Antidepressant Discontinuation Syndrome After Stopping Lexapro and Trazodone
You are experiencing antidepressant discontinuation syndrome, which is expected on the first day after abruptly stopping escitalopram (Lexapro) and trazodone—these symptoms are generally self-limiting but can be distressing and require specific management.
What You're Experiencing
The "off" feeling you're having represents discontinuation syndrome, which occurs frequently after abrupt cessation of SSRIs like escitalopram and can also occur with trazodone 1, 2.
Expected Symptoms on Day 1
Common symptoms that typically emerge within the first 24-48 hours include 1:
- Dizziness and sensory disturbances (including "electric shock" sensations or paresthesias)
- Dysphoric mood, irritability, and agitation
- Anxiety and confusion
- Headache and lethargy
- Insomnia or emotional lability
- Flu-like symptoms (fatigue, myalgia, chills) 3
For escitalopram specifically, the most frequent withdrawal symptoms are dizziness (44%), muscle tension (44%), chills (44%), confusion or trouble concentrating (40%) 4.
Trazodone withdrawal can produce similar symptoms including dizziness, headache, sleep disturbances, and mood swings, though it is generally less problematic than SSRIs 2, 5.
Immediate Management
Reinstitute Medication
If your symptoms are intolerable, resume your previous dose of escitalopram immediately 1. The FDA label explicitly states that if intolerable symptoms occur upon discontinuation, resuming the previously prescribed dose should be considered, then tapering at a more gradual rate 1.
If Symptoms Are Mild
Reassure yourself that these symptoms are typically transient and self-limiting, usually resolving within 1-2 weeks even without intervention 3, 5. However, there have been reports of more serious or prolonged discontinuation symptoms 1.
Proper Discontinuation Protocol
Never stop these medications abruptly—both require gradual tapering 1, 3.
For Escitalopram (Lexapro)
- Taper over more than 4 weeks minimum 5
- Reduce by approximately 25% every 1-2 weeks as a general guideline 6
- Very slow tapering is recommended for all patients, especially those on higher doses 4
- Escitalopram has a shorter half-life compared to fluoxetine, making it more prone to withdrawal symptoms and requiring careful tapering 7, 3
For Trazodone
- Taper at a very slow rate 2
- Reduce by approximately 25% every 1-2 weeks 6
- Though trazodone generally has lower risk of severe discontinuation syndrome compared to SSRIs, withdrawal symptoms can still occur 8, 2
Key Tapering Principles
- Monitor for withdrawal symptoms at each dose reduction; if symptoms appear, maintain the current dose until they resolve before proceeding 6
- Higher doses and longer treatment duration require slower tapers—if you've been on these medications for years, extend the taper to several months 6
- Avoid discontinuation during periods of high stress, as psychosocial strain can exacerbate withdrawal manifestations 6
Critical Warnings
Distinguish Withdrawal from Relapse
Withdrawal symptoms typically appear within days of discontinuation and resolve within weeks, whereas true relapse of depression takes longer to manifest 6. Your "off" feeling on day 1 is almost certainly withdrawal, not relapse.
Watch for Serious Complications
While rare, be alert for 1:
- Severe mood changes (hypomania or mania can occur after escitalopram withdrawal, even in patients without bipolar history) 9, 10
- Serotonin syndrome symptoms if you're taking other serotonergic medications
- Suicidal thoughts or behaviors—seek immediate help if these emerge
Avoid Misdiagnosis
Discontinuation symptoms are frequently mistaken for physical illness or depression relapse, leading to unnecessary tests and treatments 3. Understanding that your symptoms are medication-related prevents this costly error.
Risk Factors for Severe Withdrawal
You are at higher risk for discontinuation syndrome if 4:
- You were on a higher dose of escitalopram
- You have lower clearance of the medication (genetic or metabolic factors)
- You stopped abruptly rather than tapering
The duration of treatment does not significantly affect withdrawal risk—even short-term use can cause symptoms 4.
Bottom Line
Contact your prescribing physician immediately to discuss either resuming your medications for proper tapering or managing your current withdrawal symptoms. Do not attempt to "tough it out" with abrupt discontinuation—the evidence strongly supports gradual dose reduction over weeks to months to minimize these distressing symptoms 1, 3, 5.