The Daunting Discontinuation of Antidepressants

Antidepressants

After two years of being on the antidepressant Celexa following a period of unbelievable stress in her life, Sharon Jones felt well enough that she figured she didn’t need the medication any more.

So she tried to wean herself off, taking the pills every other day, every third day, and so on. But then Jones (not her real name) realized she wasn’t feeling right without the Celexa.

“There was constant buzzing in my head,” says Jones, 47, of Doylestown, Penn. “It was not pleasant. That finally stopped, but then I realized I was crying literally every day and I thought, ‘Why am I doing this to myself when there’s better living through science?’”

Jones isn’t alone. At the same time long-term use of antidepressants has been surging in the United States, people are also reporting difficulty trying to get themselves off the medications.

According to a new analysis of federal data by The New York Times, nearly 25 million adults have been on antidepressants for at least two years — a 60 percent increase since 2010.

The problem of late has been patients complaining that they can’t quit because of the withdrawal symptoms, which can range from dizziness and confusion to insomnia and electric-shock sensations in the brain that many people call brain zaps. One big issue: Some medical experts say there just isn’t enough information about what proper tapering approaches should be.

Then again, other experts say that there’s nothing wrong with having to be on antidepressants for the long term — especially if they are helping and if patients are under a doctor’s care.

“Medications for some people are necessary and critical,” says Dr. Rudolph Freeman, the physician manager for TPMG Behavioral Health in Newport News, Va., and a practicing psychiatrist for 40 years. “These medications clearly have a role to play. The key is using them judiciously and monitoring them correctly.”

Antidepressants are a class of drugs used to treat conditions such as depression, generalized anxiety disorder, obsessive-compulsive disorder, manic-depressive disorder, social anxiety disorder and post-traumatic stress disorder. Different types of medications have different effects on the brain, raising or blocking neurotransmitters in the brain such as serotonin, norepinephrine and dopamine that play key roles in stabilizing mood.

The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors, or SSRIs, which block absorption of serotonin in the brain, making it easier for brain cells to receive and send messages. This results in better and more stable moods. They’re known by the names Celexa, Prozac, Zoloft, Lexapro and Paxil.

First developed in the 1950s, antidepressants have been used increasingly since. According to the Centers for Disease Control and Prevention, the percentage of people aged 12 and over using antidepressants in the U.S. rose from 7.7 percent in 1999-2002 to 12.7 percent in 2011-2014. About twice as many women use antidepressants as men, with 41 percent of users being white women over age 45.

“What you see is the number of long-term users just piling up year after year,” Dr. Mark Olfson, a professor of psychiatry at Columbia University who helped analyze the recent federal data, told The New York Times.

Freeman says that increase isn’t without good reason. When antidepressants first hit the market, the suggested starting point was to take them for 6-12 months and then wean off to see the effects. But as medical knowledge has advanced over the last 50-plus years, so has the thinking of how to use antidepressants, Freeman says.

“Our knowledge about different chemical changes taking place in the brain and how they might affect people’s thinking and behavior are becoming more sophisticated,” Freeman says. The knowledge behind those early treatment plans for depression “is basically archaic at this point. There are some patients who need to be on [antidepressant medication] for an extended amount of time, and may be on it for an indefinite period of time.”

Freeman says, however, that antidepressants should only be prescribed after a careful comprehensive evaluation of patients to ensure what they’re experiencing is clinical depression and not just regular occasional sadness. He looks at four areas: What’s going on in someone’s life that could be causing stress, is that person using mood-altering chemicals to help them cope, are there any medical or physical health problems that could be to blame, and do depressive disorders run in the family.

Use of antidepressants is cautioned in adolescents because of the risk of an increase in suicidal behaviors, which the Federal Drug Administration recognized in 2004.

Even if antidepressants are recommended, they should be combined with counseling to have the best outcome, Freeman says. Research has shown that medication plus counseling works better than either alone, he says. And medication shouldn’t just be seen as an easy solution.

“We have a tendency as a society that we want a quick fix,” Freeman says. “Sometimes it’s easier to take a pill than look at one’s self. It’s more work, but can be meaningful and sustaining work.”

Cognitive behavioral therapy can be immensely helpful because it helps patients make lifestyle changes to improve their mood, says Dr. Lindsey B. Stone, a clinical psychologist and assistant professor of psychology at Christopher Newport University in Newport News. One issue with antidepressants is that they’re often prescribed by primary care providers rather than psychiatrists, so the therapy component is not always there. “The huge benefit in seeing a therapist is that their entire job is to find ways to make you feel better,” Stone says. “You can get a lot of relief by figuring out some of the life issues and having that source of support.”

In general, Stone says, about 64 percent of patients will get better whether they’re taking an antidepressant or are in therapy. However, she says, patients are more likely to relapse if they go off the medication — which can carry a host of problems. “People start feeling better, so they stop taking [medication] cold turkey, which can cause side effects,” she says.

In one study cited by The New York Times, withdrawal symptoms were reported by more than 130 of 180 longtime antidepressant users. Almost half said they felt addicted to antidepressants, even though antidepressants aren’t physiologically addictive. They’re not a substance you crave, such as opiate pain medications and sleeping pills.

Still, some people report feeling like they need their antidepressants. Jill, a 43-year-old from Tulsa, Okla., has tried to stop taking Lexapro in the four years she’s been on it. She experienced the so-called brain zaps, lethargy, heart palpitations and a return of depression.

“I have a busy stressful job with three children who lead active lives,” says Jill, who didn’t want her last name used. “It’s stressful keeping it all balanced. The daily Lexapro keeps me feeling calmer, and the emergency Xanax helps when I have occasional panic attacks.”

For those who do want to try stopping antidepressants, there is a way — and that’s to do it slowly under the guidance of your doctor, Freeman says.

That way patients can not only minimize potential withdrawal symptoms, but they can also be on the lookout for early signs of reoccurrence.

Every medicine has side effects. If you stay on antidepressants, you can experience commonly reported side effects such as weight gain, fatigue and decreased sex drive. Some people (up to 10-20 percent of clinical patients, in one study) report diminished emotional awareness, such as apathy and reduced empathy. Coming off them affects the receptors in the brain, creating almost a hypersensitive reaction, so tapering is the way to go, even if it takes months rather than days or weeks, Freeman says.

The current conversations about antidepressants are what frontline doctors deal with every day, and what researchers and scientists look at as they work to come up with better models to deal with depression, Freeman says. But another important point to realize about antidepressants is that the stigma about using them has decreased over the years, he says. People are more willing to seek help for their mental health.

About the author

Kim O'Brien Root

Kim O'Brien Root was a newspaper reporter — writing for papers in Virginia and Connecticut — for 15 years before she took a break to be a stay-at-home mom. When the lure of writing became too strong, she began freelancing and then took on the role of the Health Journal’s editor in Dec. 2017. She juggles work with being a chronic volunteer for two PTAs
and the Girl Scouts. She lives in Hampton, Virginia with her husband, a fellow journalist, their two children and a dog.

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