Stopping antidepressants: how to taper safely

When depression is in remission and the recommended length of treatment has passed. Antidepressants are usually continued for at least six months after symptoms have gone, with regular review by the doctor; in severe or recurrent illness, longer treatment may be appropriate.^1,2 Other legitimate reasons to consider stopping are side effects, lack of benefit or simply wanting to come off medication.²

The decision is shared. The benefit of continuing, which lowers the risk of relapse, is weighed against the risks of long-term use, such as persistent side effects or difficulty stopping.¹ The risk of relapse is higher after repeated episodes, especially within the last two years, an incomplete response or residual symptoms, severe depression, other physical or mental health problems, or ongoing sources of stress.¹ The Depression page summarises treatment as a whole. When depression does not respond to several antidepressants, the next options, such as ketamine therapy and esketamine, are described in treatment-resistant depression.

Because stopping abruptly, missing doses or taking incomplete doses can cause discontinuation symptoms, also called withdrawal symptoms.¹ Over time, the brain and body adapt to the medicine; when it is withdrawn quickly, they need time to readjust.² Stopping suddenly may also increase the chance of becoming unwell again.²

The most commonly described symptoms are:¹

• dizziness, vertigo or unsteadiness;
• altered sensations, such as brief “electric shocks”;
• irritability, anxiety, low mood, tearfulness or panic attacks;
• restlessness or agitation and problems sleeping;
• sweating, nausea, palpitations, tiredness, headaches and aches in muscles or joints.

Very rarely, suicidal thoughts may occur; if so, contact the doctor straight away.^1,2

Having symptoms on stopping is not addiction. There is no craving and no search for a pleasant effect; it is physical dependence, the body’s adaptation to the medicine.²

Estimates vary with study methods. A 2024 meta-analysis of 79 studies and more than 21,000 people found at least one discontinuation symptom in 31% of people stopping an antidepressant and in 17% of those stopping a placebo. Allowing for these non-specific effects, the authors estimate that about 15% of people, one in six or seven, have symptoms attributable to the antidepressant; severe symptoms occurred in about 3%.⁵ Results varied widely between studies, and the authors note that some symptoms may reflect the return of the underlying illness.⁵

A 2019 systematic review, including studies with very diverse methods, found higher figures, from 27% to 86%, with a weighted average of 56%, and concluded that a proportion of people have symptoms for more than two weeks.⁴ The Royal College of Psychiatrists states that between a third and a half of people who take an antidepressant will have these symptoms to some extent.²

As for duration, symptoms are often mild, appear within a few days of reducing or stopping and usually resolve within one to two weeks; sometimes they last longer, several weeks and occasionally several months, and they can be severe, particularly if the medicine is stopped suddenly.¹

Three clues help, and the doctor can help interpret them:^1,2

• When they start. Withdrawal symptoms usually begin a few days after reducing or stopping, sometimes after a single missed dose. Relapse tends to appear later, after weeks or months. With slowly eliminated medicines such as fluoxetine, symptoms may start later, which makes the distinction harder.
• What kind of symptoms. Dizziness, “electric shocks” or sensations never felt before point to withdrawal. Many people say: “this doesn’t feel like my depression”.
• How they respond to restarting. Withdrawal symptoms improve within days, or even hours, of restarting the antidepressant; improvement in relapse takes weeks.

Withdrawal symptoms are common and do not mean that depression has returned.¹ During tapering, the doctor monitors for both.¹

In stages, at a pace agreed with the doctor and led by the person taking the medicine.¹ NICE guidance recommends:¹

• reducing the dose gradually to zero, in several steps;
• making smaller reductions as the dose gets lower, that is, going more slowly towards the end;
• moving to the next step only when symptoms from the previous one have resolved or are tolerable;
• taking into account the medicine, the length of treatment and how quickly it leaves the body;
• accepting that the process may take weeks or months.

There is no one-size-fits-all plan. Someone who took an antidepressant for a short time may need only a few steps; after months or years of treatment, or after symptoms in earlier attempts, a slower taper usually helps.² A 2019 analysis based on brain imaging proposed progressively smaller and slower reductions than those traditionally used.³ Skipping doses on alternate days is not a good way to taper, because it makes the amount of medicine in the body fluctuate.²

The specific plan, formulations and intervals between steps are set in consultation; this page does not replace that advice.

It is not yet possible to predict who will have more severe symptoms, but some factors raise the risk:^1,2,5

• stopping suddenly or reducing quickly;
• long treatment, especially at high doses;
• medicines that leave the body quickly; paroxetine and venlafaxine are more often associated with these symptoms;
• withdrawal symptoms in previous attempts.

Even so, having had symptoms before does not prevent stopping: it usually means the taper should be slower.²

It depends on how intense they are:¹

• Mild symptoms: these are common and usually pass; they are monitored, and the doctor should be contacted if they do not improve or get worse.
• More severe symptoms: the doctor may suggest going back to the previous dose and, once symptoms have resolved, resuming the taper more slowly with smaller steps.

Even after restarting the previous dose, symptoms may take a few days to go.¹ Changing the dose on your own without speaking to the prescriber is not advisable. Suicidal thoughts during tapering, whether a withdrawal symptom or a sign of relapse, need immediate contact with the doctor or emergency services.²

Continuing an antidepressant after remission lowers the risk of relapse. In a review of 31 trials, 41% of people switched to placebo relapsed, compared with 18% of those who stayed on the antidepressant.⁶ In a 2021 primary care trial of people who felt well and had had several episodes or long treatment, relapse within a year was 56% with discontinuation and 39% with maintenance.⁷ These figures do not make maintenance compulsory; they help decide case by case.

For people at higher risk of relapse who decide to stop, NICE suggests group cognitive behavioural therapy or mindfulness-based cognitive therapy focused on relapse prevention as an alternative.¹ It also helps to have a plan with personal warning signs, such as anxiety or poorer sleep, foreseeable stressful situations and what to do if they arise, and to seek help early if symptoms return or residual symptoms get worse.¹ People who decide not to continue medication should be given advice on how to stop, rather than stopping on their own.¹

Assessment and follow-up take place in a psychiatric consultation, in person in Lisbon or by online consultation, in Portuguese, English or Spanish.