Depression or Antidepressant Withdrawal

By: Garry Cooper, LCSW

Reprinted with permission from Psychotherapy Networker magazine. Copyright, Psychotherapy Networker, Inc.

 

The day after Steve, a psychotherapist, decreased his dose of Prozac by only 5 mg, he felt bleak, hopeless, and highly anxious. His doctor, suspecting that Steve’s depression was returning, quickly prescribed a dose of Prozac higher than his original one, and added an antianxiety medication. Steve’s experience is surprisingly common, according to a new book by Harvard psychiatrist Joseph Glenmullen. Patients and doctors often mistake the symptoms of antidepressant withdrawal for depression, and people who try to wean themselves from antidepressants frequently end up back on equal or higher doses of the drugs, and sometimes on additional medications, too.

In The Antidepressant Solution: The Only Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Glenmullen cites studies from several peer-reviewed psychiatric journals finding that 66 percent of Paxil patients and 60 percent of Zoloft patients developed withdrawal symptoms within a few days of stopping their medications. Forty percent of people suffering withdrawal from Luvox reported symptoms so severe that they couldn’t go to work. Yet a 1997 study in the Journal of Clinical Psychiatry, found that 70 percent of family doctors–the health professionals who write the majority of antidepressant prescriptions–weren’t aware that their patients were going through antidepressant withdrawal.

How can you distinguish withdrawal from the return of depression? Symptoms that appear within a day or two of tapering off–you should never stop antidepressants suddenly–are likely signs of withdrawal. Also, symptoms that disappear as soon as you resume the antidepressants were likely withdrawal symptoms.

Withdrawal symptoms, Glenmullen says, can occur every time you miss a day or two of your antidepressant or intentionally step down a dosage, even in minute amounts.

In addition, different antidepressants have different washout times, and so anyone who decides to discontinue an antidepressant should consult a physician–making sure it’s a physician who’s well-versed in withdrawal. That’s especially important because the wide range of withdrawal symptoms can be mistaken for other conditions. Although several symptoms mimic depression–such as lethargy, suicidal thoughts, suicide attempts, crying spells, difficulty concentrating, insomnia, and changes in appetite–other symptoms show up as anxiety, bipolar disorders, and even, occasionally, psychosis. Another long list of withdrawal symptoms may present as flu or gastroenteritis. Other symptoms are dizziness, tremors, electric zaps to the brain or body, or tinnitus.

On his second withdrawal attempt, after he’d learned about gradual withdrawal from psychologist Ann Blake Tracy’s audiotape Help I Can’t Get Off My Antidepressant, Steve stepped down his dose by only 2.5 mgs every three weeks. That methodical decrease, along with exercise, meditation, and other activities that energize him, seems finally to be working.