About one in seven Australians take antidepressants. Many people start these medications during a crisis, thinking they'll help for a short time and then be stopped. Most don't expect to take them for life.
Recommended Duration for Antidepressant Use
Clinical guidelines suggest taking antidepressants for six to 12 months for a single episode of moderate to severe depression. However, about half of the people taking these medications use them for longer than a year. When trying to stop, they may face unpleasant withdrawal symptoms, leading them to restart or continue the medication.
Withdrawal Symptoms and Statistics
A recent review in The Lancet found that around one in six people experience withdrawal symptoms when stopping antidepressants. These symptoms include dizziness, headache, nausea, insomnia, and irritability. This number might be low because many studies only included people who had been on antidepressants for a few months.
Severity of Withdrawal Symptoms
The review, which included 79 studies with 21,000 participants, found that 15% experienced withdrawal symptoms after stopping the medication. Around 3% experienced severe symptoms, such as suicidal thoughts. Again, these figures might be underestimated as they did not include long-term users.
Long-Term Use and Its Effects
Some people take antidepressants long-term, thinking they are preventing anxiety or depression. However, they might actually be preventing withdrawal symptoms. Long-term use (over 12 months) isn't without risks and can cause:
- Emotional numbness
- Sexual dysfunction, including low libido and difficulty achieving orgasm
- Weight gain
- Lethargy or fatigue
- Increased risk of falls in older people
Misinterpreting Withdrawal as Relapse
Both doctors and patients often mistake withdrawal symptoms for a relapse of anxiety or depression. This is because withdrawal symptoms, like nervousness, irritability, insomnia, and fatigue, are similar to symptoms of anxiety and depression. Withdrawal can also cause dizziness, brain zaps, imbalance, increased sensitivity to light or noise, tinnitus, nausea, diarrhea, muscle spasms, vivid dreams, tremors, confusion, and sweating.
How to Safely Stop Taking Antidepressants
Until recently, advice on stopping antidepressants safely was limited. Common suggestions included halving the dose or switching to a different antidepressant, which often led to withdrawal symptoms.
Now, brain imaging studies support a slow tapering of doses to minimize these symptoms. A method called "hyperbolic tapering" involves gradually decreasing the dose in smaller and smaller amounts, like this: 50mg, 25mg, 15mg, 10mg, 6mg, 4mg, 2mg, 1mg, and then stopping. This approach allows the brain to adjust steadily.
Current Recommendations and Support
Updated guidelines recommend hyperbolic tapering to safely stop antidepressants. The University of Queensland is testing this method in a trial. While mini-doses for tapering aren't widely available in Australia, they can be accessed through a compounding chemist or by diluting the medication under a doctor's guidance.
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