Preparing for Coming Off Antidepressants
Taking stock of the person’s present condition can be instrumental in designing a workable plan for discontinuation. This could include checking on some basics like sleep, diet, and any ongoing stress factors before adjusting dosages.
It is advisable to take some time off work/school to allow for adequate rest, at least for the preliminary stages of coming off antidepressant medications. Avoid stressful social commitments. This is time for you to heal. You may need to enlist the help of close family or friends to assist you with shopping, meal preparation, and household chores to take these burdens off you if that is possible. This is one reason why people opt for inpatient treatment if this can be arranged.
A productive next step would entail working with your prescriber. You need one who can take the time to plan your taper schedule correctly. You may need to take care of sleep and diet first, so that you are starting from a place where you are getting decent sleep and eating well. Exercise may be another beneficial preparation point, if only getting outside for daily walks or short sessions of stretching, yoga, Qigong, or other activities that you can manage.
If sleep is an issue, your prescriber may be able to offer you holistic or herbal sleep remedies. In extreme cases, a short course of medication for sleep might be necessary — for example, if a person has not slept well for months. Lack of sleep should be addressed before beginning a withdrawal program to whatever degree is manageable. A warm Epsom salt bath before retiring may also be beneficial. Get blue light and electronics out of the sleeping area. There are many drug-free ways to block noise and light that you may consider putting in place to get some improvements to sleep.
Assembling your team of helpers can be highly beneficial so you are starting from a less stressful position, even if it’s a couple of hours a day or a few days a week, to come in and help you with the logistics of daily life.
Talking Points for You and Your Prescriber that Follow the Revised FDA & NICE Guidelines
Working with your prescriber is your overall best strategy for planning successful antidepressant withdrawal that follows the revised FDA and NICE guidelines. If your prescriber is unwilling or feels incapable of helping you, find one who will. The following gives a list of things your prescriber should ask you about so that a slow and gradual withdrawal plan can be designed for you.
Factors to consider in antidepressant withdrawal:
Age and general health of the patient, including co-occurring disorders- How long the medication has been taken, and the dosage
- Whether multiple medications are being taken simultaneously
- Genetic profile — a knowledge of polymorphisms affecting metabolism
- The presence of toxic accumulations in the body
- Sleep quality or lack thereof
- Nutritional profile and diet
Unless the prescriber is an independent practitioner, modern doctors are very frequently operating under severe time limits, getting each patient in and out of the office as quickly as possible. The above list of considerations would obviously take more than a 15-minute interview to delve into, for an accurate snapshot that would help determine a correct estimate for a discontinuation timeline that ends favorably for the patient. Lab testing for nutritional deficits, toxic elements, and genetic factors may take some time — but will open many doors for choosing a correct set of strategies that will prove beneficial.
You will want to work with a professional who understands the importance of these points in designing your unique antidepressant time line.4,5
Commonly Reported Antidepressant Withdrawal Symptoms and Side Effects
One can study the most commonly reported antidepressant withdrawal symptoms, also called antidepressant discontinuation syndrome (ADS) by reading the antidepressant medication’s label carefully. The drug label will also indicate more rare side effects. It’s a very long list. For the sake of brevity, we’ll list out the ones found to be most commonly reported. We’ll also expand the hypothetical definition referred to as “F I N I S H” — a theoretical consensus put forward by a panel of psychiatrists in the late 1990s. They were beginning to notice some “troublesome” discontinuation symptoms of their patients. There were no clinical studies back then on coming off antidepressants, and “FINISH,” though incomplete, became a handy yardstick for prescribers to use.7 Modern prescribers have additional clinical data available to them, which if they study it, will enable them to understand the width and breadth of phenomena associated with antidepressant withdrawal more completely.1,3,9-12
Most commonly reported ADS and side effects of antidepressant discontinuation include:
- Flu-like symptoms, i.e., muscle aches, lethargy, headache, general malaise
- Insomnia
- Nausea
- Imbalance
- Sensory disturbances, i.e., brain zaps, shivers, prickling skin
- Hyper-arousal
- Return of original symptoms
- “Rebound” symptoms, much intensified compared to pre-medication
- Anxiety
- Dizziness, vertigo, lightheadedness
- Crying spells
- Irritability
- Dizziness
- Aggressive or impulsive behaviors
How have the FDA and NICE Guidelines for Antidepressant Withdrawal Changed?
While some researchers have been clearly sounding the alarm bells for decades, it has taken this long for the regulators to acknowledge that antidepressant withdrawal is a real and common medical problem. The previous approach of basically ignoring the subject has been replaced with much stronger guidelines including to never abruptly stop antidepressants. Instead, strong recommendations are now in place for a slow and gradual tapering of these medications.
ATMC’s Approach for Safe & Tolerable Antidepressant Withdrawal
ATMC has always approached antidepressant withdrawal by taking the time for a thorough assessment, pre-taper, as outlined above. The client’s medical history, genetic polymorphisms, dietary habits, burden of toxicity, checking for chronic sleep issues, are all important pieces of information in planning safe and tolerable antidepressant withdrawal. Comprehensive lab testing is also used to analyze these important data points.
Our medical and care team are ready to assist you in your quest for improved mental health in tandem with safe withdrawal from medication. If one’s original symptoms have not been addressed, there is little point in simply stopping medication as they will still be there. Finding root causes for the original symptoms and addressing these without drugs is prime real estate in recovery at ATMC.
Counseling, exercise, and holistic detox protocols are blended into each client’s program as well as a wealth of adjunctive comfort therapies to make the process much easier to tolerate, always under careful medical oversight. Nutritional deficits, toxic impairments to neurotransmitters, for example, are all addressed at ATMC for relief of original symptoms.
For more details on how ATMC addresses the fundamentals in antidepressant withdrawal so comprehensively, please visit our services overview and antidepressant withdrawal pages. Then give us a call and find out how easy it may be for you to enroll in the most cutting edge antidepressant withdrawal program available on the planet.
Other Helpful Resources for Antidepressant Withdrawal
We understand that not everyone is a candidate for inpatient treatment. If you are looking for help closer to home, please check out these 2 resources to find excellent help for antidepressant withdrawal that follows the revised guidelines from the FDA (US) and NICE(UK, International).
Visit ACAAM.org and IMMH.org
The first problem with older antidepressant withdrawal guidelines was that in the past, regulatory bodies seemed to discount or be unaware of the many difficulties that can be encountered. So, doctors simply passed on to their patients the regulators’ advice that antidepressant withdrawal will most probably be mild and “self-limiting” and might take a week or two. The idea was to cut your dose in half for a couple of days or a week, followed by another 50% cut, and after another week or so, just stop.7,11 This strategy is no longer an “official” FDA guideline for antidepressant withdrawal.
