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Stopping an antidepressant - quick tips, tapering regimes, withdrawal symptoms to exect, half lives


If patient has not responded to an antidepressant at 4 weeks, they may get a benefit if the same one was continued until 8 weeks

Upon recovery, patients should normally continue antidepressants for at least 6m to greatly reduce risk of relapse.

If history of recurrent depression or risk of relapse significant, consider:

Continuing antidepressants for at least 2y.

Usually reduce slowly over 4w (no need to do this with fluoxetine because of longer half-life).

More slowly with drugs with short half-life (e.g. paroxetine, venlafaxine).

Advise patient to seek help if significant discontinuation symptoms.

Offer additional monitoring/support if mild.

Your tapering schedule will depend on which antidepressant you're taking, how long you've been taking it, your current dose, and any symptoms you had during previous medication changes. Below is a chart with sample tapering schedules for some of the most popular antidepressants. However, depending on how you respond to each dose reduction, you may want to taper more gradually using smaller dose reductions, longer intervals between dose reductions, or both. If you experience discontinuation symptoms after a particular dose reduction, you may want to add back half the dose — or all of it — and continue from there with smaller dose reductions. There are no hard and fast rules for getting off antidepressants, other than that the approach should be individualized! Some people can taper off an antidepressant in a matter of weeks, while others may take months.



Suggested dose reductions for tapering off antidepressants



Starting dose (mg)

1st dose reduction (mg)

2nd dose reduction (mg)

3rd dose reduction (mg)

4th dose reduction mg)

Fluoxetine  60 40 30 20 10
Paroxetine 60 40 30 20 10
Sertraline  200 150 100 75 50
Citalopram 40 30 20 10  
Escitalopram 20 15 10 5  
Venlafaxine 300 225 150 75 37.5
Duloxetine* 90 60 30 20  
Bupropion 300 200 150 100  

*Pill should not be cut.


What withdrawal effects can different types of antidepressants cause?


Symptoms that will feel new to you
  • dizziness or vertigo
  • electric shock sensations in head
  • flu-like symptoms
  • problems with movement
  • sensory disturbance (such as smelling something that isn't there)
  • stomach cramps
  • strange dreams
  • tinnitus (ringing in the ears)
Symptoms that could feel like your original problem


  • agitation
  • difficulty thinking
  • disturbed sleep
  • extreme sleepiness
  • hallucinations
  • irritability
  • psychotic experiences, such as paranoid delusions
  • problems with movement
  • strange dreams
  • unsteadiness

Tricyclics and tricyclic-related drugs

  • anxiety
  • fast or irregular heartbeat
  • flu-like symptoms, such as:
    • aching muscles
    • chills
    • goosebumps
    • headaches
    • nausea (feeling sick)
    • sweating
  • insomnia (inability to sleep)
  • low blood pressure
  • problems with movement
  • restlessness
  • spontaneous orgasm
  • strange dreams

Switching antidepressants to help with withdrawal

If patient experiencing withdrawal symptoms when coming off a drug with a short half life switch to a related drug with a longer half-life, which should be easier to come off.  For example, the SSRI with the longest half-life is fluoxetine. If you are taking an SSRI with a short half-life, iswitch to fluoxetine an withdraw slowly from that.


Antidepressant Drug class Half life
isocarboxazid MAOI about 36 hours
phenelzine MAOI 11–12 hours
tranylcypromine MAOI about 2 hours
agomelatine other 1–2 hours
mirtazapine other 20–40 hours
reboxetine other about 13 hours
vortioxetine other about 66 hours
moclobemide reversible MAOI 2–4 hours
duloxetine SNRI 8–17 hours
venlafaxine SNRI 4–7 hours
citalopram SSRI about 36 hours
escitalopram SSRI about 30 hours
fluoxetine SSRI 96–144 hours (4–6 days)
fluvoxamine SSRI 17–22 hours
paroxetine SSRI about 24 hours
sertraline SSRI 22–36 hours
amitriptyline tricyclic 9–25 hours
clomipramine tricyclic 12–36 hours
dosulepin tricyclic about 50 hours (just over 2 days)
doxepin tricyclic 33–80 hours (1.5–3.3 days)
imipramine tricyclic about 19 hours
lofepramine tricyclic 12–24 hours
nortriptyline tricyclic about 36 hours
trimipramine tricyclic about 23 hours
mianserin tricyclic-related 6–39 hours
trazodone tricyclic-related 5–13 hours


Taking Antidepressants: Your Comprehensive Guide... and Glenmullen, The Antidepressant Solution: a Step-by-Step Guide...





fluoxetine paroxetine venlafaxine Sertraline Citalopram Escitalopram Duloxetine Bupropion isocarboxazid phenelzine tranylcypromine agomelatine mirtazapine reboxetine vortioxetine moclobemide fluvoxamine amitriptyline clomipramine dosulepin doxepin imipramine lofepramine nortriptyline trimipramine mianserin trazodone

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