What You Need To Know About The Symptoms and Phases of SSRI Withdrawal
SSRIs, or selective serotonin reuptake inhibitors, are a class of medications used to treat certain mental health conditions. They are most commonly prescribed for depression and anxiety, but they are also approved by the FDA for the treatment of panic disorder, bipolar disorder, obsessive compulsive disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, and bulimia nervosa. SSRIs work by altering the way serotonin—a neurotransmitter involved in functions such as mood, anxiety, the sleep/wake cycle, and sex drive—is delivered to the brain.
Why Might Someone Stop Taking SSRIs?
SSRIs can lead to significant improvements in mood, anxiety, and someone’s day-to-day functioning, but they can also cause unwanted side effects such as weight gain, decreased libido, and gastrointestinal issues. These are some of the reasons people may decide to stop taking SSRIs; other reasons include the SSRIs losing their effectiveness or because a person’s symptoms have improved or become more manageable and no longer require the assistance of medication. Just as the decision to start taking SSRIs should be made with a prescribing physician, so should the decision to stop taking them, lest they lead to some unpleasant, and sometimes dangerous, symptoms.
Who Can Experience SSRI Withdrawal?
SSRI withdrawal, also known as antidepressant discontinuation syndrome, is important to be aware of when you are considering starting or stopping any SSRI. Unfortunately, many patients are not given adequate—if any—information on this by their doctors, which prevents them from being able to make an informed decision about their treatment. Anyone who stops taking an SSRI can experience withdrawal, but it is more likely to occur if a medication is stopped suddenly or if someone has been taking it for several months or years. This is why it is crucial to develop a tapering plan with your prescribing physician that takes into account your unique biology, medical history, and desired outcome. It is also important to closely monitor your symptoms and alert your doctor if anything becomes unmanageable or so severe that it puts your safety at risk.
What Are the Symptoms of SSRI Withdrawal?
SSRI withdrawal symptoms can be grouped into three categories: physical, psychological, and neurological. Here are some of the most common symptoms of SSRI withdrawal in each category:
Physical
Headaches
Dizziness or light-headedness
Balance problems or unsteady gait
Gastrointestinal discomfort (nausea, vomiting, diarrhea)
Flu-like symptoms (sweating, chills, body aches, fatigue)
Sleep disturbance (insomnia, vivid dreams, nightmares)
Sexual dysfunction
Psychological
Heightened depression or anxiety
Panic attacks
Irritability or agitation
Extreme mood swings
Suicidal ideation
Difficulty concentrating or “brain fog”
Depersonalization (feeling detached from one’s thoughts or feelings)
Neurological
Sensory disturbances
Visual distortions (flashes of light, blurred vision)
Tinnitus (ringing in the ears)
Disorientation or confusion
Body tremors
Brain zaps (tingling, burning, “electric shock” sensations)
What Are The Phases of SSRI Withdrawal?
Withdrawal symptoms can start as soon as 24 hours after stopping medication, with the typical onset being within a few days. Symptoms can last anywhere from one to several weeks, with those taking higher doses or for longer periods experiencing more prolonged and intense withdrawal symptoms. While everyone’s individual experience varies, SSRI withdrawal has been observed as occurring in the following phases:
Onset (1-7 days)
Begins within hours to days after stopping or reducing dose
More likely to be rapid with SSRIs that have a short half-life (e.g. paroxetine, venlafaxine)
Main symptoms include heightened anxiety and depression, difficulty concentrating, sleep disturbance, nausea, dizziness and lightheadedness, headaches, blurred vision, brain zaps, flu-like symptoms
Acute (1-3 weeks)
Symptoms tend to peak and be felt most intensely
Main symptoms include mood swings, irritability, nausea, vivid dreams, brain zaps
Adjustment (3-6 weeks)
Symptoms start to fade and are felt less intensely as the brain adapts
Main symptoms include mild anxiety, fatigue, sleep disturbance, emotional sensitivity or lability
Protracted (several months to years)
While uncommon, some people experience prolonged withdrawal symptoms, which may be referred to as protracted withdrawal syndrome (PWS) or post-acute withdrawal syndrome (PAWS)
Main symptoms include headaches, sleep disturbance, sexual dysfunction, depersonalization, disorientation, brain fog, suicidal ideation
What To Do If You Experience SSRI Withdrawal Symptoms
The safest and most effective way to stop taking your SSRIs are by gradually tapering your dosage with medical supervision. However, you still might experience SSRI withdrawal symptoms, and if this is the case you can consider taking the following steps:
Symptom Monitoring
It can be helpful to log your symptoms using an app, a notebook, or in the notes app on your phone. Let your doctor know immediately if any of your symptoms are so severe they are impairing your ability to function, causing significant distress or discomfort, or jeopardizing your or someone else’s safety.
Symptom Management
Prioritize the supportive behaviors and coping strategies that address your specific symptoms. For example, you can alleviate nausea with over the counter nausea medication such as dramamine or by consuming bland foods or ginger tea. For brain zaps, it is advised to move more slowly, stay hydrated, and avoid alcohol. You can practice deep breathing exercises, mindfulness, grounding techniques, and gentle movement when feeling anxious or irritable. And for insomnia or vivid dreams, you may try basic sleep hygiene strategies or temporarily using sleep aid medication if approved by your doctor.
Adjust Your Plan
The tapering plan least likely to cause severe withdrawal symptoms is one that is more gradual and extends over a longer period of time. If the dosage reduction feels too rapid or the symptoms are too intense or unbearable, re-evaluate your plan with your doctor and they can help you make adjustments as needed.
Ask For Support
While you are hopefully already working closely with your prescribing physician on your tapering plan, let them know if you feel like you need additional support from them or someone else. If you already have a therapist, make sure to inform them of your symptoms or consider finding a therapist who can provide additional monitoring and tools for symptom alleviation. It is also a good idea to let those close to you know about your plan to reduce your SSRI dosage and the potential for withdrawal symptoms, or to notify them if you are struggling so they can help support you.
Share With Others
Lastly, it is important to talk about the real and often underreported withdrawal symptoms that can occur with SSRI use. Many people are still unaware that it is common to experience SSRI withdrawal, which can cause confusion, shame, self-blame, hopelessness, and in some cases, life-threatening consequences. The more open you are with others about your experience, the more it helps others feel less alone and encourages them to seek help. If you would like to learn more about how therapy can support you while you are undergoing SSRI withdrawal, schedule a complimentary consultation here.