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
|
Drug |
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?
SSRIs and SNRIs
- 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)
- anxiety
- crying spells
- depersonalisation (feeling detached from your surroundings)
- depression
- disturbed sleep
- fatigue (feeling very weary)
- mania
- mood swings
- poor concentration and memory
- suicidal thoughts
MAOIs
- 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...
https://www.health.harvard.edu/diseases-and-conditions/how-to-taper-off-your-antidepressant
