Many people who take antidepressants wonder if they will have to remain on them indefinitely. The prospect of lifelong medication can be concerning. The good news is that for many people, antidepressants provide temporary relief during an acute episode of depression. As the person recovers, they may be able to stop taking the medication eventually. However, this is not true for everyone. Let’s take a closer look at some key questions around discontinuing antidepressant use.
How long should you take antidepressants?
Clinical guidelines generally recommend continuing antidepressants for at least 6 to 12 months after you achieve remission of depressive symptoms. Remission means your symptoms are minimal or gone. However, the risk of relapse is high if you stop taking antidepressants too soon after remission. Up to 50% of people relapse after stopping antidepressants within the first 6-12 months. Extending use to at least 9 to 12 months after remission significantly decreases the risk of relapse.
Some experts suggest continuing antidepressants for 2 years or longer after achieving remission of symptoms. This further reduces the risk of relapse compared to stopping sooner. For people with multiple past episodes of major depression, at least 3 to 5 years of antidepressant use after remission is recommended.
The bottom line is the longer you take antidepressants after remission, the lower your risk of relapse once you stop. This allows your brain more time to adapt while being protected by the medication.
When is it possible to stop antidepressants?
For many people with a single episode of major depression, antidepressants provide temporary relief of symptoms during the acute phase. After taking antidepressants for 9 to 12 months after remission, tapering off medication under a doctor’s supervision is an option. However, relapse rates are still around 41% over the next 12 months after stopping antidepressants.
Long-term use for 3 or more years provides the greatest protection against relapse. Up to 70% of people are able to stop taking antidepressants after 3 years without relapse. After 5 years, the success rate increases to 85%. However, rates of relapse remain around 15% even after 5 years of treatment.
For people with recurrent major depression or other risk factors like family history, longer term treatment for more than 5 years is often recommended. Stopping medication becomes riskier since each successive episode increases vulnerability. In these cases, continuing antidepressants indefinitely may be advised.
What are the signs you can stop taking antidepressants?
Your doctor will assess several factors to determine if you are a good candidate for tapering off antidepressants. In general, the following circumstances indicate you may be ready to begin discontinuation:
– You’ve been taking antidepressants consistently for at least 9 to 12 months after remission of symptoms
– You have been symptom-free and maintained stable mood and functioning for prolonged period
– You have no history of recurrent episodes of depression prior to current treatment
– You have good psychosocial supports, lifestyle habits, and coping skills to help prevent relapse
– You understand risks of relapse and agree to monitor symptoms carefully for signs of return
Caution is warranted if you have risk factors like history of recurrence, childhood trauma, chronic medical conditions, or ongoing psychosocial stressors. Your doctor may advise a slower taper or continued treatment in these cases.
How do you stop taking antidepressants?
It is very important to never just stop taking antidepressants “cold turkey.” This can trigger unpleasant withdrawal symptoms. It also drastically increases your risk of relapse.
Antidepressants must be gradually tapered under your doctor’s direction. The taper proceeds slowly over a period of weeks or months, with dose reductions occurring at regular intervals. This gives your brain chemistry time to re-adjust to functioning without the medication. Your doctor will craft an individualized tapering schedule and monitor for recurrence of symptoms.
Some doctors may switch from your initial antidepressant to Prozac for the last phase of tapering. This is because Prozac has the longest half-life and is least likely to cause discontinuation symptoms during the final taper to zero. However, tapering plans can vary based on your specific medication.
It is critical you follow the exact tapering protocol without adjusting the dose or timing on your own. Contact your doctor immediately if significant mood changes, depression, or other concerning symptoms develop during the taper. This may indicate the need to slow down the taper, pause your reduction, or resume your prior therapeutic dose.
What are risks and side effects of stopping antidepressants?
Potential side effects and risks associated with discontinuing antidepressant medication include:
– Withdrawal symptoms – Headaches, dizziness, nausea, flu-like aches, insomnia, irritability. These may be temporary but can be discouraging.
