Antidepressant discontinuation symptoms

Antidepressants change how brain chemicals such as serotonin and noradrenaline are handled. After weeks or months, the brain adapts to the medicine being present. When the amount drops quickly, the system needs time to readjust and the person may feel physically and emotionally off-balance during that period.

The NHS describes these effects as a normal part of discontinuation rather than a sign that the medicine is harmful or that depression is returning. The reaction tends to be more marked with shorter-acting medicines and with abrupt rather than stepwise reductions, though it can occur with any antidepressant.

Symptoms are varied, and different people notice different clusters. The NHS lists headaches, muscle aches, nausea, sweating, heart palpitations, dizziness, sleep disturbances, low mood, restlessness, anxiety and unusual sensations described as brain zaps.

• Physical: dizziness, nausea, flu-like aches, sweating, tremor.

• Sensory: brief electric-shock sensations, tingling, buzzing, sensitivity to noise.

• Sleep: vivid dreams, difficulty falling or staying asleep.

• Emotional: tearfulness, irritability, agitation, anxiety, low mood.

This is the question most people ask, because the two can look alike. Several clues help. Discontinuation symptoms usually begin within days of a dose change, include physical effects such as dizziness or electric-shock sensations, and often improve if the dose is raised back up. Relapse tends to build more slowly, over weeks, and looks like the original illness, with persistent low mood, loss of interest and negative thinking.

The distinction is not always clear-cut, so do not try to settle it alone. The prescriber can review the timeline with you and decide whether to hold the dose, slow the reduction or restart. If you have thoughts of harming yourself, tell someone straight away and use the urgent routes described below.

The NHS advises continuing treatment for at least six months after symptoms improve, and says not to stop suddenly or without speaking to the doctor. For sertraline it states that the doctor will gradually reduce the dose over several weeks or months, and that stopping may be suggested after you have felt better for some time. Citalopram guidance is similar, with a reduction over a few weeks.

In practice, a plan sets each step, how long to stay at it and what to do if symptoms flare. If symptoms are significant, the clinician may suggest going back to the previous step for a while and then making smaller reductions. Some people need smaller steps than tablet strengths allow, which the prescriber and pharmacist can help arrange using liquid forms or different formulations where they exist.

• Agree the plan in advance and write it down.

• Choose a time with less pressure at work or home if possible.

• Keep sleep, meals, movement and alcohol habits steady during each step.

• Book a review soon after each change rather than waiting until the end.

Some people have symptoms that last well beyond a few weeks, especially after long periods on treatment or higher doses. The NHS says symptoms can sometimes last for months. Tell the doctor if symptoms are severe, long-lasting or interfere with work, caring or relationships.

Options include slowing down the taper, pausing at a lower step, short-term symptom relief for sleep or nausea and psychological support such as talking therapy, which also helps reduce relapse risk. Peer support groups run by mental health charities can help people who are tapering slowly.

Call 999 or go to A&E if you feel unable to keep yourself safe, or if you have serious thoughts of ending your life. Use NHS 111 for urgent advice if symptoms are severe, you are very agitated, confused or having seizures, or you have a fast heartbeat, high temperature and shaking after changing a dose, which can sometimes indicate serotonin toxicity. Crisis lines such as Samaritans and NHS mental health crisis services are available at any hour.