By Paula Connell

Updated November 07, 2019

Selective serotonin reuptake inhibitors (SSRIs) are a class of drug commonly used to treat depression. The drugs help normalize brain function in people with certain mood disorders by increasing the amount of serotonin in the brain. While beneficial, one of their downsides is that some people may experience a form of withdrawal called SSRI discontinuation syndrome when treatment is stopped.¹ This most commonly occurs when treatment is stopped abruptly and can manifest with symptoms that seem very much like the depression and anxiety SSRIs were being taken to treat.

People experiencing SSRI discontinuation syndrome often believe that they are having a "relapse" and request to be placed back on SSRIs.

Why It Occurs

Serotonin is a type of chemical, called a neurotransmitter, whose purpose is to deliver messages to and from brain cells. By doing so, the chemistry in the brain can be regulated in a way that typically improves depression or anxiety.

The assorted SSRI drugs used to treat mood disorders have similar mechanisms of action, but varying degrees of drug half-life.

Drug half-life is a term to describe how long an active drug molecule stays in the bloodstream before being expelled from the body.

If a drug has a short half-life, it will require frequent dosing to maintain the ideal concentration in the blood (and, therefore, the desired effect). If it has a long half-life, it will remain in a steady state for longer and be less prone to ups and downs.

Common SSRI medication used to treat depression include:

• Prozac (fluoxetine)
• Zoloft (sertraline)
• Paxil (paroxetine)
• Celexa (citalopram)
• Lexapro (escitalopram)

Of these, Prozac has a very long half-life and, when stopped, will gradually clear from the bloodstream.² The others, by contrast, have a short half-life and, when stopped, will drop off abruptly. When this happens, the person taking them may experience disconcerting or even profound symptoms of withdrawal.

Changes in the Brain

Drug half-life is only part of the reason for SSRI discontinuation syndrome symptoms. When used over a period of time, SSRIs can effect changes in the brain that result in alterations in serotonin receptors.³

When this happens, the brain will "down-regulate" the number of receptors in response to the increased volume of serotonin. It's a physiological balancing act meant to prevent the overstimulation of brain cells.

When treatment is eventually stopped, there will be fewer receptors than before and a short-term deficiency of serotonin activity. The body will typically correct this, but, until it does, a person may have to go through a period of adjustment until the system normalizes.

What People Experience

The most common symptoms of SSRI discontinuation syndrome are described as either being flu-like or feeling like a sudden return of anxiety or depression.¹ They include:

• Dizziness
• Vertigo
• Lightheadedness
• Difficulty walking
• Nausea/vomiting
• Fatigue
• Irritability
• Headaches
• Insomnia
• Diarrhea
• Chills
• Shock-like sensations
• Paresthesia (burning, prickly, or skin-crawling sensations)
• Visual disturbances
• Impaired concentration
• Vivid dreams
• Depersonalization (a detached, out-of-body experience)
• Suicidal thoughts
• Psychosis
• Catatonia (a state of unresponsiveness)
• Muscle pain (rare)

While these symptoms can be uncomfortable, they are rarely severe. Most people only experience mild to moderate forms of SSRI discontinuation syndrome.

Prevention

Around 20 percent of people on Paxil, Zoloft, Celexa, or Lexapro will experience some degree of withdrawal following termination of treatment, lasting anywhere from one to three weeks.⁴ For those who have been on SSRIs for many years, the symptoms may persist for longer.

To lower the risk of SSRI discontinuation syndrome, speak with your doctor of about weaning you off your drug gradually. Typically, if treatment has lasted less than eight weeks, tapering off over one to two weeks would be reasonable. After six to eight months of treatment, you may need to taper off over the course of six to eight weeks.

Don't try to make up your own course of action or stop taking your recommended treatment without your doctor's knowledge. Work with her to do so, as she will better understand the limitations and potential hazards of any drugs you are taking, and help guide you accordingly.

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