There are various reasons you might want to stop taking a drug you have been prescribed. For example, you might think that the original problem has gone away, or you might be worried about dependence, or you might be experiencing unwanted side-effects.

But remember that a lot of people are helped by these drugs. Antidepressants, as we have seen, are used over a matter of months rather than weeks, and may be required for even longer periods. If you're using an antidepressant, don't feel under pressure to stop taking it prematurely.

The side-effects for different drugs vary very widely, and different people react to different drugs in different ways, so if you're experiencing unwanted side-effects, talk to your doctor. Depending on the drug, there may be various options in these circumstances, including varying the dose, changing to another drug, and opting for a form of treatment that doesn't involve drugs.

Various antidepressants not only have different side-effects, but the factors involved in discontinuing them are different. Moreover, within these classes of drugs, some individual medications are associated with more problems than others. However, despite all the differences, there are some useful guidelines that apply to the discontinuation of all these drugs.

The experience can be strongly influenced by:

• whether or not you know what to expect, so you don't get surprises
• the speed at which you do it: the advice is generally to come off these drugs slowly, allowing the mind and body to adjust. Talk to your doctor about the right length of time for your circumstances and the particular drug you're taking
• the amount of support and help you get from others (including your doctor)
• whether or not the underlying problem has gone away.

Four main things might happen:

• nothing at all – many people stop taking these drugs without any problems at all
• a short period of re-adjustment whilst the brain and body adapts. For example, you might find that your sleep patterns are a little disturbed and that there is some fluctuation in your mood and levels of depression or anxiety. These symptoms are lot less worrying if you're prepared for them.
• in a minority or people, more severe, unpredictable or prolonged symptoms. These can seem quite scary, though again they will be less so if you know they are a possibility in advance. With antidepressants, such symptoms include stomach problems, disturbed sleep and nightmares, anxiety and irritability, dizziness, numbness and other unusual sensations. If you experience such symptoms, talk to your doctor.
• the re-emergence of the problem for which the drug was prescribed in the first place.

Bear in mind that sometimes symptoms caused by stopping taking a drug can be mistaken for the symptoms of the original problem. If you haven't been told about ways of managing possible symptoms of antidepressant discontinuation, you might be tempted to go straight back on to the drug and so get stuck in a vicious circle. So, again, you need to discuss these problems with your doctor, both in advance and when they occur.

Who might have a harder time coming off these drugs?

• people who aren't getting much support from their doctor, or family and friends, or other sources
• people who are by nature more anxious or have a tendency to rely on support from prescription drugs or other drugs, including alcohol
• people who have been on doses that are higher than average and for longer than is normal
• people who believe that their underlying problem was cured by the drug, as opposed to the drug being used to manage the problem
• people who choose the wrong time to try and stop the medication: ideally it should be done at a quiet, non-stressful time.

What is being done to address these problems generally?

• Doctors now have guidelines for how to prescribe these drugs and inform their patients better about the risks.
• Treatment guidelines also stress the importance of looking for ways to treat problems without using drugs.
• The organizations that regulate the prescribing of these drugs, for example the government and your local health authority, have initiatives to check that doctors are not over-prescribing. (The number of prescriptions for benzodiazepines has gone down dramatically over the last few decades. On the other hand, the prescription of antidepressants has risen a lot.
• The pharmaceutical companies are trying to find drugs that don't cause these problems.

What can you do about them specifically?

• If you are on an antidepressant and you're worried that you've been taking it for too long or you want to stop taking it for other reasons, talk to your doctor about whether it's appropriate for you to stop taking the drug – and if it is, about how to do so safely and when you should start.
• Never stop an antidepressant drug suddenly (especially from a high dose) without talking to your doctor first. Generally you should come off these drugs by gradually reducing the dose.
• Educate yourself.
• Seek the support you need – from your doctor, from your family and friends, and from self-help groups.

next: Antidepressant Discontinuation Syndrome

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Reviewed: 01/2006