alt Hacker NewsDoctors are finally learning to manage antidepressant withdrawal
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I went cold turkey off of citalopram when I was a teenager and it was a pretty unpleasant two weeks of heart palpitations, but the immediate benefit of no longer experiencing emotional blunting made me avoid taking any more antidepressants for 10 years. I was prescribed it by a GP and never given any real support in my mental health or in coming off of it. It was a real black pill for me on the UK's treatment of mental health issues.
Last year I started taking buproprion (Wellbutrin) after seeing a private psychiatrist in Romania, and I found it beneficial, but ended up losing more than 10kg, and becoming malnourished to the point of my hair falling out. Again I stopped of my own accord, and buproprion has basically no cessation symptoms.
This spring I saw a psychiatrist through Romania's public health service who prescribed me vortioxetine (Brintellix/Trintellix) after I shared my history and it's been a game changer. I experience basically no side effects besides a slight reduction in libido, with no other effects on sexual function. It's really helped me to find my balance again. And I see a psychiatrist once a month paid for by my public health insurance with the medication fully comped. Vortioxetine has a half-life of 66 hours so the one time I did have to skip a day and a half, the withdrawal was not noticeable.
Just sharing this to say that there are good doctors and good meds out there, and that having low tolerance for one medication doesn't mean that you shouldn't talk to a doctor about it and try others.
To provide one additional anecdote: I came off escitalopram with no taper after taking it for about five years (10mg). I got brain zaps for a while, got very irritated at times, but largely was fine after a few weeks. Not downplaying the withdrawal effects for some people, but they’re not as catastrophic as this article suggests for many (perhaps most).
And overall I’m very glad I took it! It got me through a rough patch, and seems (in combination with therapy, and some life changes) to have rewired me a little. Symptoms I had for a decade prior have not returned. And I’m not sure I could have made those life changes without it.
Sadly my arachnophobia came back though. Oh well.
This is an absolute failure on the part of medical science. SSRIs went mainstream in 1988.
By 1992! We knew about withdrawal issues: https://www.wikidoc.org/index.php/SSRI_discontinuation_syndr...
Let's be generous and give it until the 2000s for the knowledge to spread and science to validate; and we're still left with 26 years of blundering around without IMO sufficient warning to patients about withdrawal risks.
I would wager some of the doctors who prescribe today were well past a glint in their father's eye when we started to know about this.
I’ve been on a SSRI for 5 years and not once have I thought about getting off of it. It literally saved my life.
I remember a while life of depression and constant churn of recursive emotions destroying me.
I’m worried that too many people are downplaying the benefits that this drug for those of us that it has helped immensely. And it’s extra risky to be downplaying it while RFK jr is actively working to remove the drugs from the market.
Though this article concentrates on the SSRIs, other meds like the SNRIs can have a similar or even worse withdrawal effect. We didn't call it "Side Effexor" for nothing.
People legitimately need these drugs, including in the short term. The problem for acute stressors once they resolve is how to get them back off.
Going cold turkey is always the worse way to wean off a SSRI, but the half-life of the drug is also a good indicator of the intensity of the withdrawal. Also, some people might eliminate a drug faster than others, so the result is surely harder on some that others.
Doctors that tells you how to reduce the SSRI/SNRI are following what's available on the market, and generally the gap between doses is always huge and gives a big gap and so bigger withdrawal. Once I asked to a pharmacist if he could make smaller doses and he answered me to be like a good junky and open the capsules and cut them myself. I was a bit shocked at the moment, but at least it costs me less that him having to do it a that helped me greatly to reduce a SNRI without feeling too much symptoms.
So a good advice, is look at the half-life of the drug you are taking, and be a good junky and split the capsules or have liquid form to reduce by small amount.
Half-Life of Specific SSRIs
- Fluoxetine (Prozac): 4 to 6 days, with its active metabolite norfluoxetine lasting 7 to 16 days.
- Sertraline (Zoloft): Roughly 22 to 36 hours.
- Citalopram (Celexa): About 36 hours.
- Escitalopram (Lexapro): About 27 to 32 hours.
- Fluvoxamine (Luvox): 17 to 22 hours.
