Withdrawing Patients from Antidepressants
This guidance is designed principally for use in conjunction with primary care guidelines for
management of anxiety, depression and postnatal depression.
Introduction - Pharmacological Treatment of Depression
• Acute pharmacological treatment of depression should include a 4-6 week trial of an
 antidepressant at adequate dose (see ’Primary Care Depression Treatment Guidelines’).
• Drug therapy should continue for 6 months after recovery for 1st episode (at least one year in
elderly) and for several years, if not for life with recurrent depression.
Discontinuation of Antidepressant Therapy - When and Why?
1. As described above, at the end of appropriate treatment.
2. Due to serious adverse reaction or intolerability of side effects.
3. Patient Choice - following discussion of risks and benefits.
4. Relative contraindictions, for example, pregnancy.
5. Relapse of depression despite current treatment.
Antidepressants Discontinuation Syndrome - Common Symptoms:
Occur within 24-72 hours of stopping drug; last 1-2 weeks, occasionally longer.
| SSRI |
Tricyclic |
Venlafaxine |
| Dizziness |
Nausea and Vomitting |
Headache |
| Nausea |
Diarrhoea |
Nausea |
| Headache |
Fatigue |
Shock like sensations |
| Fatigue |
Flu like symptoms |
Low mood |
| Low mood |
Low mood |
Dizziness |
|
Anxiety and Agitation |
Akathisia |
|
Sleep Disturbance |
BP Irregularities |
|
Nightmares |
|
|
Abdomonal Pain |
Diarrhoea |
|
Tremor |
Hallucinations |
|
|
|
| Less Common |
Occasional Effects |
|
| Electric shock sensations |
Movement Disorder e.g. Akathsia |
|
| Insomnia |
Behaviour Activation with Hypomania |
|
| Nightmares |
|
|
| Diarrhoea and abdominal spasms |
|
|
| Sweating |
|
|
| Balance Problems |
|
|
*BP = Blood Pressure
MAOI Discontinuation - more severe
Acute confusional states, hypomania, paranoid delusions, hallucinations, depression, seizures.
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