Give me hope: tapering off SSRIs
March 17, 2019 8:18 AM   Subscribe

I think I'm ready to quit, but all the stories I've found so far are of people in the middle of withdrawal and freaking out about it...

Stories about people who took SSRIs, restructured their lives, tapered off successfully and are happier! Also articles about whether it is a good idea to taper off, tips for smoothing that process out, etc. would be super appreciated. Thank you :)
posted by Crookshanks_Meow to Health & Fitness (21 answers total) 3 users marked this as a favorite
A really recent article in the Lancet medical journal recommends a much slower taper than usually recommended -- maybe ask your prescriber about that? Tapers over a period of months and down to doses much lower than minimum therapeutic doses have shown greater success in reducing withdrawal symptoms.
posted by lazuli at 8:27 AM on March 17, 2019 [3 favorites]

I took 'em, tapered off them and had nearly a year of brain shivers, but that was okay, not as distracting as having an clock that does Westminster Chimes in the apartment. No problem. Brain shivers are just the sound of someone flapping a sheet of metal in the distance.

I'm back on them again, but this time to suppress cancer treatment side-effects, and in a few more years when that medication is discontinued I intend to go off them again.
posted by Jane the Brown at 8:28 AM on March 17, 2019 [1 favorite]

I was prepared to break the capsules open and take partial capsules to taper even more gently but it wasn't necessary. I just followed the standard tapering routine. I believe I had headaches for a few days during the first week of each stage of tapering but ordinary ibuprofen took care of that.
posted by Jane the Brown at 8:30 AM on March 17, 2019 [1 favorite]

I might be an aberration, but I've quit several different SSRIs cold turkey on several different occasions and didn't experience any symptoms (either mental or physical) that I could pinpoint specifically as SSRI withdrawal on any of those occasions. I stopped talking fluoxetine, citalopram (twice) and sertraline in this fashion and the experience was basically the same (i.e. a non-event) for each of them.

It's worth noting that I wasn't in the best place mental health-wise on any of those occasions, so there might have been some mood changes that were withdrawal-influenced, but it was basically impossible to pick out what was cause and what was effect. It was no more distressing in any of the cases than the background level of mental illness I was trying to deal with at the same time.

I'm not saying you'll definitely have a good experience, but counter-data points to the people whose lives are made miserable by withdrawal do exist, I guess we're just not writing about it on the internet at length because mostly painless withdrawal is nowhere near as noteworthy as difficult withdrawal.
posted by terretu at 8:32 AM on March 17, 2019 [3 favorites]

(also I'm definitely not saying quit cold turkey instead of tapering - you should approach this in the safest and most sensible way you can, I just wanted to offer the data point that some people can do it the most dumb way and still have a completely fine experience)
posted by terretu at 8:33 AM on March 17, 2019

SSRIs gave me the space to deal with the root causes of my depression in therapy. With the help and approval of my doctor, I tapered over a number of months and the only side effects I remember are some minor bouts of increased anxiety. I'm a much happier person than I was before I started treatment for depression -- and I would not hesitate to go back on anti-depressants in the future if I needed them.
posted by mcduff at 8:42 AM on March 17, 2019

Some of it depends on the med - Paxil and Effexor are notorious for brain zaps etc, Prozac has a longer half life and is more forgiving.

Effexor withdrawal was so bad for me that I resorted to opening the capsules and taking out one more grain each day. It took months and the brain zaps didn't let up until a few weeks after the last dose, but eventually they did end and my brain regained its pre-SSRI equilibrium.
posted by Flannery Culp at 8:50 AM on March 17, 2019 [1 favorite]

I’m afraid I don’t remember the process of getting off of them, but just to give you hope, I was on SSRIs and other meds in combination for at least a decade. It took at least three different meds for me to feel my depression was kind of manageable, and I assumed I’d be on them forever. I haven’t taken anything for depression or anxiety for years, and I can’t imagine needing to, even though I’m now dealing with a cancer diagnosis.

I do know that the thing that really helped me was somatic experiencing.
posted by FencingGal at 9:11 AM on March 17, 2019

I was on cipralex/lexapro for about a year and then tapered off almost a decade ago. I had the brain zaps while on it even though I took them like clockwork so I started tapering to reduce that and the side effects I was suffering (gastro issues, libido, weight gain). I just tapered off over several months iirc, just broke them into smaller and smaller pieces. I went on for general anxiety and panic attacks, took up yoga and meditation afterwards and have felt pretty good since, haven't had any major panic issues since but my life is a lot healthier than it was when I went on.