- Paroxetine (Paxil): About 21 to 24 hours.
Half-Lives of Common SNRIs
- Venlafaxine (Effexor): About 5 hours for immediate-release (extended-release has an effective transit/clearance profile, though parent half-life remains short); its active metabolite (desvenlafaxine) has a half-life of about 11 hours.
- Desvenlafaxine (Pristiq): About 11 hours.
- Duloxetine (Cymbalta): About 12 hours (range of 8 to 17 hours).
- Levomilnacipran (Fetzima): About 12 hours.
SSRI's saved my life with no side effects that I can discern, yet I still have the urge to try and get off of them from time and so do friends and family of mine that also benefit from them. Maybe that urge needs more study because it is not taking us in a good direction. I'm not saying that because of the difficulty of weaning off, but because of the benefits of staying on. For those of us that need them, trying to wean off of them is like trying to wean off of I don't know, vitamin C or something else essential. Don't do it! Be glad you found something that helps! Keep taking it!
I've been on 40mg citalopram for about 20 years now. I've tried a few times to come off either tapering or cold turkey and in all cases it's been horrendous. My biggest worry is that I'll never be able to come off them as I'm on such a high dosage, even if it was tapered off over a very long period of time.
> Likewise, a 2025 study found that people with dementia who were taking antidepressants experienced more rapid cognitive decline. “Sometimes we think a lot about medications when we start them, but we don’t think enough about stopping them at some point,” says Sara Garcia Ptacek, a neurologist at the Karolinska Institute in Sweden, who worked on the study.
My aunt had Alzheimer's and had to be put on anti-anxiety medication just so that her caretaker could manage her. (This was at the point where she no longer recognized her children, but recognized her siblings.)
Even if it accelerated her eventual end, it certainly improved the situation. She would have been impossible to take care of otherwise.
That being said, before Alzheimer's, she was a very anxious person and often difficult. If she was medicated earlier in life, would it have accelerated the onset of Alzheimer's?
All cases are possible with S{S|N}RIs (I am a doctor but I know a little regexp). Patients that took them for two months and never needed again and others that cannot stop them after 20y. The start, the stop and every restart of the drug needs an indication so it should be approached with the same care as any medical decision.
It's not right to call it withdrawal. These drugs are not addictive like benzos or alcohol are. If any symptom reappears it's just that the mental disease most usually changed form after so long time. As for the sexual dysfunction, a common known side effect is that they kill (delay or eliminate) the orgasm. Libido and male erection are affected by so many psycho-social, somatic and genetic factors that it's usually difficult to spot the exact relation with these drugs.
There’s a lot of focus on negatives in comments. I will say ssris probably saved my life and I have had zero side effects to date. It’s easy to say “just suck it up and power through it”. That advice can kill people
Only slightly related, but can anyone ELI5 why Bupropion XL is not the universal first line treatment for depression and is hardly used at all in Europe?
It has fewer side effects vs. SSRIs, can be safely used as a long term medication (which many people do with SSRIs even though it can have negative effects), and doesn't have the same horrible withdrawal symptoms (although you still need to taper).
I am by no means advocating against taking anti-depressants, I am just sharing my own experience. I have to say this because I have seen people with severe depression make night and day transformations off of these medications and know they can work.
For me, it wasn't an SSRI, but a norepinephrine-dopamine reuptake inhibitor - often prescribed for treatment-resistant depression. In my early 20's, I had tried everything, nothing seemed to work, then these treated the physical symptoms pretty well - I got my energy and motivation back, sleep normalized.
After several years though they stopped working. We upped the dose until there was nowhere left to go. At the dose I was taking, it was very important to take it at the precise right time or you could spiral into some very bad symptoms. Drink at all, or just a little too much, could spiral you into an episode. I finally decided that it was worth being depressed than what I was dealing with physically and emotionally on the drug, so I stopped it.
It was a rough month or two but I entered a new treatment program, the doctor found I was severely D3 deficient. We worked on my sleep habits, nutrition, diet - finally discovering what I had was seasonal affective disorder. So we have a plan for those months, and honestly, it's been 2 years off of them and I have never felt better.
