Withdrawal Symptoms from Antidepressants: A Patient's Guide

Q: Withdrawal Symptoms from Antidepressants: A Patient's Guide

Hello OO： Thank you for your hard work! I can imagine how uncomfortable it must be to experience these symptoms. <br>It seems that your symptoms are indeed related to the discontinuation of the antidepressant. <br>Most antidepressants can cause varying degrees of withdrawal sympt

Medication Consultation: Antidepressant Withdrawal Symptoms

Hello,
I have been taking Escitalopram (10mg) daily for a year due to autonomic nervous system dysfunction.
At the beginning of last month, my doctor determined that I could reduce the dosage to half a tablet (5mg) daily.
I have been on this dosage for about six weeks without any discomfort.
After my follow-up appointment, the doctor said I could stop the medication entirely.
However, since stopping the medication last Friday, I have experienced daily symptoms including headaches, dizziness, shortness of breath, a sensation of pressure in my chest, gastrointestinal discomfort, elevated eye pressure, and occasional difficulty focusing with my eyes.
The dizziness and headaches are particularly severe; I feel dizzy and lightheaded upon waking up, similar to motion sickness, and the symptoms worsen with eye movement or body movement.
There is a persistent feeling of tightness and dull pain in my head, which also causes discomfort in my eyes.
The severity of these symptoms is greater than before treatment, and they have not shown any signs of alleviation.

I have consulted my doctor, who suggested that these might be withdrawal symptoms and advised me to endure and observe.
If the discomfort becomes intolerable, I can resume taking the medication, even if it's just every two to three days.
However, since the advice was somewhat vague, I would like to seek further recommendations:
1.
Why did I not experience any discomfort when reducing from 10mg to 5mg, but began to have multiple symptoms when stopping completely? How can I determine if this is withdrawal?
2.
How long should I observe these symptoms before deciding whether to resume medication and taper off slowly? If I reduce the dosage more gradually, will I still experience these symptoms after stopping?
3.
The doctor mentioned that withdrawal symptoms would gradually lessen, but so far, there has been no trend of improvement; the symptoms fluctuate between severe and mild.
What does this indicate? Given that the severity of these symptoms has exceeded my pre-treatment experience and is interfering with my daily life, I hope to receive advice regarding medication management.
Thank you!

OO, 20~29 year old female. Ask Date: 2020/10/24

Dr. Lin Mianzhang reply Psychiatry

Hello OO: Thank you for your hard work! I can imagine how uncomfortable it must be to experience these symptoms.
It seems that your symptoms are indeed related to the discontinuation of the antidepressant.
Most antidepressants can cause varying degrees of withdrawal symptoms upon cessation, which may last from a few days to several weeks.

1.
After completely stopping the medication, the concentration of the drug in your body gradually decreases to zero.
However, while taking 5mg, there is still some medication present in your system, which means it is possible to be asymptomatic while on 5mg but to develop symptoms after discontinuation.
The simplest way to determine if these are withdrawal symptoms is to resume taking the medication; if they are indeed withdrawal symptoms, they should resolve upon restarting the medication.
2.
As I mentioned earlier, symptoms may persist for several weeks.
It is also possible that symptoms may reappear if you decide to stop the medication again later.
3.
In addition to withdrawal symptoms, it is also possible that your condition still requires a low dose of medication for treatment.
Therefore, when the medication is completely discontinued, the original symptoms of your condition may resurface, potentially mixing with withdrawal symptoms, leading to a situation that seems unmanageable.
If this is the case, I would recommend continuing the medication.
I suggest that if you feel extremely uncomfortable and unable to tolerate it after stopping the medication, you should resume taking it.
If you wish to discontinue the medication in the future, it would be advisable to incorporate some non-pharmacological methods to improve your original condition.
For example, psychotherapy, mindfulness therapy, aerobic exercise, avoiding caffeinated beverages, and maintaining a regular routine can make it easier to successfully discontinue medication later on.
Wishing you a speedy recovery!

Reply Date: 2020/10/24

More Info

Withdrawal symptoms from antidepressants can be a significant concern for patients who are tapering off their medication. In your case, it seems that you have been experiencing a range of symptoms after stopping the medication completely, which can indeed be indicative of withdrawal. Let’s address your questions and provide some guidance based on medical knowledge.

1. Why did I not experience withdrawal symptoms when reducing from 10mg to 5mg, but did when stopping completely?
The body can often tolerate gradual reductions in medication better than a complete cessation. When you reduced from 10mg to 5mg, your body likely adjusted to the lower dose without significant disruption. However, stopping the medication entirely can lead to withdrawal symptoms because your body has become accustomed to the presence of the drug. This phenomenon is not uncommon; different individuals can have varying sensitivities to changes in medication dosages. The symptoms you are experiencing, such as headaches, dizziness, and gastrointestinal discomfort, are classic signs of withdrawal, which can occur when the body reacts to the absence of a substance it has adapted to.

2. How long should I observe my symptoms before deciding to resume medication?
Withdrawal symptoms can vary widely in duration and intensity. Typically, they may last from a few days to several weeks, depending on the individual and the specific medication involved. It is essential to monitor your symptoms closely. If they persist or worsen, it may be prudent to consult your healthcare provider about resuming the medication, even if only temporarily, to stabilize your condition. A slower tapering schedule may also be beneficial. For instance, instead of stopping completely, you might consider taking a reduced dose (like 2.5mg if feasible) for a longer period before attempting to discontinue again. This approach can help mitigate withdrawal symptoms.

3. What if my symptoms do not show signs of improvement?
If your symptoms are severe and have not shown signs of improvement after a reasonable period (usually a week or two), it may indicate that your body is struggling to adjust to the absence of the medication. In such cases, it is advisable to return to your previous dosage or consult with your healthcare provider about alternative strategies. Your doctor may suggest a different tapering schedule or even a different medication that might be easier to discontinue in the future.

In addition to these considerations, it is crucial to maintain open communication with your healthcare provider. They can offer personalized advice based on your medical history and current symptoms. It may also be beneficial to explore non-pharmacological interventions, such as cognitive behavioral therapy (CBT), mindfulness practices, or other supportive therapies that can help manage withdrawal symptoms and improve your overall mental health.

Lastly, remember that withdrawal symptoms are a common experience for many individuals tapering off antidepressants, and they do not reflect a failure on your part. It is a process that requires patience and careful management. Seeking support from mental health professionals, support groups, or even friends and family can also provide additional coping strategies during this challenging time.

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