From the Guidelines
You should not quit SSRIs abruptly, as this can lead to discontinuation syndrome, and instead, they should be tapered gradually under medical supervision. Selective Serotonin Reuptake Inhibitors (SSRIs) such as fluoxetine, sertraline, escitalopram, paroxetine, and citalopram have been associated with discontinuation syndrome, characterized by symptoms such as dizziness, fatigue, lethargy, general malaise, myalgias, chills, headaches, nausea, vomiting, diarrhea, insomnia, imbalance, vertigo, sensory disturbances, paresthesias, anxiety, irritability, and agitation 1.
A typical tapering schedule might involve reducing your dose by 25% every 1-2 weeks, though this varies based on your specific medication, current dose, and how long you've been taking it. The brain has adapted to increased serotonin levels, and needs time to readjust when the medication is reduced, which is why stopping SSRIs suddenly can lead to these effects 1.
Some key points to consider when tapering SSRIs include:
- Paroxetine, fluvoxamine, and sertraline have been associated with a higher risk of discontinuation syndrome 1
- The risk of discontinuation syndrome is higher with shorter-acting SSRIs, such as paroxetine and sertraline 1
- Medical education, training, and experience are necessary to safely and effectively prescribe and taper antidepressant medications 1
- A conservative medication trial for mild to moderate anxiety presentations may entail increasing the dose as tolerated within the therapeutic dosage range in the smallest available increments at approximately 1- to 2-week intervals when prescribing shorter half-life SSRIs 1.
Even if you're experiencing side effects or feel your medication isn't working, always consult with your healthcare provider before making any changes to your SSRI regimen, as they can help you develop a safe and effective tapering plan 1.
From the FDA Drug Label
Discontinuation of Treatment with Prozac — During marketing of Prozac and other SSRIs and SNRIs (serotonin and norepinephrine reuptake inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania. While these events are generally self–limiting, there have been reports of serious discontinuation symptoms. Patients should be monitored for these symptoms when discontinuing treatment with Prozac A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible.
No, you should not quit SSRI abruptly. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible 2. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate.
- Key points:
- Abrupt cessation may lead to adverse events such as dysphoric mood, irritability, and anxiety
- Gradual reduction in dose is recommended
- Patients should be monitored for discontinuation symptoms
- Intolerable symptoms may require resuming the previously prescribed dose or a more gradual tapering schedule 2 2
From the Research
SSRI Discontinuation
- Stopping SSRI treatment can lead to withdrawal symptoms, which can be severe and may compel patients to recommence their medication 3.
- Guidelines recommend tapering SSRI treatment to mitigate withdrawal symptoms, with short tapers of between 2 weeks and 4 weeks down to therapeutic minimum doses or half-minimum doses before complete cessation 3.
- However, studies have shown that these short tapers may not be effective in reducing withdrawal symptoms, and tapering over a period of months to doses much lower than minimum therapeutic doses may be more successful 3, 4.
Tapering vs. Abrupt Discontinuation
- Abrupt discontinuation of SSRI therapy can cause a larger increase in the number of discontinuation symptoms compared to tapering 4.
- A study found that 21% of patients abruptly discontinued their SSRI therapy, resulting in a significant difference in the number of discontinuation symptoms compared to those who tapered off the medication 4.
- Another study suggested that tapering SSRI therapy gradually, with small steps, especially in the low-dose range, can minimize withdrawal symptoms 5.
Withdrawal Symptoms
- Withdrawal symptoms from SSRI discontinuation can be multiform and include unspecific physical symptoms, which can be difficult to distinguish from the recurrence of depressive symptoms 5.
- Most withdrawal symptoms are mild and self-limiting, but there is insufficient evidence on the extent and frequency of rebound depression 5.
- Patients should be informed about the risk of withdrawal symptoms when starting SSRI treatment and regularly during the course of treatment 5, 6.
Dependence and Withdrawal
- SSRI use can result in dependence and withdrawal, and acknowledging this allows patients to be better informed around decisions related to these drugs 6.
- Strategies for safe tapering, such as gradual tapering with small steps, can help minimize withdrawal symptoms and inform patients about the risks and benefits of SSRI treatment 3, 4, 5.