Discontinuing Antidepressants – what you need to know
Are antidepressants addictive?
Antidepressants do not cause an addiction as with opioid drugs (such as heroin), barbiturates, amphetamines (speed), alcohol and nicotine. This means that taking your medicine regularly should not cause tolerance or craving.
• Tolerance: This occurs when the body gets used to the drug or medicine when it is taken regularly, so that you need to take higher doses to have the same effect.
• Craving: This is a physical urge, where the body needs the drug or medicine to maintain a desired state or feeling such as euphoria (feeling high), or to avoid an unwanted one such as delirium tremens (the shakes). It can also have a psychological element to it.
What are discontinuation symptoms?
Antidepressants can sometimes cause symptoms called ‘discontinuation’ symptoms. These may happen if the dose is reduced, if you miss a dose or if you suddenly stop taking the medicine. At least one in every three people may get these symptoms.
Symptoms are usually mild and should go away after a few days, but occasionally can be more severe. Symptoms may take up to five days to occur and may last for up to two weeks. Be careful not to confuse discontinuation/withdrawal symptoms with the side effects of any new antidepressants prescribed. The following table lists some of the main discontinuation/withdrawal symptoms:
|Antidepressants||Withdrawal / discontinuation effects|
|All antidepressants||‘Flu-like’ symptoms (chills, muscle aches, sweating, headache, nausea), trouble sleeping and excessive dreaming.|
(For example amitriptyline, dosulepin (dothiepin), imipramine, clomipramine)
|Excessive production of saliva, runny nose, diarrhoea, abdominal cramping.|
|Venlafaxine and SSRIs
(For example sertraline, citalopram, fluoxetine, paroxetine, fluvoxamine)
|Dizziness, electric shock-like sensations, irritability, crying spells.|
How do I avoid discontinuation symptoms?
Your antidepressant should be taken as prescribed, and should only be discontinued after discussing with your doctor. Antidepressants should not be stopped suddenly. They should be discontinued gradually, generally by reducing the dose over a four-week period until they have stopped completely. Your doctor or pharmacist will advise you on how to do this for the medicine that you are taking.
Some people still experience discontinuation symptoms despite stopping the antidepressant slowly. If you think that you are experiencing troubling symptoms, discuss this with your doctor, as you may need to decrease more slowly, or in smaller steps.
Please refer to the manufacturer’s patient information leaflet that comes with your medicine for more information and the full list of side effects and precautions. If you have any questions or concerns about your medicines, or if you are worried about anything you think might be a side effect, ask your doctor, pharmacist or nurse.
This leaflet gives you some information about this medicine. It does not replace the expertise or judgement of a doctor, pharmacist or other healthcare professional. It is not a manufacturer’s patient information leaflet and is not to be taken as a substitute for, or an endorsement of, the manufacturer’s information or advice in respect of any medicine referred to in this leaflet. You might find more information in other leaflets or books, or on the internet but remember, the internet is not always accurate.
Whilst every care has been taken in the compilation of this leaflet, CNWL is not responsible for any loss or damage howsoever caused as a result of any inaccuracy or error contained in this leaflet, including (for the avoidance of doubt) in relation to breach of contract, misrepresentation or negligence whether of CNWL or any other person; but nothing in this leaflet shall exclude or restrict liability for death or personal injury resulting from negligence.
The information given in this leaflet is current as at the publication date.
This leaflet has been written by Central and North West London Mental Health NHS Trust Pharmacy Department, 30 Eastbourne Terrace, London W2 6LA www.cnwl.org – Publication Date: May 2007
A previous article entitled Tricyclic Antidepresants provides information... agitation, amitryptyline ve Blurred vision
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