All Articles
Antidepressant Withdrawal: How Long Can It Last?
Expert Insights

Antidepressant Withdrawal: How Long Can It Last?

October 20, 2023
#
 min read
Mark Horowitz, MD, PhD
Written by

Table of contents

Build your personalized tapering plan
Check Elegibility

Antidepressant Withdrawal: How Long Can It Last?

Background

Antidepressants are psychotropic drugs. When you take a psychotropic drug every day, your brain, nervous system and body gradually adapt over some weeks to the constant influence of the drug (read more about this here). 


Once this adaptation is established, the body moves into a state called physical dependence. In this state a person becomes at risk for the development of withdrawal symptoms if the dosage of the drug is reduced too fast (15).


Withdrawal symptoms demonstrate that the brain, nervous system, and body have become physically dependent on the drug. Physical dependence is not the same as addiction, where the person also craves the drug(17). While antidepressants are not addictive, they do cause dependence(13). 


But what we know about the phases of withdrawal comes from addiction medicine, where psychotropic withdrawal has been more closely studied. Withdrawal is said to occur in an early acute phase starting shortly after stopping the drug, followed by a protracted (lasting for a longer period of time) phase(23).

What is acute withdrawal from antidepressants?

Early in the history of the newer antidepressants, SSRIs were presumed to be different from addictive drugs and old antidepressants in that they did not cause dependence or withdrawal. Eventually, case reports from doctors revealed that people did get withdrawal symptoms when SSRIs were stopped (20,22).


The long lists of symptoms that are the core of what doctors know about antidepressant withdrawal were derived from these clinician observations as well as adverse drug reaction databases and clinical trials. In all these instances, the antidepressant was stopped abruptly or over perhaps a week or two (8).


Once withdrawal from the newer antidepressants was recognized, it was said to be minor and over within a few weeks(24,25). There was no need to define phases of antidepressant withdrawal.


Because these symptoms arise suddenly and dramatically after cessation of the drug, we now recognize and refer to this period of initial, intense antidepressant withdrawal symptoms as acute withdrawal(3,23).

How long does acute withdrawal last?

Across psychotropic drugs, the acute withdrawal phase has been observed to last about 2-3 weeks before it changes into the protracted withdrawal phase. The difference between the two phases is the duration of the symptoms and symptom pattern(15).


Coincidentally, the entire antidepressant withdrawal syndrome was long believed to last only 2-3 weeks (14). It seems likely now that early papers were describing the symptoms of the acute phase, where symptoms sometimes completely resolve, while the protracted withdrawal syndrome that might come afterward went unrecognized (6,10).

What are acute antidepressant withdrawal symptoms?

Although there are dozens of antidepressant withdrawal symptoms, doctors are often taught to recognize only a handful with the simple mnemonic FINISH, devised in 1998 (Berber, 1998):


Flu-like symptoms

Insomnia

Nausea

Imbalance

Sensory disturbances

Hyperarousal (anxiety/agitation) 


This gives doctors a vague but narrow expectation of the  symptoms to look for when their patients go off their drugs. In contrast, a 2019 international survey of 867 patients(21) found their most frequent acute withdrawal symptoms were


  • Anxiety/Panic
  • Irritability
  • Dizziness
  • Brain Zaps
  • Nightmares
  • Nausea


“Brain zaps”, the electrical shock sensation in the head that is perhaps the most recognizable antidepressant withdrawal symptom, does not appear in the early journal articles, but is now known as a hallmark of acute antidepressant withdrawal (7,18).

What is the treatment for acute antidepressant withdrawal?

The only known treatment for acute antidepressant symptoms, which is the period shortly after discontinuation of the drug, is reinstatement of the drug. This should assist nervous system stabilization. After the withdrawal symptoms go away, the person might be able to taper off more gradually(2,27).

What is protracted withdrawal?

Like “acute withdrawal”, the term "protracted withdrawal" has only recently been used in connection with antidepressants, because antidepressant withdrawal has long been assumed to be "time-limited”  to a few weeks(14,24). 


Given this expectation, antidepressant withdrawal symptoms that persist past a short period are often misidentified by doctors and patients as “relapse” rather than protracted withdrawal(12).


However, it has become clear that as with addictive psychotropics, a protracted phase may follow the acute phase of antidepressant withdrawal – a previously unidentified serious risk of antidepressant use. (4,7,9,10).


There is no clear border between acute and post-acute withdrawal syndrome. One authority suggests if withdrawal symptoms last more than 6 weeks, the protracted withdrawal phase has begun(3).

What are the symptoms of protracted withdrawal?