This book talks about tapering off SSRI's and may be encouraging.
posted by lafemma at 9:16 AM on March 17, 2019 [1 favorite]

I was prescribed a low dose of Citalopram (10mg) after years of spiralling GAD finally tipped over into classic depression. I remember being scared to death of taking SSRIs due to internet horror stories, but it turned out great for me - the side effects were minimal, and none were related to coming off the medication. After the year was up I felt worlds better so tapered off by halving the tablets to taking 5mg every other other day for a week, then 5mg each day for a week, then 5mg every other day for a week after that. I did notice a slight dip in mood on the half days at first, but it righted itself after a week. I was terrified of brain zaps but I didn't get them, or anything else out of the ordinary. That was a couple of years ago and things have been good since - I'll never be the most zen of folk but am generally happier, calmer and much more able to deal with my weird anxieties these days.

YMMV, especially on higher doses, but coming off them is not guaranteed to be dreadful, especially if side effects have been manageable to date. Just take it at your own pace.
posted by freya_lamb at 9:22 AM on March 17, 2019

Assuming your doctor is supportive, they can perscribe the SSRI in a liquid form for you, which allows you to measure incrementally smaller doses, for very gradual tapering.
posted by ethical_caligula at 9:25 AM on March 17, 2019

I had no problem at all going off zoloft (twice) and wellbutrin (once) with no taper; getting off effexor was more difficult but with my doctor's guidance I did the standard taper, and then opened the capsules and took a half-dose, and then a half-dose every other day, and then I was done. Going cold turkey off effexor was a nightmare, but the controlled taper wasn't too bad, maybe just a bit brain-zappy the day or two after each stepped-down dose. A week after my last half-dose I felt fine.

If you're tapering off one of the more difficult-to-quit ones (effexor is notorious) and the taper is making you miserable, there are some options, like you can take wellbutrin while ramping down effexor, which can blunt the effects of the effexor withdrawal, and then go off the wellbutrin, which is easier for most people to quit. Or if you're getting anxiety or sleeplessness as a result of withdrawal, your doctor might offer a "simple" and short-acting anti-anxiety med (like xanax) for when the anxiety spikes or a sleep aid (like ambien) for a month or two.

So definitely talk to your doctor about your intention to taper and get some guidance on how best to taper your specific med, and often thereafter you can contact them through your "patient portal" or talk to their nurse on the phone and say, "Hey, remember how I'm tapering? The sleeplessness is killing me" and they can just call in a sleep aid since you've already discussed the taper process and potential problems.
posted by Eyebrows McGee at 10:22 AM on March 17, 2019

I have taken a couple different SSRIs and was on Effexor when I wanted to stop taking them. My doctor had me switch to Prozac first and I tapered with no problem.
posted by radioamy at 10:30 AM on March 17, 2019

Unfortunately, I have too much experience with this.

I would say to go sloooooooowly. If you can go slower than the DR recommends, I would. Some doctors just go off of how long until it is out of your system. I don't think that they realize that you brain is still trying to adjust to not having the medication.

I would go super slow and take care of yourself in general - diet , exercise etc.

Good Luck!!!!
posted by kbbbo at 10:33 AM on March 17, 2019

I have discontinued use of SSRIs a couple of times. The first time I stopped more or less cold turkey and I do not recommend that. This was a long time ago, before SSRI withdrawal problems were widely known, and I got through it but it was a rough time for both me and the people around me. The second time, I tapered off gradually over about 6 weeks and that process went fine. I did experience some withdrawal effects but they were manageable and reduced steadily over time. I didn't have any big problems keeping up with work and daily life during that period. The few most prominent effects were
  • Emotional range. I'm one of those people for whom SSRIs work more as a mood dampener than a mood lifter. When I started tapering off, I also started having a lot more FEELINGS and it took me by surprise. I knew something was going on when I, who seldom gets misty-eyed during even the most tear-jerking of movies, started sobbing during a sad moment in a TV show. It was a bit of a rollercoaster for a while and I had to learn how to work with this broader emotional "palette". Try to check in with yourself every so often, stepping back and reflecting on new or more intense feelings that may come up during this process.
  • Brain "slips" or "wobbles". This one was just weird. Every so often I would get the sensation of something slipping or lurching in my head. This sometimes felt like it slightly affected my balance or gait. Vigorous physical exercise helped a lot with this.
  • Higher sex drive and better sex. SSRIs are notorious for squashing sex drive and contributing to anorgasmia. Hopefully you're in a position to enjoy that being, well, less of a problem.
It's been almost exactly 10 years since I stopped taking the SSRI, and I have not had a relapse of the major illness that caused me to seek medical treatment. SSRIs gave me support to remain functional and experience some healing when I was really sick, and ultimately helped enable the further healing and growth that I believe became possible when I stopped taking them.
posted by 4rtemis at 10:35 AM on March 17, 2019

