One of the most important aspects of taking antidepressants is when and how to eventually come off them. Dr Lesley Hickin investigates

Deciding when and how to stop taking your antidepressant medication is an important step. You should always discuss this with your doctor and together decide whether it is the right time to stop. It is also important to keep in touch with your doctor during the time while you are coming off your medication to deal with problems that arise.

Usually these drugs should be slowly reduced in dose, since all antidepressants have the potential to cause withdrawal reactions. This is not a new finding, and has been recognized since these drugs were first introduced. Many doctors remain unaware of these and much more research is necessary into the causes.

If you have been on an antidepressant continually for six weeks or more (some writers on the subject say more than four weeks), you should not stop treatment abruptly unless there are special circumstances. The exception to this is fluoxetine at 20mg a day, because it remains in the bloodstream for such a long time anyway it performs its own gradual reduction in blood levels. If you prefer (and this is what the advice is in the pack information leaflet), the best thing to do with fluoxetine is to gradually space out the doses from once daily to once every two days and so on. With antidepressants that have a shorter time in your bloodstream (doctors call it the half-life of a drug), the best thing is to reduce the daily dose every one to two weeks.

Withdrawal symptoms
Antidepressants are not usually thought of as drugs of addiction in the way that cocaine, heroin, morphine and nicotine can be. When you stop taking antidepressants you will not suffer from 'cold turkey' in the way that opiate addicts do. However, it is common to get some symptoms if you stop an antidepressant abruptly, and these withdrawal symptoms are known as antidepressant discontinuation syndrome.

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Reviewed: 01/2006