STOPPING ANTIDEPRESSANTS
Stopping use of antidepressant medication should be considered if:
- The depression is in remission and medication is not needed
- The drug has not helped
- Side effects or risks outweigh the benefits.
Little research is available to guide how to successfully stop.
There is research indicating high risk of relapse of depression if there are:
- Three or more previous depressions
- Short periods of wellness between depression
- Very severe prior depression
- Depression with psychotic features
- Age of first depression before age 17 or after age 65.
In general, a minimum 9 months on medication is best in order to lower risk of relapse
Psychotherapy is known to help depression about as well as medication. People who want to maximize their chance of getting off medication and to stay off should give therapy their best effort while they are stabilized on medication.
In addition, lifestyle changes can provide significant support. Regular vigorous exercise has been shown to be effective in mild to moderate depression. Since negative thoughts are a hallmark of depression, learning to practice mindfulness can have a major impact in learning to recognize and reduce these damaging thoughts. In conjunction with your therapist, physician, or other helpers, each person should develop a personalized plan of self-support and implement it.
To increase your chance of success, avoid stopping medication during a difficult time such as a physical health challenge, family crisis, job loss or times of high stress. Slow tapering of the total dosage of antidepressant over 4 to 6 weeks will help minimize withdrawal symptoms. Some people may need even slower tapering with each dose reduction every 4-8 weeks. Despite slow tapering, many people may have symptoms of anxiety or depression occur that are actually from withdrawal. These usually subside in 1-2 weeks but they can be very distressing. If depressive symptoms worsen over time when off the medication, it means a relapse has occurred and medication should be restarted.
Supplements that may be helpful in treatment of depression include Vitamin B12, (possibly Vitamin D), folic acid, omega-3 fatty acids, SAMe and St. Johns wort. Consult with your physician or knowledgeable natural health practitioner about use of these.
Resources include:
- "Taking Antidepressants: Your Comprehensive Guide to Starting, Staying on and Safely Quitting" by Michael Banov MD.
- "Wherever You Go, There You Are" by Jon Kabat-Zinn (excellent book on mindfulness – what it is, how to develop a practice, benefits and pitfalls).
Daniel Blodgett MD