“Addiction” is a loaded word.
It comes with a lot of emotional baggage.
Because SSRI antidepressant medications typically do not produce a “high” that can be abused recreationally and because they do not produce “cravings” like coffee, sugar, alcohol or opium, they are widely assumed to be non-addicting.
People typically don’t steal from their grandmother’s medicine cabinet, rob the corner gas station, or murder to get more SSRI antidepressant medications.
To further obscure their addictive nature, the symptoms of SSRI antidepressant withdrawal syndrome (a.k.a. “discontinuation syndrome”) are frequently mistakenly misunderstood as a return or relapse of the underlying disorder that is being treated.
Whether or not they are worthy of being labeled “addictive” remains disputed. One thing we do know is that when users of SSRI antidepressant medications stop using them bad things often happen.
Symptoms regularly occur that were not there before the drugs were started.
In addition, symptoms that were already there before medication treatment may rebound with greater intensity than ever.
If the drugs are reinstated these new symptoms quickly disappear again, whereas, there is usually a time lag before an underlying depression either returns or responds to renewed treatment.
Some scientists call these withdrawal phenomenon “addiction,” while others do not.
Which side of the argument they fall on may depend on their loyalties and on paycheck bias.
Question: What is the difference between SSRI antidepressant withdrawal syndrome and depression relapse?
Answer: Withdrawal syndrome presents new or more intense symptoms than you had before you started taking the antidepressant medications, whereas relapse is a slow return to the same symptoms you had before you took the drug.
Experiencing symptoms of withdrawal syndrome indicates that you may have become dependent on or addicted to the drug.
They indicate that the drug has changed your body’s makeup.
Why you need to know
If and when you decide to quit your antidepressant medications, you may experience unusual or severe symptoms.
It is important to understand that these symptoms are not necessarily a return of your original depression.
If you are automatically or reflexively advised to restart and stay on your medications, you may need to find a medical doctor who understands SSRI antidepressant withdrawal syndrome and who can help you with a controlled medication taper.
In spite of what is believed by many, you may not need to resign yourself to a life-sentence of increasing doses, add-on drugs, and unsavory side effects.
But don’t take my word for it
Always seek the advice of a qualified and supportive medical doctor who is experienced with withdrawal syndrome before making any changes in your medications.
For a professional review and discussion of this topic follow the links provided in this article.
I am not a doctor or a trained mental health professional. My comments are my opinions and should not be considered as advice.
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SSRI antidepressant withdrawal syndrome definition
This definition is derived from several sources, but primarily from new guidelines set forth by Chouinard & Chouinard in 2015 (see link below).
SSRI antidepressant withdrawal syndrome is a constellation of two or more symptoms experienced when quitting an antidepressant medication. These include:
- new symptoms that are known to be associated with discontinuing this particular class of medication
- symptoms that were not present prior to starting the medication
- symptoms that are not due to another medical condition, mental disorder, or substance abuse
Withdrawal symptoms can occur as psychological or physical symptoms and can be further divided into three sub-groups:
- minor and major new symptoms
- rebound symptoms (symptoms of the original illness that return rapidly and with greater intensity)
- persistent post-withdrawal symptoms that last for several months to years (i.e. anxiety disorders, delayed-onset insomnia, delayed-onset movement disorders, major depression or bipolar disorder)
For a more detailed discussion see New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal, Chouinard & Chouinard, 2015, (also linked below).
Relapse symptoms definition
Relapse (recurrent) symptoms happen gradually as the effect of the medication dissipates. They are a return of the original symptoms of the underlying condition that was being treated.
They typically do not return suddenly and are not of significantly increased intensity.
SSRI antidepressant withdrawal syndrome versus “discontinuation syndrome”
SSRI antidepressant withdrawal syndrome is sometimes given the more innocuous sounding label of “discontinuation syndrome.”
This seems to suggest that there is no substance dependence with SSRI antidepressants.
However, studies and analysis show that the symptoms are very similar to those experienced when discontinuing addictive drugs like benzodiazepines, barbiturates, and other psychotropics; see:
- Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review, Fava et al, 2015
- New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal, Chouinard & Chouinard, 2015
- What is the difference between dependence and withdrawal reactions? A comparison of benzodiazepines and selective serotonin reuptake inhibitors, Margrethe Nielsen, Ebba Hansen, Peter C. Gøtzsche, 2011
The “discontinuation syndrome” labeling seems to suggest that these symptoms are relatively benign discomforts that will go away in a few days or weeks.
That may be the case in many instances, but for about half of the people who discontinue them, the reality of quitting antidepressants can be severe; see Discontinuing Psychiatric Medications: A Survey of Long-Term Users, Laysha Ostrow, Ph.D., M.P.P., Lauren Jessell, L.M.S.W., Manton Hurd, M.S.N., P.M.H.N.P., Sabrina M. Darrow, Ph.D., David Cohen, Ph.D., M.S.W., 2017
This internal drug company document (see section 3) states clearly that the term ‘withdrawal syndrome’ was to be avoided as it implied dependence.
