Navigating Antidepressant Withdrawal: What You Need to Know & the Power of Hyperbolic Tapering
A Holistic Perspective
As a psychiatrist, I wholeheartedly advocate for treatment of mental health conditions and prescribe psychiatric medications. However, as a holistic psychiatrist, I believe psychiatric medications should be prescribed judiciously, as one treatment tool, instead of as the only tool.
If psychiatric medications have positively impacted your life, that’s something to be celebrated. However, many individuals either don’t find the relief they seek despite trying different medications, experience challenging side effects, or wish to explore alternatives or discontinue their use.
In either situation, my goal is to offer an alternative perspective on mental health care—one that goes beyond the common belief that antidepressants and other psychiatric medications are the only solution or treatment. With more knowledge at your disposal, you can make informed decisions that are personalized to you, helping you reach your full potential.
Today, let’s dive into a crucial topic: coming off antidepressants.
The Reality of Antidepressant Use
Antidepressants are prescribed for a variety of reasons, not just depression. They are often the go-to treatment for anxiety disorders like GAD (generalized anxiety disorder), SAD (social anxiety disorder), and panic disorder. Beyond these, they’re also used for conditions like fibromyalgia, neuropathic pain, migraine prevention, and conditions like premature ejaculation and agitation in dementia. The term “antidepressants” encompasses a range of medications, including SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin-norepinephrine reuptake inhibitors), and atypical antidepressants such as Wellbutrin, Mirtazapine, and Trazodone, to name a few.
The use of these medications is widespread. According to the CDC, “During 2015–2018, 13.2% of Americans aged 18 and over reported taking antidepressant medication in the past 30 days.” The number of antidepressant prescriptions has increased since then, especially over COVID. This figure doesn’t even account for the growing number of children under 18 who are also being prescribed these medications.
The Challenge of Coming Off Antidepressants
The experience of discontinuing antidepressants varies widely. For some, it’s a straightforward process. But for others, it can be incredibly challenging, both physically and emotionally, leading many to stay on their medication simply to avoid the discomfort of withdrawal—even when they’re unsure if the medication is still effective.
Approximately 50% of people who stop taking antidepressants experience withdrawal symptoms. These can range from dizziness and anxiety to more severe symptoms like "brain zaps" (electric shock sensations in the head) and even suicidal thoughts. The likelihood of experiencing withdrawal depends on several factors, including the type of antidepressant, the duration of use, and individual differences in how the body processes these medications.
The Medical School Narrative
In medical school, doctors are taught that stopping antidepressants too abruptly can lead to something called “discontinuation syndrome.” We’re told that a small percentage of patients might experience mild “flu-like” symptoms if they stop suddenly, and that tapering off—gradually reducing the dose over a couple of weeks—can help avoid these symptoms. The process is often presented as straightforward and manageable. If emotional symptoms reappear during the tapering process, it’s assumed that the underlying mental health condition is resurfacing, and the patient must remain on the medication.
However, this narrative has significant gaps.
The Realities of Antidepressant Withdrawal
First, withdrawal symptoms are not just “mild, flu-like symptoms.” They can be severe and debilitating, including intense anxiety, muscle aches, and even suicidal thoughts. Here’s a full list of possibilities:
Flu-like symptoms (lethargy, fatigue, headache, achiness, sweating, diarrhea)
Insomnia (with vivid dreams or nightmares)
Nausea (sometimes vomiting),
Imbalance (dizziness, vertigo, light-headedness)
Sensory disturbances (“burning,” “tingling,” “electric-like” or “shock-like” sensations)
Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness)
Impaired concentration
Low mood (hopelessness, suicidal thoughts)
Second, these symptoms don’t only occur when you stop the medication. For some, withdrawal symptoms can start to appear between doses, especially with medications like Effexor, where missing a dose by just a few hours can trigger withdrawal.
Third, withdrawal is not a rare occurrence. As mentioned, about half of all people on antidepressants experience withdrawal symptoms when they stop.
Fourth, even individuals without a psychiatric diagnosis who take antidepressants can experience withdrawal symptoms, both physical and emotional, when they discontinue the medication. This indicates that the symptoms aren’t merely a return of the original mental health condition but rather a response to the body’s dependence on the medication.
