Psychiatry

Antidepressant Awareness

I have a love/hate relationship with antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs).  Basically, I love them when they actually help my patients, but hate the intolerable withdrawal that may occur when taking patients off of them.  If you’ve ever contemplated abrupt discontinuation of an antidepressant, consult your doctor before stopping them altogether, particularly if you’ve taken them for at least six weeks.

In my practice, I never hesitate to prescribe antidepressants when indicated, however, I always warn my patients of potential withdrawal effects that may occur if the medication was to be discontinued in the future.  Informed consent and patient education should be given before a physician prescribes any new medication.  Over the course of my training and practice in psychiatry, my observations of the negative impact of weaning off antidepressants shocked me, mostly because I never learned about the phenomena in textbooks the way that I learned about other withdrawal syndromes (such as alcohol, opioid, methamphetamine, etc).  From flu-like symptoms to acute somatic pain symptoms  — I witnessed a full range of issues (see below for a more extensive list).  The unfortunate thing is that patients often internalize the symptoms and believe there’s something wrong with them, though typically the only factor that changed since the last visit was lowering the antidepressant dose.

A telling statement was hearing a patient say that getting off an antidepressant was worse than getting off heroin.  Antidepressant discontinuation is no joke.  And the unfortunate thing is that many people aren’t aware of the negative withdrawal effects that may occur from lowering the dose or discontinuing the antidepressant.  I was fortunate to have an amazing mentor during residency training, who taught me that “slower is better” when it came to lowering the dose of antidepressants.  A literature search for any research articles regarding weaning off antidepressants yields little results, therefore, guidance on how to take patients off of them is minimal.

I am NOT writing this post to bash antidepressants especially since they have improved the quality of life of many.  However, I AM writing this post to raise awareness because I see this issue OFTEN.  And if this information encourages one person to advocate for him/herself and the symptoms they experience, then mission accomplished!

Possible Antidepressant Withdrawal Symptoms:

  • insomnia
  • agitation
  • worsened anxiety
  • resumption of depressive symptoms
  • headache, “brain zaps”
  • stomach upset
  • flu-like symptoms
  • increased pain
  • tiredness
  • nightmares
  • dizziness
  • suicidal thoughts

 

21 thoughts on “Antidepressant Awareness

  1. “Brain zaps”…been there, strangely unpleasant! Great post! It pisses me off when attendings/residents/med students in any given team I’m working with don’t warn about side effects and withdrawal symptoms. It’s one of my pet peeves. Glad to hear you’re empowering your patients 🙂

    • Hi Laura – that’s a pet peeve of mine too, though I’ll admit I was like that during internship (mostly because most of my attendings didn’t inform my patients about them!), but once i worked with attendings who were stringent about patient education, i did the same and realized it’s not just our duty, it’s the patients’ right and makes a huge difference in developing trust in the therapeutic relationship. And yes, brain zaps are way too common and unpleasant!

  2. After taking one Elavil pill (amitriptyline,) several hours later I had to admit myself to the ER for something I wont write about here, as I don’t wish to trigger anyone. I totally realize that Elavil does help some people; we all have such different reactions to meds, as I know *you* know! Thank you for writing about this subject!

  3. Great post, I love “brain zaps” it’s such an accurate description, I called them brain shivers, did the cold turkey though I was only on “them” for 5 weeks. Converting from Edward Hyde to Dr. Henry Jekyll and staying as Dr. Jekyll was no easy feat, though I will say the antidepressants allowed me to move my son from in my face to the periphery, where I could learn to chew on small bites, take small breaths and not choke or drown on his death. Some other subtle points to remember about antidepressants, if you are thinking about getting life insurance (term or whole), the best you rate you can get is a high risk “table” rating, even if you have never been on the meds or its only temporary such as mine was. I was lucky, my wife worked in the insurance industry, and she was able to write enough letters explaining that I was grieved to get me a better rate, where now we can afford a policy. Transportation workers (anyone holding a TWIC card) may lose their job after being perscribed and taking antidepression medications (my oldest surviving son has to get a letter from his doctor every time he bids on a job he’s a merchant marine sailor) I never believed in using meds before but I do now. You are absolutely correct; the patients need to know the after effects and the long term life effects as well. Have a great weekend, if you have any more of the pictures of the west coast weather, we could use it here on the east coast; 4” of the white stuff with 3 more on the way 