As protracted withdrawal syndrome is essentially a continuation of acute withdrawal syndrome, it encompasses all of the symptoms that can appear in the acute phase. Withdrawal symptoms are known to change throughout both phases, with patients often being able to recognize the difference between symptoms related to withdrawal versus symptoms related to the original psychiatric complaint(3, 10).


A study of protracted antidepressant withdrawal cases reported on an Internet site found these were the most common symptoms, with about ⅔ of the cases having both physical symptoms and emotional symptoms(10):


Anxiety - 53.6%

Depression - 36.3%

Insomnia - 36.2%

Gastrointestinal - 33.3%

Decreased concentration (brain fog) - 26.1%

Brain zaps - 21.8%

Headache - 21.8%

Suicidal thoughts - 20.3%

Muscle aches - 17.3%

Visual - 15.9%

Tremor - 15.9%

Fatigue - 13%

Dizziness - 11.6%

Sweating - 5.8%

Post-antidepressant sexual dysfunction (PSSD) - 2.9%


Psychotropic drugs might differ somewhat among their acute withdrawal symptoms, but protracted withdrawal syndrome tends to have similar features across psychotropics(1,26).

How long does protracted withdrawal from antidepressants last?

Very little investigation has been done into protracted antidepressant withdrawal. One large study in patients who had been on antidepressants for more than a couple of years and then roughly tapered off found a clear increase in withdrawal symptoms a month after stopping antidepressants, with those with withdrawal symptoms continuing after 9 months mostly resolved by 12 months on average (Lewis 2022). 


Evidence extracted from patient narratives on an Internet site suggests that protracted withdrawal in these likely more severe cases tends to resolve in 2-3 years (10). This accords with what is known about protracted withdrawal from addictive drugs (15,16). 

What is the treatment for protracted antidepressant withdrawal?

Protracted withdrawal from antidepressants has only recently been recognized and is poorly understood. Doctors may prescribe many different kinds of drugs to address the wide range of symptoms, but they may or may not have a beneficial effect. Informal patient reports indicate a very low dose reinstatement of the original drug may help. Any drug treatment, though, may make protracted withdrawal syndrome worse, due to accompanying increased neurological sensitivity.  Perhaps the most reliable treatment is to be patient and allow the symptoms to naturally and gradually resolve over time(7).

How to avoid acute or protracted withdrawal syndrome?

It’s important to recognize that all that is known about acute or protracted withdrawal from antidepressants is from people who were abruptly discontinued from their drugs or tapered over only a few weeks. There is evidence that very gradual tapering over months rather than weeks reduces the incidence and severity of acute withdrawal symptoms, and thus protracted withdrawal syndrome as well(12).

Sources:

