How Do I Stop My Antidepressant?

You’re pregnant, and you’re thrilled. But then you remember you’re taking Effexor for your depression. Well, not anymore…

I’m receiving an abundance of emails from readers who want to stop taking their antidepressant(s). Some use them for depression. Others take them for anxiety. And some use them for irritable bowel syndrome, chronic pain, menopausal symptoms, and more.

I’ve written an article on antidepressant discontinuation syndrome (ADS) (click here), as well as a need-to-know series on antidepressants (click here).

Given the influx of emails I’ve received, I’m going to provide yet more information. Let’s get it done in two-parts, okay?

The Rules

I am not a physician, and I’m providing objective information for general purposes. If you’re thinking about stopping your antidepressant, you need to discuss it with your doc. Do not go cold-turkey! Believe me, you won’t be happy with the outcome. In fact, it could be dangerous to your health.

Be sure to read the articles I mentioned above.

Elimination Half-Life

In any discussion of discontinuing an antidepressant, it’s important to understand elimination half-life (EHL).  Simply, it’s the time it takes for a drug’s plasma concentration to reach half of its original level. This occurs through our functions of metabolism and elimination.

Here are the average EHLs of some popular antidepressants…

  • desvenlafaxine extended-release (Pristiq) serontonin-norepinephrine reuptake inhibitor (SNRI) 11 hours
  • duloxetine (Cymbalta)  SNRI 12 hours
  • phenelzine (Nardil) monoamine oxidase inhibitor (MAOI)  12 hours
  • paroxetine (Paxil) selective serotonin reuptake inhibitor (SSRI) 21 hours
  • bupropion (Wellbutrin, Zyban) norepinephrine-dopamine reuptake inhibitor (NDRI) 21 hours
  • sertraline (Zoloft) SSRI 26 hours
  • citalopram (Celexa)  SSRI 35 hours
  • amitriptyline (Elavil) tricyclic antidepressant (TCA) 36 hours
  • fluoxetine (Prozac) SSRI 8 days

Here’s a question for you. Let’s say Lisa suddenly stopped taking her Paxil (EHL: 21 hours). And Jack suddenly stopped his Prozac (EHL: 8 days). Who’s going to feel the effects of cessation first? That’s right – Lisa!

Now, that doesn’t mean she’s going to start feeling the effects of cessation at 21 hours and one minute. For example, I take sertraline (Zoloft). If I run out and forget to get a refill, and can’t catch my doc over a weekend, I begin feeling it sometime during the third day.

Discontinuation Strategies & Techniques

The most common method of discontinuation is intentional or unintentional cold-turkey.  But that sure isn’t the way to go. So – next in line is slowly reducing a dosage (tapering) over several weeks – maybe months. This method doesn’t guarantee an absence of symptoms; however, it makes cessation a lot more comfortable – and less potentially dangerous.

It’s typically accomplished by breaking tablets into parts or using a graduated oral syringe with the liquid form. And, yes, many antidepressants come in a liquid.

And then there are compounding pharmacies. It’s where a pharmacist will mix drugs to fit a patient’s unique needs. In this case, the pharmacist can take your prescription and divide it into smaller graduated doses. Don’t know where to find one? Ask your physician or click here to check-out the website of the International Academy of Compounding Pharmacists.

Here’s another technique used by physicians. Let’s say our Lisa wanted to stop taking her Paxil and she went to her physician for help. She knew from past experience that going cold-turkey wasn’t a happening thing.

Her physician may suggest she stop the Paxil right now, and begin taking Prozac. Again, take a look at our EHL roster above. Prozac’s much longer EHL will very likely provide an easier discontinuation experience for Lisa.

Should symptoms of discontinuation become a major problem, there’s always the option of taking meds to manage the symptoms. For example, let’s say insomnia became an issue. Your physician could prescribe a sleep med or suggest melatonin. Of course, you may decide getting involved with yet another med isn’t such a hot idea.

As a last resort, you can go back to your original dosage until other discontinuation strategies can be designed and implemented.

Finally, here’s kind of a rule-of-thumb number. It’s not uncommon for those enduring a tough discontinuation experience to have their doses tapered by some 5% per week. For some, that can become a month or longer.

Until Tomorrow

Okay, let’s call it a wrap on today’s piece. Be sure to come tomorrow because we’re going to get into more detail regarding discontinuation techniques – and stories. And we’ll discuss the reality of antidepressant discontinuation syndrome in newborns.

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