Millions of people worldwide take antidepressants to help with depression. But as a recent BBC Panorama found, many aren’t aware of the fact that antidepressants can cause withdrawal symptoms when you stop taking them. For some, these symptoms can be severe and long-lasting.
Here’s what you should know.
What causes antidepressant withdrawal?
When we take psychotropic medications such as antidepressants, over time the brain and body adapt to the drug. This process of adaption is often termed physical dependence, which leads to tolerance (lessening effects over time) and withdrawal when stopping. Dependence is different from addiction, which also involves cravings and compulsive use. People do not become addicted to antidepressants.
Most modern antidepressants flood the brain with abnormally high levels of serotonin – a naturally occurring brain chemical that carries messages between nerve cells. Serotonin is involved in many body processes including learning, memory, sleep and sexual function. After even just a few weeks of antidepressant use, our serotonin receptors become less sensitive, meaning that we probably need more serotonin to elicit the same effects.
So, when the drug dose is reduced or stopped, the brain and body “miss” the drug. This is what causes withdrawal symptoms.
Withdrawal can also happen with other psychotropic drugs such as benzodiazepines (used to treat insomnia and seizures), nicotine and caffeine.
What are the symptoms?
Since antidepressants affect multiple organ systems, there’s an array of potential withdrawal symptoms they can cause – both emotional and physical.
Emotional withdrawal symptoms include low mood, anxiety, panic attacks, irritability, anger, crying spells and feeling suicidal. These can occur even in people who have never had these symptoms before – for example, those prescribed antidepressants to treat conditions, such as menopause, that are unrelated to mental health problems.
As these symptoms overlap with those of anxiety and depression, they can easily be mistaken as someone’s underlying mental health condition returning. This can lead people to being advised to continue taking the medication.
Physical withdrawal symptoms can include dizziness, light-headedness, a sensation that things are “not real” (depersonalisation/derealisation), muscle cramps, headaches, insomnia, trouble concentrating, nausea, and brain “zaps” (the feeling of electrical sensations shooting through the head). In severe cases, withdrawal can cause akathisia – defined as “restlessness”, this may feel as though the nervous system is “on fire”.
There are a few ways to distinguish withdrawal symptoms from relapse – the return of a past mental health condition. First, withdrawal symptoms often happen soon (typically days but sometimes weeks) after reducing your antidepressant dosage. Relapse tends to occur after a longer period.
Physical withdrawal symptoms will be distinct from the original condition, and sometimes the emotional symptoms are recognisably different from the symptoms you initially had. These physical and emotional symptoms generally resolve swiftly when you take antidepressants again.