Understanding Physical Dependence
Antidepressant withdrawal occurs because the body develops a physical dependence on the medication. This means that when you stop taking it—whether abruptly or gradually—you’re likely to experience withdrawal symptoms, which can sometimes be worse than the symptoms you started with.
Physical dependence occurs when the body adapts to the presence of a substance to function normally, leading to withdrawal symptoms if the substance is reduced or stopped. In this case, the substance is an antidepressant.
You might be thinking of the term "addiction," which is understandable since withdrawal is often associated with it. However, it's important to distinguish between physical dependence and addiction. While addiction always includes physical dependence, physical dependence alone doesn't mean you're addicted. Addiction involves not just dependence, but also compulsive drug use, loss of control, persistent cravings, continued use despite negative consequences, and disruptions in daily life and relationships.
For example, you might develop a physical dependence on caffeine—needing two cups instead of one to feel energized, and experiencing headaches if you skip it. However, this isn't an addiction unless it's causing serious issues like losing your job or engaging in harmful behaviors to get your fix (though some do experience caffeine addiction).
The Solution: Hyperbolic Tapering
Unfortunately, there’s no way to predict whether you’ll have an easy time coming off antidepressants or if you’ll struggle. The only way to know is to try. However, there’s promising research on how to improve the tapering process to minimize withdrawal symptoms from the start.
Traditionally, tapering is done linearly—reducing the dose by half every few days over a couple of weeks. But for many, this method leads to withdrawal symptoms. A more effective approach is hyperbolic tapering.
Unlike the linear method, hyperbolic tapering involves decreasing the dose by smaller and smaller amounts as you get closer to discontinuation. This method recognizes that the body perceives these reductions differently depending on the stage of tapering. For instance, going from 100mg to 75mg might feel like a 25% reduction, but the same decrease of 25mg from 25mg to 0mg is a 100% reduction, which the body perceives as a much more significant change, often leading to withdrawal symptoms.
Hyperbolic tapering allows for a smoother transition, minimizing withdrawal symptoms by tricking the body into not noticing the decrease in medication as much.
Challenges and Solutions:
One of the challenges of hyperbolic tapering is that it’s not always possible with standard prescriptions due to dosing limitations. For example, Zoloft’s smallest available dose is 25mg which isn’t small enough to accomplish hyperbolic tapering. However, there are solutions. Some antidepressants come in liquid form, allowing for more precise dose reductions. If your medication doesn’t, compounding pharmacies can create custom doses, though this may not be covered by insurance. For medications that can be split (such as those that aren't extended-release formulations), pill cutters are also useful to split tablets into smaller doses.
Due to the misinformation taught in medical school, mant doctors see antidepressants as safe and prescribe them without much hesitation. However, most aren’t aware of the real risks of withdrawal or how to properly taper someone off to minimize those effects. I think every doctor who prescribes these medications should also know how to use hyperbolic tapering, so their patients don’t have to deal with tough withdrawal symptoms or stay on a medication they want to stop just to avoid them.
Given that many doctors are not trained in hyperbolic tapering or the realities of antidepressant withdrawal, it’s crucial to seek out a healthcare provider who is knowledgeable in these areas.
At Brain-Body Psychiatry, we help you taper off antidepressants and other psychiatric medications with the gentle approach of hyperbolic tapering. We also provide whole brain and body support as you come off them.
If you’re unable to work with us directly, here are some resources to consider or bring to your psychiatric provider:
Final Thoughts:
Remember, never stop your antidepressant cold turkey to avoid severe withdrawal symptoms. And know that there are resources and support available to help you through this process. You deserve the best possible chance of coming off antidepressants without withdrawal symptoms. I’m excited to work together to achieve your goals.
With care,
Dr. Luisa Cacciaguida
Disclaimer:
This blog post is intended to be informative and does not replace individual medical advice. Always consult with your healthcare provider or a professional for any personal medical decisions or concerns you may have. Everyone's health situation is unique and should be evaluated by a healthcare professional.
This blog post is designed as a general guide. This is not a substitute for personalized medical advice, nor is a patient-physician relationship established in this blog post.
