Nature of Withdrawal Symptoms

Antidepressant withdrawal symptoms generally appear after prolonged usage of these medications. The usage should be long enough, say for at least six weeks or more, for the body to feel the absence of medication. The body will come to depend on medications and any abrupt suspension will lead to serious body conditions. The characteristic withdrawal symptoms of antidepressants include insomnia, nausea, sensory difficulties, suicidal tendencies, giddiness, diarrhea, bad dreams, etc.

Coping with possible discontinuation of medications should also be part of overall management of depression treatment and rehabilitation. The patient should be made known the consequences of cessation of medications and the methodology to be adapted to deal with the changed situations. The withdrawal symptoms may not be serious and may disappear soon after or cease with restarting of medications.

Generally, the most prescribed medications for treating depressive disorders are selective serotonin reuptake inhibitors (SSRIs). Yet, these medication treatments are of short duration and withdrawal symptoms, if any, will simply disappear slowly. But for some, the withdrawal may become a nightmare and people may suffer until they are treated. The side effects of SSRIs are many and severe. People generally settle for alternative medications.

Selective serotonin reuptake inhibitors (SSRIs) retard the re-absorption of neurotransmitters such as serotonin from the synaptic space. They also act on nerve receptors. When SSRIs are withdrawn or stopped abruptly, the effect will also be on other neurotransmitters such as norepinephrine and dopamine, besides serotonin. In the absence of inhibitors, synaptic serotonin may be re-absorbed and there may be deficiency of serotonin in the brain. This deficiency, combined with retarded nerve receptors, will cause depressive and anxiety disorders to relapse.

When a medication is ingested and is absorbed into the blood stream, its effect will slowly reach to peak levels and later the drug will slowly taper off and dissipate. When the drug presence in the blood falls to half the initial peak level attained, then it is called half life. It is reckoned in hours or days. The period of time that it requires for a drug to be absorbed or dissolved in the system is known by the half life. Some medications may have a brief half life as the system may quickly absorb them.

So, having short half life medications at a frequency of, say, two times a day will not lead to any significant buildup in the body. But, significant concentrations of drug will stay in the body for longer periods of time, say days, when medications with longer half life characteristics are administered. This will help in deciding the dosages and frequencies of medications which will help in better management of withdrawal problems.

General Tips on Withdrawal

First thing is to consult physician before stopping antidepressant drug. Arrive at a drug tapering time table.

Withdrawal of antidepressant should be measured so as to stay away from withdrawal consequences.

Each dosage cutback should be as little as possible.

If lesser potency medications are not obtainable, reduce the frequency of ingestion.

There should be at least 1 to 2 weeks gap between each dosage cutback.

Check at each cutback stage. If withdrawal effects are harsh, restore previous cutback dosage. Once it becomes normal, continue the schedule at reduced pace.

With this methodology, the withdrawal effects from antidepressant discontinuation can be managed.

Antidepressant Categories and Withdrawal Symptoms

Tricyclic Antidepressants (TCAs)

Insomnia and increased dreaming, headache, sweating, chills, nausea, diaphoresis, restlessness, giddiness, coryza, weakness, fatigue, body pains, abdominal cramps, malaise, anxiety, irritability, EKG changes, delirium, etc.

Monoamine Oxidase Inhibitors (MAOIs )

Severe depression, acute anxiety, delirium, convulsions, mania or hypomania, acute psychosis, cognitive deficiency, anorexia, lethargy, sweating, lack of energy, etc.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Persistent motion sickness, headache, nausea, giddiness, vomiting, sweating, fever, abdominal discomfort, chills and hot flashes, crying spells, suicidal thoughts, anxiety, fatigue, muscle and skeletal pains, insomnia, tremors, aggression, blurred vision, diarrhea, memory problems, etc.

Serotonin and norepinephrine reuptake inhibitors

Dizziness, nausea, headaches, lethargy, anxiety, paresthesias, numbness, tremors, sweating, insomnia, irritability, vertigo, diarrhea, etc.

Norepinephrine and dopamine reuptake inhibitors (NDRIs)

Nausea, headache, giddiness, lethargy, flu-like symptoms, etc.

Combined reuptake inhibitors and receptor blockers

Agitation, crying spells, irritability, over-activity, aggression, memory problems, confusion, lowered mood, flu-like symptoms, sleeping disorders, sensory problems and motor disorders like tremor, loss of balance, muscle stiffness, and abnormal movements.