Depression is a complicated condition, there's no one treatment in my mind, it's a lot of contributing factors. I won't take them again, especially since there's a moderate chance these drugs actually worsen depression and highly increase risk of suicide. Doctors will just prescribe them without much warning, and that is what I hate, not the drugs themselves.
Lookup "occupancy chart antidepressant", study the chart. There is an exponential drop-off at lower doses. Hence to taper off without feeling it, one needs to cut smaller and smaller doses, (or liquify) which may be impractical.
Zoloft for me (Sertraline) years ago. Was on for a few years and came off cold-turkey when it didn't seem to help any more.
My life outside my head was crazy enough. My mind then matched it. I don't regret taking it, but it is a real trap of taking sanity from your own future and paying it back later. Advice I received was if my body could handle it, I should stay on it forever. I didn't like that idea, though. Among the negative side effects, the chemical sexual drive suppression caused its own problems. YMMV of course.
>The baffling science of SSRIs: how do they really work?
SSRIs not Benzodiazepines. Withdrawals from the later can be life-threatening if you abruptly stop after prolonged use.
I forget exactly which antidepressant I was on, but when i finally stopped taking it, i was instructed to reduce dosage by half a pill every two weeks.
Anecdotally, that was not anywhere close to slow enough. I had panic attacks almost every day while I was reducing the dosage. Those weeks were hell. I couldn’t think straight. I honestly don’t remember much of what occurred during that time, because the withdrawal took over my life. The pills were too tiny to split into fourths easily, but I wish I had done something to reduce dosage in smaller increments or over a longer time period.
It makes me strongly reconsider ever taking any antidepressants ever again. They didn’t tell me when I started taking them that the withdrawal would be so terrible. Those months were easily some the worst of my life.
This is a serious issue, but for a humorous sci fi take on this issue, go read The Lust Lizard of Melancholy Cove by Christopher Moore.
It deals with a small town psychiatrist who takes a whole town off of anti-depressants, and an ancient monster is summoned from the depths attracted by all the heightened emotions and terrorizes the town.
I’ve known two people who experienced psychosis after quitting their meds. One was retired and rode it out, but the other quit his job and ended up being committed, totally upending his life.
SSRIs and SNRIs just didn't work very well for me. If they had an positive effect at all, it wasn't enough to rise above the proverbial noise.
Coming off of them wasn't too bad though. I got the brain zaps, but those were easy to cope with.
More than anything the whole experience was a waste of money, and what finally fixed my problems was retirement and a greater attention to my health.
Withdrawing from citalopram after dropping out of college was one of the worst summers of my life. Brain zaps are real.
I've taken antidepressants for years (20 mg prozac) and have sometimes tapered off them, restarting later. I can barely tell that I'm taking them, I feel 100% like myself on--and off of--them. I know they do something because when talking about difficult traumas with my therapist, if I'm not taking flouoxetine I will get choked up to the point I can't speak. That's the only difference I can perceive. My dose is not a "happy pill", it simply smooths out some extreme lows. Tapering off (a few weeks of 50% exponential declines) I've done because it's recommended, but again, I've never noticed any affect on mood before, during, or after.
after a number of years, a small dose of lithium (300mg) was recommended by a psychiatrist who stood apart (at least in that respect), and it was magic at mood stabilization, I never before even realized that I experienced hypomania (and I took it for anxiety), I just thought I was "bold".
(Lithium is not a drug, it's an element, taken as a metallic salt. It occurs naturally in the water in various parts of the world, and those populations have been studied and suffer lower rates of mental illness. My shrink said his recommendation was based in conjunction with the prozac I was taking, i.e. a known correlation. Bipolar II is a different mental condition than bipolar I, and somewhat slippery/loosely defined)
The extreme anecdotal stories people report online as in this forum strike me, an experienced but likewise only an anecdotal user, as more an artifact of underlying emotional distress rather than a result of the drugs.
I just wanted to contribute a different voice to this topic.
I should add, I do have "extra money" and am able to pay extremely qualified and expensive doctors, an option that is not available to everyone, including those with full public health services.
None of my doctors spoke of the withdrawal side effects. But they'd happily prescribe stuff.
