Earlier this month, The New York Times Health section published an article titled: Many People Taking Antidepressants Discover They Cannot Quit.

Many, many clinicians and antidepressant users alike have contacted me, inquiring about my “take” on the article, as to its accuracy, validity and the extent to which antidepressant discontinuation is actually a problem. First, a bit of discussion before I weigh in on this issue.

It’s true — long-term use of antidepressants is on the rise in the U.S., with approximately 15 million Americans now on these drugs for a minimum of 5 years. And this is not just an issue in the United States, antidepressant prescriptions are at all-time highs in New Zealand and rates of use have doubled over the last 10 years in Great Britain.

Antidepressants were originally intended for short-term use, but later studies suggested that “maintenance” treatment could curtail a reemergence of depression in some users. And debate is unceasing as to whether improvement is drug-driven, or related more to the mere passage of time, improved overall life circumstances via the user’s efforts or the placebo effect. In other words, what or who gets the credit?

The major issue I have with this article is in a part of its title — “people discover they CANNOT quit.” This is sensationalism and it fuels confirmation bias, as the piece goes on to provide brief anecdotes of some people’s struggles with weaning off antidepressants. Accounts such as “I couldn’t finish my college degree” because of Zoloft withdrawal or “only now am I able to re-enter society” are not clinically meaningful, and have me wondering what’s wrong with this picture. I say this not to belittle or summarily dismiss the agony that some antidepressant users experience during the discontinuation process, instead I take issue with the word CANNOT. Any drug can be stopped, not necessarily easily or comfortably, but it’s definitely doable; if not, there would be no such thing as abstinence.

Here are my suggestions, recommendations and comment regarding antidepressant discontinuation for anyone using them:

  1. Think it through. An obvious way to avoid discontinuation syndrome is to not start antidepressants in the first place. Are you clear on what you want the drug to do and for how long? Are your expectations regarding improvement realistic? Antidepressants will not send anyone over the moon with joy and indescribable contentment, but they can ease the strains of daily life some people experience, while improving mood and decreasing anxiety. I routinely describe their benefits this way: If they’re working in your favor, you’ll likely feel “brighter,” and have more energy and motivation with variable mood improvement, but there will be some trade-off with side effects.
  2. Place yourself in competent hands. Most antidepressants are prescribed via primary care, but by in large, primary care is not adequately equipped or knowledgeable enough to properly guide discontinuation. So seek the services of psychiatry – any competent psychiatrist should be able to handle this, they do it all the time.
  3. Tapering. The tapering/eventual discontinuation process is generally not difficult to manage. It begins with tapering the dose of the existing antidepressant, and then if discontinuation symptoms emerge, often a switch to Prozac can ease the withdrawal process considerably because of its long half-life. This is known as “micro-tapering.” Difficulties are linked to the antidepressants used, length of use and dosage. Paxil, Effexor and Cymbalta are historically the most problematic. Appendix VI of my third edition book, Psychopharmacology: Straight Talk on Mental Health Medications describes a tapering process I recommend (p.218).
  4. Go slow. Only a modest number of people have demonstrable withdrawal symptoms from these medicines — despite the Times assertions to the contrary. And although I believe most people can successfully accomplish the process in 3 months with competent care and a plan with an established track record, there’s no reason to rush. Go slow, in fact very slow if needed. Psychiatrists understand the sensitivity some people have to this.
  5. Think it through, part two. If you stop successfully, what about relapse to depression? A subsequent return to antidepressants would defeat the purpose of discontinuation in the first place. If stopping is plan A and it doesn’t work for you, do you have a plan B? If not, you really didn’t have a plan A.

Finally, it’s not that people can’t taper off and quit, it just that some of them choose not to quit. Many simply decide that because of possibly falling again into the black hole of hopelessness, together with the absence of significant side effects and the prospect of living a happier more content life, it’s worth it to continue taking antidepressants for the long haul. With no definitive, credible, proven research, warning of significant consequences of long-term use, I see this as a viable alternative.

I’m just sayin’.

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Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.

To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.