID: 18515448. [cited 2022 May 19]

Originally Published Oct 16, 2019 by Diane Ridaeus

This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Antidepressant Tapering, Weaning, Titration Help
Medical Disclaimer:
Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.

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