Imipramine Should Not Be Stopped Abruptly
No, you should not stop imipramine suddenly—gradual tapering is required to avoid withdrawal symptoms and potential relapse of your underlying condition. 1, 2
Why Tapering Is Necessary
Abrupt discontinuation of tricyclic antidepressants like imipramine can precipitate withdrawal symptoms including:
- Flu-like syndrome (headache, myalgia, weakness, fatigue) 2
- Neuropsychiatric symptoms (anxiety, agitation, nervousness, insomnia, jitteriness) 2
- Sleep disturbances 2
- Gastrointestinal distress 2
- Movement disorders (akathisia, parkinsonism) 2
- Paradoxical behavioral activation or mania 2
These symptoms can occur even after missing a single dose during ongoing therapy 3, and typically appear within 24-48 hours of discontinuation 2.
FDA-Approved Tapering Protocol
The FDA label explicitly states: "Dosage should be tapered off gradually rather than abruptly discontinued; this may reduce the tendency to relapse." 1
Specific Tapering Approach:
- Reduce doses gradually over days to weeks 4
- Start with small decrements to assess tolerance 5
- Monitor closely for withdrawal symptoms versus relapse of depression 2, 4
- For patients on higher doses (150-300 mg/day), taper to maintenance doses of 50-150 mg/day before further reduction 1
Critical Distinction: Withdrawal vs. Relapse
Withdrawal symptoms appear within 1 week and resolve spontaneously within 1-3 weeks, while relapse of depression develops more slowly (2-6 weeks) and does not improve without treatment 6. This distinction is crucial for determining whether to resume medication or continue tapering 2.
Special Populations
- Elderly patients and adolescents: Already on lower doses (30-100 mg/day), requiring even more cautious tapering 1
- Children with enuresis: Taper gradually after therapeutic trial; abrupt discontinuation increases relapse risk 1
Clinical Caveats
- Never stop abruptly unless there is confirmed diversion or serious medical toxicity 5
- Withdrawal symptoms from tricyclics are generally less severe than benzodiazepine withdrawal but still require management 7
- Imipramine and its derivatives (desipramine, clomipramine) are particularly associated with withdrawal reactions 3
- Some patients who relapse after discontinuation may not respond to subsequent treatment courses 1