How hard is it to taper off of an SSRI?
April 15, 2021 10:55 PM   Subscribe

I have taken this type of medication for almost 20 years now and am on a high dose. (Yes I will be tapering gradually, and under the supervision of my psychiatrist)

I've been on SSRIs since I was 18 (first Prozac, then Zoloft, and now Lexapro). I need to quit because I will be trying psychedelic medications (in a therapeutic setting) for my trauma symptoms in a few months to see if I respond better to these, and you can't mix them.

I would like to know how difficult this process will be and what to expect.
posted by CancerSucks to Health & Fitness (18 answers total) 1 user marked this as a favorite
I think this is one of those different for everyone situations? When I tapered off Zoloft it caused brain zaps, a disjointed sleep cycle, and some adjustment of hormonal stuff like appetite and libido fluctuations. I was on a standard dose and it took me maybe three weeks to feel like it was all out of me and I evened out. It was maybe a little harder than tapering up to it in the first place. Just recently I got back on it and it was like the taper up was barely noticeable, I had maybe two days of funkiness each increase before it was like it found its previous grooves. I hear that’s not the case for everyone though.

A friend of mine tapered off Prozac after quite some time on it at a high dose and he took maybe a month? He had a lot of headaches and some focusing problems. For both of us we tapered off because we were wanting to try life without the meds for a while for sundry reasons, we were both in good supportive places and all that, had made progress with our big challenges and forming good coping techniques. So that’s very different from your situation where you are going from maintenance meds to a guided experimental period for trauma processing.

If I were you I would think about keeping a taper down journal, maybe a short entry when you wake up and one before bed, with how you feel and how you’re sleeping, eating, and all that. That way you can look back and see trends, or realize that some things were just blips, and how long things are taking. And you can bring this to your psychiatrist when you check in with them. I’ve been monitoring my blood pressure for a couple months now, during which I started back on Zoloft and jotting notes in my BP spreadsheet has really helped me gain perspective on my adjustment as I make an array of lifestyle changes. They are just little notes or complaints about three times a day but it’s super useful to me and if or when I change my meds I will absolutely continue the practice.
posted by Mizu at 11:34 PM on April 15, 2021 [4 favorites]

I was on a lower dose of Sertraline (Zoloft) and it took me a good few weeks to taper off. The main issues I had were brain zaps and dizziness, but I didn't have any emotional problems. I wouldn't say it was difficult. The symptoms were manageable and did go away gradually with the tapering. It was just sticking with it, which I imagine will be easier with the specific goal of taking different medication that you have.

Going on to it in the first place was a much much worse experience for me.
posted by Balthamos at 12:33 AM on April 16, 2021 [1 favorite]

Agreed that it's different for everyone. In the past I've both tapered off SSRIs and gone off them cold turkey (not recommended, but hey) and I had zero withdrawal symptoms via either method, in spite of expecting issues like brain zaps because of how commonly reported they are. The only way to know how your body & chemistry will respond is to try it yourself and see how it goes.
posted by terretu at 1:29 AM on April 16, 2021 [1 favorite]

My partner and I have both tapered off SSRIs and had very different experiences. His experience was much better than mine, even though he was on a very high dose, because he tapered much more gradually than recommended by his doctor. If you have a specific date a few months from now by which you need to be off the meds, I would start tapering off now, nice and slow.
posted by third word on a random page at 4:02 AM on April 16, 2021 [2 favorites]

I think the best approach with this is to be prepared for the possibility that you'll have a rough time and might need to be extra gentle with yourself but not expect it. It varies so much, and people who have a really hard time are having real experiences, but sometimes people are terrified about the process/assume it will be awful for them in a way that seems counterproductive.
posted by needs more cowbell at 4:10 AM on April 16, 2021 [1 favorite]

I've gone off two different SSRIs over the years and experienced no unpleasant symptoms in either case. One was cold turkey and one was more of a "forgetting to take it every night turned into a sort of gradual taper by accident and then intentionally" situation. No way of knowing what it'll be like for you, so I agree that starting soon is probably best so that if you find you need to take it very slow, you can.

Good luck! I hope both the taper and your psychedelic experience go well for you.
posted by Stacey at 4:19 AM on April 16, 2021 [2 favorites]

I did this successfully with Effexor. I was on a low dose for over 20 years. After two disastrous attempts to wean over a 6-8 week period, I took a radical approach and weaned over three years. It was the absolute hardest thing I ever had to do, but also the best, and I have no regrets and feel a huge sense of accomplishment. It took around a full after I hit 0mg before I felt like a human being again. One of the many doctors that I spoke to in that time compared it to the same recovery process that he tells people that had traumatic brain injuries - Basically, give it a year. That advice got me through the tough patches. YMMV is pretty much the golden word here. Listen to your body. Feel free to memail me if you want more details.
posted by sxtrumpeto at 4:26 AM on April 16, 2021 [4 favorites]

I had a terrible time both times. The first was Effexor, terrible brain zaps and general lethargy. I followed my doctor's recommended weaning program which was 28 weeks. It was awful. I went from 150 down to 0.

The second time it was Cymbalta. That was even worse. I felt so sick I could barely get out of bed some days. I went off book and slowed the weaning process to a crawl, I dropped one dose per week by the smallest possible amount... it took months and months to finally get off it but going slowly was far, far easier.

