Last updated 4/4/2024
Withdrawal
If you stop an antidepressant too fast, you can have “withdrawal” symptoms: physical stuff like nausea, dizziness and “brain zaps” (electric-like sensations in your head), and emotional symptoms like anxiety, anger, agitation, attention problems, and “lability” (tears, laughter — too much and too fast). For some people, these symptoms are very mild, easily managed. For some people they are horrible, making it impossible to work or take care of family or go to school, for weeks and sometimes for many months.
This experience can be avoided, or kept to a minimum, by gradually decreasing the antidepressant dose — “tapering”.
Everyone should taper, not just stop cold
It’s your brain, be gentle, lower the dose gradually. Some people can stop faster than others, but here’s my strong recommendation. Start with the smallest step down that you can easily create. That means:
- Ask your prescriber for the smallest pill size available for your antidepressant. Keep an active prescription for the larger size, if you have one, because it’s more expensive to use a bunch of small pills than to chop larger ones in halves or quarters.
- Cut that smallest pill in half. Do the math to determine what pills and parts of pills you need to take to lower your dose by just a half of that smallest pill. Examples below.
This might seem like a hassle, but if you want that first step down to go as smoothly as possible, it’s worth it. If you have no problems, you can take a bigger step next time (try one more small step first, to be sure).
(If you’re tapering venlafaxine, that’s a whole other story).
How fast should I go?
Some people just stop, all at once. That’s the fastest rate, obviously. The slowest rate can take several years. Years? Right: some people have to take years to get off their antidepressant, taking tiny steps down. If they go any faster, they get terrible withdrawal symptoms.
Most people find they need to wait at least 2 weeks in between steps down. If you’re taking bigger steps, wait longer, like a month; smaller steps, you can try going faster, like weekly*.
(*fluoxetine is different. Each dose lasts a long time. So weekly steps down is too fast: your body won’t have finished the last step in a week. With fluoxetine, wait at least 2 weeks between steps. Longer is better, less likely to cause trouble. For some people even monthly is too fast.)
The Process
Remember, the goal is to go down and then off your antidepressant without any problems. Therefore for most people I recommend taking the smallest possible first step. If that goes well, with no problems, great. Your confidence will increase that tapering can go smoothly. If you were already confident, no problem: take a bigger step down next time, and maybe even bigger the next time.
But if you sense any “wobble”, any problem at all after that first step, your next move is clear. Don’t take another step down until you’ve recovered (you’re back to how you were doing before you started down). Then wait at least a week before taking another step down (if fluoxetine, wait longer, because all its changes are slooooow).
If the “wobble” was really rough, then you need to go down by smaller steps. Either quarter your pills or get a prescription for a liquid version.
Doing this, some people discover that even tiny steps down cause significant withdrawal problems. If you can tough it out, those symptoms should gradually decrease over a week or so. The longer you wait before taking another step, the less severe will be the problems the next time. Some people have to wait a month or more in between steps. And for a few people, they’ll need to try again to make then next step down even smaller.
Smallest available doses for common antidepressants
Antidepressant | Smallest size (mg) | Liquid available? |
bupropion XL | 100 | *(no) |
bupropion SR | 100 | *(no) |
fluoxetine | 10 | yes |
sertraline | 25 | yes |
citalopram | 10 | yes |
escitalopram | 5 | yes |
venlafaxine XR | 37.5 | no |
desvenlafaxine | 25 | no |
duloxetine | 20 | no |
Worst case: 10% of your current dose, per month
This means 10% of your dose at the time you’re ready to take a next step, not 10% of your starting dose. So the steps get smaller as you go, and really small near the end. For months.
This is the method recommended by a very large group of people who’ve had terrible withdrawal: survivingantidepressants.org. The process takes over two years, which at first sounds ridiculous. But the site’s founder points out: “The 10% method protects everyone. You have the option of tapering faster if you can tolerate it.“
I’ve described the 10% method and given an example on a separate page because it’s a little hard to believe some people actually have to do this. They do.