How to avoid relapse after coming off antidepressants

box of citalopram antidepressants
How widespread is relapse after coming off antidepressants? (Image: Shutterstock/Unsplash)

Antidepressants are available in many types, together with generally prescribed SSRIs like as citalopram, sertraline and fluoxetine, SNRIs like duloxetine and venlafaxine, and NASSAs like mirtazapine.

In addition to despair, they can be utilized to deal with bulimia, panic issues, generalised anxiousness dysfunction, obsessive compulsive dysfunction (OCD), post-traumatic stress dysfunction (PTSD), and critical phobias.

The newest statistics from the NHS reveal that an estimated 6.53 million of us had been prescribed antidepressants in England between April to June 2022, a 3.34% enhance from the identical quarter within the earlier 12 months. Figures present that girls are twice as more likely to be prescribed antidepressant remedy as males.

Whereas antidepressants is usually a great tool in managing our psychological well being, they will additionally include uncomfortable uncomfortable side effects whereas taking them, in addition to when coming off them.

Earlier this 12 months, six months after I began taking mirtazapine for anxiousness, the remedy stopped working, however the uncomfortable side effects (extreme lethargy and weight achieve) had been in full swing, so I made a decision to come back off it. As I used to be abroad and couldn’t converse to my GP, I researched the right way to taper off it safely and did so over the course of some months. 

Ending up in June, I felt higher than ever – euphorically pleased and (largely) anxiety-free.

Nevertheless, a month or so later, the anxiousness got here again worse than ever. A few months after that, despair and suicidal ideas crept in and lingered for per week.

I haven’t skilled that for a very long time, so it was extremely scary – I’d been ready for withdrawal signs, however I wasn’t ready for signs coming again months later.

Young depressed woman is sitting on the large pill
Focus on coming off antidepressants along with your GP (Image: Getty Photos/iStockphoto)

Antidepressant withdrawal is fairly widespread, and signs embrace anxiousness, temper swings, dizziness, irritability, gastrointestinal points, ‘mind zaps’, flu-like signs and the return of depressive emotions.

The NHS states that antidepressant withdrawal signs often happen inside 5 days of utterly stopping remedy, and stop inside one or two weeks, though extreme withdrawal signs could final for a lot of months.

A 2019 evaluate revealed that 40% of individuals had withdrawal signs for six weeks, whereas 25% felt them for 12 weeks or extra.

‘Withdrawal results are extra widespread than relapse – though you will need to say that most individuals nonetheless received’t expertise this,’ explains Dr Tom Pennybacker, a marketing consultant psychiatrist & psychotherapist and co-founder of The Chelsea Psychology Clinic.

‘Withdrawal signs are the results of the physique adjusting to not having the remedy, moderately than a change in psychological state. It's subsequently a really distinct course of.’

Nevertheless, whereas your physique could turn into bodily depending on a drug, this doesn’t imply that you simply’re addicted – docs don’t imagine that antidepressants are addictive (within the conventional sense).

Dependancy is outlined as compulsive use of and longing for a drug, like heroin, alcohol or prescription meds that make you're feeling excessive, resembling sure painkillers or benzodiazepines like Xanax.

Relapse is when a affected person has efficiently been handled for no matter they had been taking the remedy for, however finds the signs return after a couple of months of feeling higher.

A research revealed final 12 months discovered that 56% of people that’d been taking antidepressants for greater than two years relapsed inside 12 months of coming off them. (Nevertheless, it’s necessary to notice that 39% of those that continued taking meds additionally relapsed.)

Additional analysis reveals that when utilizing antidepressants to deal with anxiousness, OCD or PTSD, relapse charges are increased and sooner when discontinuing remedy, in comparison with staying on meds.

Sad black woman with closed eyes on a blue background
Maintain a journal of the way you’re feeling (Image: Getty Photos/iStockphoto)

My first mistake was not speaking my choice by with my physician – your GP can assess your particular person circumstances and pre-empt any potential points when petering out your meds.

‘When sufferers come to me wanting to come back off their antidepressants, we'll focus on if that is one thing that they've accomplished earlier than, or had a relapse earlier than,’ explains Dr Hana Patel, GP and psychological well being coach.

‘The rationale for this, is that some folks with usually tend to have a relapse if additionally they have persistent well being or psychological well being situations, in the event that they’ve had a earlier historical past of extreme despair, and different causes that your physician will undergo with you. 

‘Often if the explanation that individuals want remedy with antidepressants has handed – e.g. if there's a life occasion or private motive that led to their psychological well being situation – then your physician will converse to you about the way it’s vital to scale back the dose in levels over time, and this will probably be accomplished along side your physician, to scale back withdrawal signs. 

‘Most individuals do cease antidepressants efficiently, and persons are often taking them for at the least six months to a 12 months earlier than they resolve to come back off them.

‘Having a plan along with your physician is a good suggestion as everybody’s psychological well being is completely different, and all of us reply to medicines otherwise.’

Dr Tom additionally advises timing your tapering correctly: ‘It’s higher to keep away from coming off antidepressants if you’re about to undergo plenty of life adjustments/a very traumatic interval, as this may enhance the chance of getting a relapse.’

Analysis exhibits that cognitive behavioural remedy (CBT) or mindfulness-based cognitive remedy taken concurrently coming off meds can assist minimise the possibility of relapse. Nevertheless, with lengthy NHS ready lists, it’s greatest to plan this upfront should you can’t afford personal remedy.

It’s additionally value maintaining a temper diary when petering out remedy, to trace the way you’re feeling, and work out should you’re experiencing withdrawal or relapse. You must also embrace life occasions which may be contributing to the way you’re feeling, because it’s regular to really feel down if one thing dangerous occurs to us, and doesn’t essentially imply you’re relapsing.

Ideally, you’ll have mentioned along with your GP earlier than stopping your meds, so get again in contact with them should you’re struggling.

Don’t be disheartened should you come off remedy and find yourself needing to return on them – should you stopped the meds since you didn’t just like the uncomfortable side effects or felt they weren’t working sufficiently, you'll be able to focus on making an attempt different varieties of remedy along with your physician.


Want help? Contact the Samaritans

For emotional help you'll be able to name the Samaritans 24-hour helpline on , e-mail jo@samaritans.org, go to a Samaritans department in individual or go to the Samaritans web site.

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