    • Hi Bob – I am currently reading your comment while sitting out in the patio of a coffee shop on a bright, sunny day in LA 😉 yikes about the snow, hope you’re staying warm! thanks for the tip about life insurance…useful info if it ever comes up. i’ve also had to write letters of support for some of my patients with driving jobs. good to hear you had a positive experience with the antidepressant and that you were able to taper off (or cut cold turkey) within a decent time period…unfortunately, many people who only need it for temporary use end up staying on them longer than needed and struggle when they try to stop taking them, though i’m sure they would’ve tried to wean off them sooner had they been informed. thanks for your comment as always and enjoy the weekend! will try to get more sunny pics for my next posts 🙂

  4. Thank you for this piece. Reading through some of the responses, I have to admit that I can relate to the withdrawal symptoms. I have had the brain zaps, the nausea, and insomnia. The suicidal ideation was there as well.

    While I am an angry writer, my opinion is that my experiences are my own. I have a tendency to make judgments that are broad. For me, the pharmaceutical companies are completely irresponsible. How does a country like America allow these companies to advertise on media? With the exception of New Zealand, the world does not allow it. The perpetuation of this type of behavior does not help a society that I call addicted. I also feel that depression, in my case, was addiction. It is addiction to passivity.

    There really are no silver bullets. Fortunately, we have good intentions. We also have hope. The stories are sacred. In those stories, there is spirituallity. I thank God and I particularly thank one special doctor here in Texas.

  5. Great post. Retrospectively I have suffered from depression since I was a child. I had my first noted Major Depressive Episode 18 tried zoloft, felt better and then of course stopped the meds, another when I was 21 this time lexapro, stopped it again, another when I was 24 restarted lexapro and stopped it again and finally when I was 26 and I started cymbalta and have been on it since. I take it like clockwork. I notice if I miss a single dose it affects me. I also have definitely experienced withdrawal effects in the past. I think part of the problem is primary care physicians readily prescribe antidepressants now (don’t get me wrong its a good thing they are thinking about mental health) but they don’t provide the proper follow up needed with a psychiatrist. In some areas – i.e. the Bay Area/SF it is extremely hard to find a psychiatrist that takes insurance! This is another set back to the proper follow up that is required for those potent drugs. $400/hr is daunting for most especially those that temporarily need to be seen every week or every other week. I like this post because although cymbalta has been such a life changing medicine for me – it is not a medicine to be taken lightly. It interacts with several medications and I have actually once had serotonin syndrome when it was combined with a triptan to treat my migraine headaches. That was not fun. As these drugs are more and more commonly used physicians need to be aware of their side effect potentials and drugs that can commonly interact and cause the life threatening serotonin syndrome.

    Great post!

    • so very true about physicians needing to be aware of the side effects/interactions of antidepressants. i once had a patient experience serotonin syndrome on a very low dose of cymbalta + trazodone, but since she was on such low doses, her PCP and the ER doc said it wasn’t possible…well, i believe anything is possible and there’s nothing i hate more than when a patient reports a side effect and just because it isn’t listed as a “common side effect” or a textbook presentation, people assume it can’t be possible. and you raise a good point about the general lack of psychiatric follow-up and availability. antidepressants are prescribed so easily and proper education and monitoring is necessary but often not provided

  6. Hello,

    I’m actually curious about going on antidepressant medication, but I’m afraid that I’ll experience terrible withdrawal once I wean off of it and also side effects. Should I even start taking meds? I’ll be seeing a psychiatrist for the first time this Friday. I dont know if I should just cancel the appointment or go and use that opportunity to ask questions. I just feel like I’ll be wasting their time if I just ask questions and at the end of the appointment tell them I do not want to start taking meds. :/ What do you advise I do?

    Chloe

    • Hi, the posts on my site are used for informational purposes as I’m unable to provide advice through my blog. Seeing a doc for the 1st time can be very anxiety-provoking, but specific questions regarding meds are best addressed with your doctor and they can answer questions/concerns you have regarding taking meds.
      Best, Vania

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