Symptoms of SSRI antidepressant withdrawal syndrome
We have become so habituated to the lists of side effects that accompany drug advertisements that our eyes glaze over. It is important to remember, however, that these side effects can range from minor nuisances to catastrophic, life-disrupting events (warning, this link is disturbing).
Some may be mild and transient, lasting only a little while, while others may be severe and take years to go away.
We are told we need to weigh these legitimate fears about “what might happen” against the benefits of taking the “miracle” drugs. When we are severely depressed and feeling suicidal this seems to make sense. The drugs can sometimes set us back on our feet in a few short weeks.
They may “save our life,” however, what’s often left out of that equation is that if we are willing and able to change our lifestyle, including diet, exercise, and sometimes — situation — the need for the risky and unhealthy drugs can be greatly reduced or eliminated (in most cases).
Below is a partial list, in layman’s terms, of the withdrawal symptoms associated with quitting SSRI antidepressant medications.
- rapid heartbeat/breathing difficulties
- trouble concentrating/confusion/memory problems
- vivid dreams/nightmares/trouble sleeping
- lack of energy/excessive sleep
- hyperarousal/hypersensitivity (sexual)
- poor balance/dizziness/lightheadedness
- loss of muscle control
- visual changes/ringing ears/changes in taste perception
- shock-like sensations/brain zaps
- tingling/prickling/pins and needles
- itching/skin crawling sensations
- chills/excessive sweating/hot, red skin
- muscle pain/nerve pain
- neurological symptoms like tremors/spasms/facial numbness
- restless legs, movement disorders
- diarrhea/abdominal pain/nausea/vomiting
- loss of appetite
- hallucinations/visual disturbances/hearing things
- agitation/ panic/ anxiety
- increase in suicidal thoughts
- feeling detached
- crying spells/mood swings/increased depression
For an authoritative list of signs and symptoms of SSRI antidepressant withdrawal see Table 1, of Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review, Fava et al, 2015
Did You Know?
There it helps regulate the speed at which food passes through our digestive tract and may send signals of nausea when things aren’t going well.
Serotonin helps our bodies clot blood and may help regulate bone density and sexual function. It likely serves many other purposes not yet well defined by scientific inquiry.
Attempting to regulate serotonin levels in the brain with selective serotonin reuptake inhibitors (SSRI) is a bit of a scatter-gun approach. It is one reason why SSRIs have so many unintended side effects and why we experience SSRI antidepressant withdrawal syndrome.
Tapering off compared to quitting abruptly
Gradually tapering off the medications can reduce the incidence or severity of withdrawal symptoms in some cases.
One study showed no advantage in a 14-day taper over a 3-day taper. However, a 14-day taper is still a very short taper and studies like this should not preclude the advantages of a long taper: see The effect of rate of antidepressant tapering on the incidence of discontinuation symptoms: a randomized study, Tint A, Haddad PM, Anderson IM, 2009
My only successful taper lasted 20-months! It was preceded by lifestyle changes including exercise and diet.
Some medication tapers last several years.
Chouinard & Chouinard recommended gradual tapering over a long period of time to help control the severity of withdrawal symptoms. However, they also indicate that it may be that tapering has no effect on preventing persistent post-withdrawal disorders: see New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal, Chouinard & Chouinard, 2015
Another study also showed that withdrawal symptoms were reduced by tapering off medications versus quitting abruptly: see Discontinuation symptoms in users of selective serotonin reuptake inhibitors in clinical practice: tapering versus abrupt discontinuation, van Geffen EC, Hugtenburg JG, Heerdink ER, van Hulten RP, Egberts AC., 2005
Chouinard & Chouinard‘s study says fluoxetine is easier to taper off than paroxetine; paroxetine is the most troublesome SSRI in several regards and they recommend it should “not be given before exploring other treatment alternatives.”
Before beginning a regimen of SSRI antidepressants, and before discontinuing them, be sure to ask if your doctor is experienced with antidepressant medication tapers to help prevent withdrawal syndrome.
I have no affiliation with the academic reference articles linked from this page. No endorsement from either the authors or publishers is implied. I am grateful to them for allowing access to this copyrighted material on the internet.
You have a right to know
Antidepressants may be necessary to save your life (or mine) just as a war may be necessary to protect ourselves from a hostile enemy.
But, as a patient, you have the right to know what SSRI medications might do to you. You have a right to know that they might fundamentally change the way your body works.
More importantly, we all have a right to know that a rapid and intense onset of symptoms following discontinuation of SSRI antidepressants is an indication of addiction or dependence — not a relapse of our depression.
This addiction or dependence can often be overcome by starting a long medication taper.
Being on antidepressant medications for the rest of our lives is not a good idea. Medications should not be continued unnecessarily simply to keep the symptoms of withdrawal in check.