  1. Alsheikh, M. Y. (2021). Post-Acute Withdrawal Syndrome: The Major Cause of Relapse among Psychoactive Substances Addicted Users. Archives Of Pharmacy Practice, 12(4), 91–97. https://doi.org/10.51847/iOICfUjpnm 
  2. Baldessarini, R. J., & Tondo, L. (2019). Effects of Treatment Discontinuation in Clinical Psychopharmacology. Psychotherapy and Psychosomatics, 88(2), 65–70. https://doi.org/10.1159/000497334
  3. Chouinard, G., & Chouinard, V.-A. (2015). New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal. Psychotherapy and Psychosomatics, 84(2), 63–71. https://doi.org/10.1159/000371865
  4. Cosci, F., & Chouinard, G. (2020). Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications. Psychotherapy and Psychosomatics, 1–24. https://doi.org/10.1159/000506868
  5. Davies, J., & Read, J. (2019). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addictive Behaviors. https://doi.org/10.1016/j.addbeh.2018.08.027
  6. El-Mallakh, R. S., & Briscoe, B. (2012). Studies of long-term use of antidepressants: How should the data from them be interpreted? CNS Drugs, 26(2), 97–109. https://doi.org/10.2165/11599450-000000000-00000 
  7. Framer, A. (2021). What I have learnt from helping thousands of people to taper off antidepressants and other psychotropic medications. Therapeutic Advances in Psychopharmacology. https://doi.org/10.1177/2045125321991274
  8. Haddad, P. (1997). Newer antidepressants and the discontinuation syndrome. The Journal of Clinical Psychiatry, 58 Suppl 7, 17–21; discussion 22. https://www.psychiatrist.com/jcp/depression/newer-antidepressants-discontinuation-syndrome/
  9. Hengartner, M. P., Davies, J., & Read, J. (2019). How Long Does Antidepressant Withdrawal Typically Last? The American Journal of Psychiatry, 176(6), 487. https://doi.org/10.1176/appi.ajp.2019.19020142
  10. Hengartner, M. P., Schulthess, L., Sorensen, A., & Framer, A. (2020). Protracted withdrawal syndrome after stopping antidepressants: A descriptive quantitative analysis of consumer narratives from a large internet forum. Therapeutic Advances in Psychopharmacology. https://doi.org/10.1177/2045125320980573
  11. Horowitz, M. A., & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The Lancet Psychiatry, 6(6), 538–546. https://doi.org/10.1016/S2215-0366(19)30032-X 
  12. Horowitz, M. A., & Taylor, D. (2022). Distinguishing relapse from antidepressant withdrawal: Clinical practice and antidepressant discontinuation studies. BJPsych Advances, 1–15. https://doi.org/10.1192/bja.2021.62 
  13. Horowitz, M. A., Framer, A., Hengartner, M. P., Sørensen, A., & Taylor, D. (2023). Estimating Risk of Antidepressant Withdrawal from a Review of Published Data. CNS Drugs, 37(2), 143–157. https://doi.org/10.1007/s40263-022-00960-y
  14. Jha, M. K., Rush, A. J., & Trivedi, M. H. (2018). When Discontinuing SSRI Antidepressants Is a Challenge: Management Tips. The American Journal of Psychiatry, 175(12), 1176–1184. https://doi.org/10.1176/appi.ajp.2018.18060692
  15. Lerner, A., & Klein, M. (2019). Dependence, withdrawal and rebound of CNS drugs: An update and regulatory considerations for new drugs development. Brain Communications, 1(1). https://doi.org/10.1093/braincomms/fcz025
  16. Melemis, S. M. (2020, March). Post-Acute Withdrawal Symptoms and Relapse Prevention Strategies. Addictions and Recovery. https://www.addictionsandrecovery.org/post-acute-withdrawal.htm 
  17. O’Brien, C. P. (2018). Chapter 24: Drug Use Disorders and Addiction. In L. L. Brunton, R. Hilal-Dandan, & B. C. Knollmann (Eds.), Goodman & Gilman’s The pharmacological basis of therapeutics. (13th ed.). McGraw-Hill Medical. https://accessmedicine.mhmedical.com/content.aspx?bookid=2189&sectionid=170270255
  18. Papp, A., & Onton, J. A. (2018). Brain Zaps: An Underappreciated Symptom of Antidepressant Discontinuation. The Primary Care Companion for CNS Disorders, 20(6). https://doi.org/10.4088/PCC.18m02311
  19. Praharaj, S. K. (2004). Serotonin reuptake inhibitor induced sensory disturbances. British Journal of Clinical Pharmacology, 58(6), 673–674. https://doi.org/10.1111/j.1365-2125.2004.02207.x  
  20. Price, J. S., Waller, P. C., Wood, S. M., & Mackay, A. V. P. (1996). A comparison of the post-marketing safety of four selective serotonin re-uptake inhibitors including the investigation of symptoms occurring on withdrawal. British Journal of Clinical Pharmacology, 42(6), 757–763. https://doi.org/10.1046/j.1365-2125.1996.00498.x
  21. Read, J. (2019). How common and severe are six withdrawal effects from, and addiction to, antidepressants? The experiences of a large international sample of patients. Addictive Behaviors, 106157. https://doi.org/10.1016/j.addbeh.2019.106157 
  22. Rosenbaum, J. F., Fava, M., Hoog, S. L., Ascroft, R. C., & Krebs, W. B. (1998). Selective serotonin reuptake inhibitor discontinuation syndrome: A randomized clinical trial. Biological Psychiatry, 44(2), 77–87. https://doi.org/10.1016/s0006-3223(98)00126-7
  23. SAMHSA. (2010). Protracted Withdrawal (Substance Abuse Treatment Advisory Volume 9, Issue 1; p. 8). SAMHSA Center for Substance Abuse Treatment. https://store.samhsa.gov/product/Protracted-Withdrawal/SMA10-4554 
  24. Schatzberg, A. F., Haddad, P., Kaplan, E. M., Lejoyeux, M., Rosenbaum, J. F., Young, A. H., & Zajecka, J. (1997). Serotonin reuptake inhibitor discontinuation syndrome: A hypothetical definition. Discontinuation Consensus panel. The Journal of Clinical Psychiatry, 58 Suppl 7, 5–10. 
  25. Shelton, R. C. (2006). The nature of the discontinuation syndrome associated with antidepressant drugs. The Journal of Clinical Psychiatry, 67 Suppl 4, 3–7.
  26. UCLA Dual Diagnosis Program. (2019). Post-Acute Withdrawal Syndrome (PAWS) | Semel Institute for Neuroscience and Human Behavior. UCLA Semel Institute for Neuroscience & Human Behavior. https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS 

Wolfe, R. M. (1997). Antidepressant withdrawal reactions. American Family Physician, 56(2), 455–462.

Sign up for launch

Be the first to hear when Outro’s clinician-guided tapering programs are available in your state.