I've tapered off basically every SSRI you can think of (and quite Wellbutrin cold turkey due to allergy) and there's been no problems at all. I never even got brain zaps. The only one that I think back now on and go "that wasn't great" was Effexor, shockingly. Which to be honest, if you're careful and slow with it you should be fine. I think we went a little too fast but after like a month I was back to "normal". Which in this instance was, depressed teenager, but. Scary Stories About Withdrawal are absolutely the new first-person hotness online and I would try to read as few of them as possible. So, none.

Also, of course it is okay to go off them if that is what you want! It's YOUR body.
posted by colorblock sock at 8:21 AM on March 18, 2019 [1 favorite]

I tapered myself off a 40mg dose of fluoxetine (Prozac) fairly quickly. (I am not recommending that you do this.) Never noticed any problems.
posted by escape from the potato planet at 9:25 AM on March 18, 2019

There's definitely a lot of personal variation. I'm very sensitive to SSRI withdrawal, in that I get the "brain zaps" a lot (little flashes of dizziness/facial numbness/tingling like a funny bone), but I don't find them to be unedurable, and I've done it enough times when trying different meds that I know what my reaction is going to be like. I get them even when I taper slowly -- I got them even when going off Prozac, which has such a long half-life that it's sometimes used to cushion withdrawal from shorter-acting SSRIs. But I know they won't go on forever (for me, they tail off by a couple of weeks after my last dose), and I know they're coming, so I use that to keep myself calm. I keep myself busy with distractions and just get the time to pass. Plenty of people have an easier time of withdrawal than I do, so I'd suggest giving it a try with tapering at a reasonable rate and seeing how it goes. Keep in mind that you can do it more slowly if you're having a lot of withdrawal effects, and don't panic because the effects (if you get them) are not dangerous. If you notice serious slippage of your mood, that's something to be alert for -- and it may mean that this isn't the time to go off the meds, if they've been working for you. But it's perfectly reasonable to try, and I wish you good results!
posted by kite at 10:29 AM on March 18, 2019

So I accidentally tapered myself off my SSRI really slowly with no real obvious side effects. First, I'll say that I once went cold turkey, years ago, due to a pregnancy scare, and it was pretty awful and I went back on pretty quickly as well.

But two years ago, I was out of the country for almost a year and was concerned that I wouldn't be able to get my prescription (escitalopram, low dose maybe 20 mg?). I think I started cutting my pills in half, and I also skipped some days. I think I got to the point where I was taking half a pill every three days or so. It wasn't exactly a plan, and it wasn't in consultation with my doctor (and I was able to get the prescription), so I'm not a model for how this should happen. But I realized that, in trying to make my prescription last, I was tapering myself, so I went with it. I think I did this over four or five months, maybe more. There was no protocol.

Anyway, it was fine! My year away was a kind of mental health reset for me anyway. If there were withdrawal symptoms, I didn't notice them as such.

After I went off, I was able to make a few big life decisions that had been both low grade and overwhelming. It's been almost two years and I haven't gone back or even been tempted to do so. Resolving a few other things in my life was really helpful to my overall mental health.

I say all this not having any idea if my experience was typical or replicable.
posted by bluedaisy at 11:40 AM on March 18, 2019

Like terretu, I have quit fluoxetine cold turkey at three different points in my life with zero visible side effects. I also quit drinking one day after daily binge drinking and didn't have any physical side effects.

Our bodies are weird and everyone's chemistry reacts differently. Don't be worried about how it will affect you - follow your doctor's recommendation and react if there is a problem, but don't worry in advance that there *might be* a problem.
posted by tacodave at 4:37 PM on March 18, 2019 [1 favorite]

During a particularly bad run-in with withdrawal symptoms, my doctor prescribed liquid fluoxetine which has a much longer half-life compared to the drug I was on. The liquid dosing allowed me to taper more slowly. Another time, I got through the hardest parts with some additional low-dose ativan. I wasn't particularly functional, but I didn't feel so awful at least.
posted by Violet Femme at 5:51 PM on March 18, 2019

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