Pay attention to your body. You know what feels wrong and what feels manageable.

I have to say that going off them was the best thing I ever did. I do more work to manage my depression now, and I have more anxious/bad days, especially in the winter. But exercise/good diet/friends/sleep are enough to keep my (mostly) moderate depression at bay. And now I feel like myself. While the SSRIs were necessary to me at a time in my life, I'm really glad I got off them.

Good luck!
posted by dazedandconfused at 5:28 AM on April 16, 2021 [2 favorites]

I've had a psychiatrist suggest adding an SSRI with a long half-life (maybe Prozac) to your current regimen. Like methadone, the long-half-life pill will keep you from having withdrawal symptoms while you taper off the Lexapro. Then you stop the long half-life one fairly quickly. I have never actually done this because I've never had that bad a withdrawal.

Looks like Lexapro is a tablet and not a capsule. I wouldn't worry too much. Just have the Dr. prescribe you different denominations and then cut them up into quarters. I have never taken Lexapro, but I have taken Celexa, of which Lexapro is a derivative, and I stopped it several times cold turkey with minimal problems.
posted by 8603 at 7:49 AM on April 16, 2021 [1 favorite]

It is possible you will taper easily; it's also possible you'll really struggle. It's terribly hard to predict.

One piece of advice I'd give: doctors will normally tell you to cut your dose in half, then another half, then every-other-day, etc etc. Going from 20mg to 10mg is a really big drop! I'd recommend cutting it by 1mg per month so that you have a much more gradual decline in dose.

I believe Lexapro has a liquid formulation - it's more expensive, but it's out there. You can augment a capsule with the liquid so that you can accurately go from, say, 20mg to 19mg for a week or two (10mg capsule + 9mg liquid), then down to 18mg.

Good luck with this, and remember to really stay mindful of how you feel. It's okay to go slowly, and even sit for a while at a lower dose before continuing to taper. The last thing you want to do is rush this transition.
posted by rocketman at 8:21 AM on April 16, 2021

I was on Effexor twice and both times tapered off it without anything but a few slightly yucky weeks, no worse than an allergy season. The second time I tapered more slowly so that it would not make it difficult enough to affect my performance at work. I tapered at approximately half the recommended speed. I was a bit cranky and foggy and had headaches.

However the brain zaps never went completely away. They are now with me on a steady basis when I am waking up or dropping off to sleep. I find them every so mildly annoying. To me they feel a bit like someone flapping a piece of sheet metal near me. Most of the perception is auditory, but there is also a tactile one of a faint wave of pressure. I have been off Effexor more than three years. Effexor is supposed to be bad that way, compared to the other SSRI's.
posted by Jane the Brown at 8:43 AM on April 16, 2021

don't anticipate brain zaps, but they're a real possibility. if one shows up, you'll know what it is. it's unmistakable. mine faded 100% after a few weeks. ymmv.
posted by j_curiouser at 8:58 AM on April 16, 2021

Lexapro was a particularly rough one to taper down from for me, and I hadn't been taking it very long. I think I did it too quickly (over the period of a couple of weeks) Other people coming down from Lexapro have said it took them a couple of months to get off it without serious reactions.
posted by Thorzdad at 9:20 AM on April 16, 2021

I had a tough time going off Lexapro. It helped me to combine with Prozac during the taper because of its longer half life — without that I think it would have taken a really long time to get off the Lexapro.
posted by imalaowai at 9:37 AM on April 16, 2021

I tapered off Lexapro a couple of years ago to start trying to conceive. It went better than I expected, honestly, but I also tapered, like, twice as slowly as recommended. I tapered over eight weeks and the only discontinuation symptoms I experienced in the moment were some very, very mild brain zaps, and some periodic vertigo. I definitely think the seemingly-slower-than-necessary approach to taper is good. The bigger problem I have had has been in the intervening two years as my depression and anxiety have come roaring back with an absolute vengeance and it hasn't been great for my functioning or quality of life, but hopefully that won't be an issue and your other treatment will work!
posted by bowtiesarecool at 10:39 AM on April 16, 2021

While Effexor can be a bear to get off, it's actually not an SSRI, so please don't be too freaked out by Effexor stories. Different class of anti-depressant!

My only data point is that my withdrawal from Zoloft was a piece of cake, even though I'd been on it for 20 years, which just goes to show that ... people have different responses, I guess.
posted by chesty_a_arthur at 11:54 AM on April 16, 2021 [2 favorites]

I've tapered off Lexapro twice and both times my experience was pretty similar to bowtiesarecool - mild zaps, a few twinges of vertigo, but little else. It took a little over a month each time; I cut the tablets in quarters, going from 10mg to 7.5mg for a week, then 5mg and so on. Unfortunately, both times I stopped taking it the anxiety and OCD-adjacent issues that had been kept at bay came roaring back and I restarted the Lexapro within a few months. Good luck with your new treatment - I hope it works for you!

(IANAD, IANYD, IANAPharmacist either)
posted by sencha at 12:49 PM on April 16, 2021 [1 favorite]

Cross taper with liquid Prozac managed the brain zaps for me when going off Paxil and Zoloft. (Celexa and Lexapro were no problem)
posted by Jesse the K at 1:34 PM on April 16, 2021 [1 favorite]

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