Our bodies and brains often have a wonderful ability to heal when given the right support and enough time.
Don’t let the misunderstood symptoms of SSRI antidepressant withdrawal syndrome dictate a life-sentence of drug addiction and dependence!
Talk to a supportive and understanding medical doctor who understands withdrawal.
Please share this important information
Getting off SSRI antidepressant medications is a personal decision people have to make with their doctors.
Unfortunately, many people have tried getting off their medications only to be beset by SSRI antidepressant withdrawal syndrome.
This can be a traumatic and debilitating experience that dashes people’s hope of recovery without medications.
Frequently, they are left feeling that they are badly broken and that they must have the medications to survive.
The medications may take on the importance of a savior. Questioning or threatening their “savior” can feel like a personal attack.
The possibility that they may actually have experienced the symptoms of addiction and withdrawal, which can be overcome by a long, slow, taper off the medications, is rarely known or spoken.
Hopefully, that will change.
But change comes very slowly when it lacks the financial incentive of an established industry.
If you know anyone who may be needing this information to help them get off their medications please share it with them with love, understanding, and patience.
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This knowledge could dramatically improve someone’s life!
It has helped me personally to get off antidepressant medications and to overcome SSRI antidepressant withdrawal syndrome. I have been free from antidepressant medications for 9-months at the time of writing this article.
Whenever I questioned my prescribing psychiatrist about the dire-sounding information on the package inserts that came along with my medications, the answers I got were usually along the lines of they have to say that to protect themselves from lawsuits; that’s a worst-case scenario; or I prescribe them every day and I’ve never had a problem with that!
When our country goes to war there is always much discussion about an exit plan. We understand that war is costly. We don’t want to stay in it for the long haul.
Taking antidepressant medications is also costly — to our health — and to our pocketbooks!
My medications for depression were costing me $3, 833 per month at the time I began discontinuing them!
When I was put on antidepressant medications for depression or was being tried on new medications, my question for the psychiatrist was often, “How long might I need to be on them?”
In the beginning, the answer was something like, check back in a month and we’ll see how you are doing; or, we’ll reevaluate after 90-days.
30-years later the answer was …. maybe…. for the rest of your life.
On a number of occasions, I tried to quit my antidepressants.
Whenever I did I would be besieged by intolerable symptoms.
The psychiatrists or their nurses would indicate that this was a return of my depression — you need to restart your medications right away!
I was never told that I may have become dependent or addicted and that I was experiencing SSRI antidepressant withdrawal syndrome.
In fact, I was told the drugs are not addicting!
Antidepressant medications appear to serve a purpose
These medications may have saved my life.
SSRI antidepressant medications certainly gave me a better quality of life — for a while.
I didn’t know then that there are healthy and effective alternatives.
However, the more I have learned of how the medications disrupt the natural order of things in our minds and bodies — beyond what we can begin to fully understand — the less certain I am that I would ever start them again under any circumstances; certainly, not until I have exhausted every natural remedy.
(I momentarily questioned, and then dismissed this recently during a brief relapse into depression.)
Declaring war on depression
Starting on antidepressant medications in the first place looks a lot like going to war. It’s easy to get into but can be very difficult to get out of. It’s a trap. And it’s costly.
Think of what might have been if our country could have spent all the money we’ve spent on going to war on creating opportunity and trust in the world. And, in my own case, what might have been if the $3,833 per month I spent on medications (mostly as health insurance premiums) had been invested in healthy, wholesome, food, water, air, exercise, and lifetime-opportunities.
Now think of the millions-and-millions of people who are prescribed SSRI antidepressant medications and other psychotropic drugs — and believe them to be a life sentence.
It’s a costly way to fight unhealthy lifestyles.
Think of the possibilities!
We’ve been treating the symptoms of unhealthy living (like depression) with medications that further compromise our health, create more symptoms, more treatments, and more costs.
30-months ago, after 30-years on antidepressant medications, (medications that were no longer working) I began a new journey.
I determined to get off the medication train.
All-be-it, on a much smaller budget than $3,833 per month, I am now investing my resources in healthy living.
I am investing my resources in overcoming my depression without medications.
Admittedly, it is a personal and social experiment. Like all experiments, it has an uncertain ending.
I invite you to join me on this journey by subscribing to my blog.
Subscribing is free, confidential, and without obligation and it will help propel me on my way.
More importantly, I am hopeful it will help propel you or someone you love on your journey to overcoming depression without medications.
(You can easily unsubscribe at any time if you change your mind.)
I can’t stress enough that attempting to discontinue antidepressants abruptly and without first addressing the causes of your depression is unlikely to be successful and could lead to serious debilitating or life-threatening consequences.
I tried it and it didn’t work.
Always seek the guidance of a prescribing physician experienced with SSRI antidepressant medication withdrawal.
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