I was on SSRI (Sertraline) for around a year, and it absolutely demolished my libido, to a point where I became repulsed by it and actively avoided anything sexual with my wife. Luckily, I didn't gain any weight but the sexual side effects were brutal. I eventually visited a couple other doctors, same story, keep sertraline, increase the dose and here are some multivitamins, good luck bro.
Eventually had enough of the bull** and stopped it all cold turkey, both Sertraline and Lamotrigine, no tapering off or anything. The headaches that followed were brutal but for me it was way better than the risk of ruining my marriage.
A year later, I went back for another try, got prescribed Bupropion and Lamotrigine (again) but neither made any difference, they basically had the same effect as the water I drank with them. So again, stopped them cold turkey and vowed to never get any drugs for my depression and anxiety, and came out with the conclusion that therapy is broken. They'd happily prescribe meds than actually get to the bottom of the issue, it's a symptomatic treatment.
Well this would be an improvement over my former NHS GP practice deciding the best way for me to come off antidepressants was immediately stopping them without renewing the prescription or even discussing it with me! I think they just forgot to renew the prescription.
TLDR: Rate is individualized and determined by the patient's tolerance. If symptoms appear, maintain or increase dose to stabilize, then try reducing again later. Use liquid medication for more granular dosing.
Doctors aren't "finally learning" how to manage withdrawals. This is essentially the common sense algorithm, and I'm pretty annoyed that they wrote this whole ass article just for that.
Myself I tapered Paroxetine without any pill cutters or special techniques and had no physical problems... But I did have something like a manic episode that lasted for about six months, had a psychogenic fever, lost more than 30 pounds in a few months (I was working out like a "maniac" and eating a mostly liquid diet at times to take stress off my TMJ) and was very high functioning in most respects despite being under the influence of a system of delusions.
The relevant book is The Maudsley Deprescribing Guidelines Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs by Mark Horowitz and David Taylor (2024).
This book is for medical professionals, but if you find your doctor doesn't have the relevant training then worth to educate yourself. The TL;DR is that you need to go really slowly in the final steps.
Horowitz also has many talks and podcast appearances on youtube. Example old video https://www.youtube.com/watch?v=LRr09mvMEAU but he has many more recent ones.
I don't have any direct experience with this, but I've been watching my best friend struggle with widthdraw symtoms for many year, and I also know from doctor friends that they are not trained on de-prescribing protocols.
Meanwhile half the world's on some kind of ADHD amphetamine with absolutely no plan for what to do when their tolerance starts degrading the quality of the high.
There is a fundamental problem with taking happy pills to treat anything... Tolerance. They work less and less and your own body begins to lessen its own production of whatever molecule in the interests of homeostasis.
If doctors have the wisdom to realise cocaine might feel good in the short term but has obvious damaging effects in the long term, then why can't they apply that logic to anything but illegal drugs? How can 7+ years in higher education still produce such illogical thinkers?
By the way - turning off scripts allows the original to load without paywall. (Probably not using Chrome.)
I think about 10 years ago maybe even more than that maybe 15 years ago I had a conversation under a different name on hacker news and I was telling them about my antidepressant withdrawal.
I was downvoted and ridiculed. Told it was just my mental illness and it was all in my head. I even attempted to show the mechanism but people thought that was not enough.
Now I see this. It makes me angry. No one listens to the mentally ill and our experiences.
By the way, this is also true for and drugs that act on receptors. Like most antipsychotics. It’s is even true for GLP1 drugs.
This is a form of addiction that is not see only because the “craving” is absent. It is an addiction which fits not tell you what you are addicted to.
Psychiatry is the worst practice right now. There has been zero progress and even less compassion.
When I was diagnosed with depression - amongst other things - my doctor prescribed SSRIs with a caveat that they might or might not work.
After a few weeks I was tapered off them.
I felt no different before, during or after them.
What helped was 3 daily walks around the park, around 9km per day after each meal.
Anecdotal but it is what it is. Right now I have bigger problems than just depression.
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This comment section is absolutely full of people ready and willing to insist that people with depression simply need to cheer up and get over it. And all I can say is: I hope someone shows them a similar level of compassion when they are at their lowest.
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Best way to manage the withdrawal would be to dramatically reduce them being prescribed in the first place.