– Crash or sudden return of depressive symptoms – This may happen within days or weeks after dose reduction. Your risk is highest in the first 6 months after stopping medication.
– Higher chance of relapse – The likelihood of having another major depressive episode increases, especially in the first year. Risk remains elevated compared to staying on medication.
– Loss of prior treatment gains – The depression may become treatment resistant and not respond as well if started back on medication.
– Psychiatric effects – Anxiety, suicidal thoughts, mood swings may emerge, even if depression was the initial condition treated. Always contact your doctor immediately if this occurs.
What can you do to stay well after stopping antidepressants?
Working closely with your doctor and taking measures to support your mental health can help smooth the transition and reduce the risks of stopping long-term antidepressants. Strategies include:
– Taper very slowly over months to give your brain time to readjust
– Monitor your mood – Keep a daily log of symptoms and mood as a way to catch signs of relapse early
– Have a plan in place to restart medication quickly if needed
– Follow up frequently with your doctor during the taper process
– Continue psychotherapy or counseling for support dealing with stressful situations
– Adopt healthy lifestyle habits like regular exercise, proper sleep, a balanced diet and stress management
– Limit or avoid alcohol which can interact poorly with residual medication effects during the taper
– Participate in meaningful activities and social support to reduce isolation and depressive thinking
– Consider natural supplements like Omega-3s and SAM-e to help manage depressive symptoms
– Avoid taking on significant life stressors during the discontinuation period
The more you can do to take care of your mental health during and after stopping antidepressants, the better your chances of staying well.
Can you stop antidepressants if you feel better?
Feeling better and no longer having depressive symptoms is not by itself a reason to stop taking antidepressants. It simply means the medication is working as intended to control the depression. Prematurely stopping the antidepressant because of this can easily lead to a relapse of symptoms or even bad withdrawal effects.
Antidepressants help restore normal functioning of brain circuits controlling mood. However, these circuits remain dysfunctional without medication, even when you are feeling better. Stopping an antidepressant too soon exposes the vulnerability that is being successfully treated.
Sticking with antidepressants for the recommended treatment duration provides extended stability needed for long-term recovery. Your doctor will advise when improvement in your condition indicates it may be appropriate to begin carefully tapering medication. But feeling better should not prompt you to independently stop the medication altogether.
Conclusion
For many dealing with acute depression, antidepressants provide a temporary bridge back to normal mood and functioning. With sustained treatment over months to years, the chances of successfully discontinuing medication increase. However, each person’s biology and history is unique. Your doctor can best assess if and when attempting to stop antidepressant use may be advisable. Patience, close monitoring and lifestyle self-care can help ease the transition off medication to sustained recovery. But antidepressants may also be required indefinitely for some individuals at high risk of relapse.
| Duration of Treatment After Remission | Approximate Relapse Rate After Stopping Medication |
|---|---|
| 6-12 months | 41-50% |
| 1-2 years | 30-41% |
| 3-5 years | 15-30% |
| More than 5 years | 15% or lower |
Key Points
How long should you take antidepressants?
– Take for at least 6-12 months after remission of depression symptoms
– Longer duration of 1-5+ years after remission reduces risk of relapse when stopped
When can you stop taking antidepressants?
– After 1-2 years of stability for acute depression episode
– After 3-5+ years for recurrent depression
– When risk factors are low and doctor agrees to supervised taper
What are the risks of stopping antidepressants?
– Withdrawal symptoms
– Higher rate of relapse or recurrence
– Worsening depression and treatment resistance
How do you stop taking antidepressants?
– Never suddenly stop medication
– Follow doctor prescribed tapering schedule closely
– Monitor mood and contact doctor if symptoms return
Can you stop if you feel better?
– Feeling better does not mean it’s safe to stop medication
– Always consult your doctor before making any changes