Does stopping an antidepressant always cause discontinuation symptoms?

Like all medications, taking an antidepressant may come with unpleasant side effects. Fortunately, most are mild and short-lived, such as nausea or headache, and can often be avoided by starting at a low dose and increasing slowly.

antidepressant discontinuation symptoms, choosing the right antidepressant
All antidepressants work, but don’t work for every individual. Prepare for some trial and error. You should know whether a medication won’t work for you within four weeks, so when you start your antidepressant, book a follow-up phone appointment.

Unfortunately, some antidepressants have side effects that may be more severe and persistent, especially weight gain, sexual problems or an inability to feel a normal range of emotions.

However, there are some antidepressants that are much less likely to cause these side effects.

Discontinuation symptoms

When depression and anxiety symptoms have fully resolved and the decision is made to stop the treatment, some patients report experiencing very unpleasant side effects, called “discontinuation symptoms.”

Two older antidepressants, paroxetine (Paxil) and venlafaxine (Effexor), are particularly problematic, sometimes provoking flu-like symptoms, intense emotions (e.g., anxiety, mood lability), and electric-shock sensations, when discontinued.

For these two antidepressants, in my clinical experience, it doesn’t seem to matter how slowly they’re discontinued (even over months), they can still provoke these symptoms.

This is why most of my psychiatrist colleagues abandoned their use years ago, choosing to prescribe antidepressants with better short- and longer-term side effect profiles.

While many antidepressants can provoke discontinuation-related symptoms, they are rare in my practice because I avoid the worst offenders, inform my patients, and ask them to keep me in the loop if they decide to stop their treatment, so I help manage the symptoms if they arise.

Distressingly, there is a persistent belief, fueled by inaccurate reporting, that every patient is at high risk of discontinuation symptoms and that every antidepressant carries the same risk. This misinformation heightens treatment fear for individuals who are already anxious and really need help.

Psychiatric reports aren't always accurate

Headlines regarding psychiatric treatments tend to focus on the worst possible outcomes.

Some are frankly dishonest.

Online and print articles have reported on a recent review (Lancet Psychiatry. 2024 Jul; 11(7):526-535) of 79 scientific papers, stating that 1 in 3 people who stop taking an antidepressant experience discontinuation symptoms. While the study did find that 31 per cent of the subjects endorsed one or more discontinuation symptoms, 17% of participants had discontinuation symptoms after stopping a placebo. The researchers concluded that 15% per cent of subjects experienced antidepressant-related discontinuation symptoms and just 2.8% experienced severe discontinuation symptoms.

Another important consideration: more than 75% of patients stop their antidepressant before they have fully recovered, so there are times when what is labeled “discontinuation symptoms” is actually a relapse or due to residual symptoms of depression. Depression relapse can be delayed by weeks or even several months after an antidepressant is discontinued.

If you’re struggling with depression or anxiety and your doctor or nurse practitioner (NP) suggests you consider an antidepressant, it’s possible to reduce the likelihood of both short- and long-term side effects and substantially reduce the risk of discontinuation symptoms, if and when it’s time to stop your antidepressant.

Finding your best antidepressant

Here are my 7 top tips for optimizing your antidepressant experience:

  1. Do your homework. Antidepressant choice is the most important risk factor for discontinuation symptoms (CNS Drugs. 2023;37:143-157.) My book, This Is Depression, reviews every available antidepressant, so you know which ones have the best side effect profiles. It’s your body—own your own healthcare by being informed.
  2. Antidepressants start to work quickly. All antidepressants work, but they don’t work for every individual. Prepare for some trial and error when treatment begins. The good news: you should know whether a medication won’t work for you within four weeks, so when you start your antidepressant, book a follow-up appointment (a virtual appointment or phone call will do) within one month. If the antidepressant isn’t improving your symptoms at all within two weeks, the dose should be increased, so long as it’s well tolerated. If you’re not noticing any benefit over the next two weeks or your symptoms are worsening, it’s probably not the right antidepressant for you and should be switched to another option. You shouldn’t continue on the wrong antidepressant for months or years, but it’s critical seek professional guidance on next steps.
  3. Speak up. If you’re having side effects, let your doctor or NP know ASAP. Sometimes just changing the timing (e.g., moving the dose from morning to evening), taking it with food, or switching from a generic to a branded product can make a huge difference.
  4. Share your plans. If you decide to stop your antidepressant, inform your doctor or NP so they can guide you and provide a plan for avoiding/mitigating discontinuation symptoms.
  5. Reconfirm your diagnosis. If you have tried two different antidepressants at usual doses for at least a month each and you’re no better or you’re feeling worse, it’s critical to ask your doctor or NP to review your diagnosis. If you have depression, it’s important to rule out bipolar depression, assess the presence and severity of anxiety and insomnia, and rule out other common disorders, such as ADHD. It’s also important that your doctor or NP is aware of any major stressors you’re facing, so they understand how that might impact your response to treatment.
  6. Do your part on the self-care front. Try to be physically active, even if it’s a short walk every day. Try to maintain your connection with supportive people in your life and avoid those who bring you down. Try to use mindfulness techniques (there are free, easy-to-use apps) to help calm your mind. Take your medication as prescribed—there are tools to help you remember (e.g., calendar reminders, dosette).
  7. There’s always a path ahead. Struggling with depression or anxiety is awful and can cause you to feel hopeless, worthless and alone. I know, from decades of experience, that there is always another option to try. Please never, never, never give up!

Dr. Diane McIntosh is a psychiatrist, innovator, educator, author and speaker. She is a passionate advocate for better mental health care, and a champion for all who suffer from mental health challenges.

This blog post is part of a series looking at the state of our mental healthcare system and ways we can create sustainable change to improve quality and outcomes for anyone impacted by mental illness. 

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Dr. Diane McIntosh

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Dr. Diane McIntosh is a psychiatrist, innovator, educator, author, and speaker. She is passionate advocate for better mental health care, and a champion for all who suffer from mental health challenges.

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