The linked article says they have "small to moderate effectiveness", but this is being far too generous. The correct way to measure drug effectiveness is if the treatment meets the standard of a minimal important difference. I.e. you measure depression on various rating scales, like the 17-point HAM-D, and research suggests a minimal important difference (i.e. one patients and clinicians can actually notice) needs to be about 3-5 points. But the average effects of almost all antidepressants do not meet these thresholds, i.e. the effect actually appears practically invisible. [1]
Then you'll get waffling like "oh, but it really has a big effect for some people", but, well, no, we've looked at that too, and the placebo groups get just as miraculous "big effects", i.e. evidence supporting the idea "they really help some people" is also largely lacking [2-3]. All the other attempted saves ("oh, but eventually you find one that works for you") are also not really well supported either [4].
Like, maybe they really help some people, but it is far, far less clear than most assume, and should be balanced with concerns like withdrawal and serious side effects like emotional blunting and sexual dysfunction.
EDIT: And just to be clear to anyone doing a drive-by downvote thinking this is about recent asinine US politics, it emphatically isn't. There are serious methodological concerns here that desperately need to be communicated to the public.
[1] https://pubmed.ncbi.nlm.nih.gov/33593736/
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC7451660/
My parents tried seeking out help for me when I was about 10 years old, but they got cold feet, and I believe that they were unwilling to accept any responsibility or blame for what was going on at home. So when I reached the age of majority, they fully funded therapist and psychiatrist sessions for me, and they foisted Prozac upon me, starting around 1991.
I began taking Prozac and suddenly exhibited a remarkable improvement in my mood and affect. These improvements were largely because I was getting attention, I was getting "weekly pep talks" from a professional, and at long last, there were names I could affix to those extremely troublesome spirits that tormented me night and day.
But the doctors, having a practice in the Children's Hospital, didn't see fit to warn me not to drink alcohol, especially not to excess, and I was simply reaching that age where this was happening frequently. So, the mixture of SSRI plus ethanol was really disastrous for me and my loved ones.
I cycled through all kinds of meds, and clinicians tried finding some other stuff to medicate, like maybe hypothyroidism, and I really hated the medication, and I got hospitalized and discharged with a cocktail of at least 5 prescriptions all at once. I suffered really awful adverse side effects. But it wasn't realistic to stop. I kept cycling through new and different drugs. Every time it was new and different, and I had more complaints, and I stopped again and again. I had all the "brain zaps" especially Zappy Zoloft, and more hospitals and more upheavals in life.
I've finally reached a point where I can steadfastly refuse any medication, up to the point where inpatient treatment is done. I am 100% off drugs, and I feel great about that. I tend to inform my providers that I have "a Lithium deficiency" because bipolar isn't real: it's merely a cluster of highly-subjective "symptoms" and behaviors, under an ever-widening umbrella, and the bottom line is that they just want to put Lithium Carbonate on the checklist of "subject is treating this thing" and then once I'm taking enough of it, they can heap on more and more drugs on top. And Lithium is one of those where they grab you for a monthly blood test, to "trust, but verify" as the Soviets would say.
So I am pleased that SSRIs and their ilk are far, far behind me. I inwardly chuckle or sigh wistfully when I hear another patient extolling the virtues of ECT or Ketamine or something. How wonderful for you to be dependent on quacks and pseudoscience. Read any Wikipedia page for these drugs.
They are fairy tales.
I am a practicing Roman Catholic: I don't need to believe in fairy tales from foreigners and infidels who distribute condoms and wear white coats.
Thank you for your attention to this matter!
Thank you for coming to my TED Talk.
There is a real lack of transparency in communicating some of the long term impacts of SSRIs to new patients. When I was prescribed sertraline not one doctor mentioned the massive (and sometimes permanent!!) sexual side effects, the likelihood of weight gain or how brutal it would be to taper off.
Also, I ended up ignoring my doctor's (way too aggressive) tapering schedule and managing my own down-dosing with a pill crusher and a milligram scale. I went about 5x slower than the standard advice and avoided all of the worst side effects.
I don't think it would have changed my decision to start taking it but I would rather have known about all this up front so I could make a more informed choice.