Learn About the Phases of SSRI Withdrawal

Here’s what you need to know about the phases of SSRI withdrawal to safely stop using antidepressants.

An Overview of SSRIs and SSRI Withdrawal

In depression treatment, SSRIs help regulate levels of free serotonin (the happy chemical) in the brain. SSRI antidepressants can allow individuals to feel better, but stopping their intake may be challenging. The SSRI withdrawal timeline may be unpleasant for most people, especially without proper supervision. Medical experts usually advise people to slowly reduce the intake of antidepressants like SSRIs and advise against abruptly discontinuing their use.

SSRI discontinuation syndrome is another term to describe a sudden stop in SSRI intake for depressive symptoms. SSRI withdrawal occurs in different phases, and many typically experience discontinuation symptoms like nausea, hyperarousal, and imbalance. Keep reading to learn more about antidepressants and the different phases of SSRI withdrawal.

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What are SSRIs?

SSRI stands for a class of drugs known as “Selective Serotonin Reuptake Inhibitors.” SSRIs normalize brain function in individuals experiencing certain mood disorders. This class of drugs is commonly used to treat certain forms of anxiety and depression.1

SSRIs help by regulating serotonin levels in the brain, allowing for more balanced neurochemistry, and resulting in a stabilization in mood. Some individuals also combine SSRIs with alcohol for a more intense feeling.

How Long Do SSRIs Take to Work?

In most cases, the effects of SSRIs differ from person to person. However, most individuals begin to observe positive changes after four to six weeks of treatment. In special cases, it takes several months to feel the effects of SSRIs in the body. Note that individuals tend to develop tolerance and dependence, making the relationship between SSRIs and addiction a major concern.

SSRI Withdrawal

How Do SSRIs Work?

Since SSRIs are inhibitors, they function by obstructing the reabsorption of serotonin into neurons. By preventing reuptake, there is more free serotonin available, which improves transmission around neurons.
Additionally, it is important to recognize that because SSRIs are selective-reuptake inhibitors, only certain types of serotonin are prevented from being taken up again. Depending on the specific type of medication, SSRIs vary in their capacity to obstruct the reuptake of serotonin. Due to the effects of the medication, SSRIs and addiction are common among individuals.

Types of SSRIs and Their Side Effects

Most types of SSRI medications have short half-lives. Some individuals also may choose to combine them with other meds like psilocybin. SSRI and psilocybin drugs may have unintended reactions. However, SSRI and psilocybin only help reduce the latter’s side effects without affecting mood. The Food and Drug Administration (FDA) approves the following SSRIs for depression treatment: 2

  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox, Luvox CR)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Paroxetine (Paxil, Paxil CR)
  • Vilazodone (Viibryd)
  • Sertraline (Zoloft)

Possible Side Effects of SSRIs

Because all SSRIs function by acting on the same neurotransmitter mechanism in similar ways it is unsurprising that they have common side effects. However, it’s imperative to note that some people don’t experience any negative effects from SSRIs. Some of the medication’s side effects may last only a few weeks after beginning treatment, while some are more prolonged. 3

Which Side Effects Require a Doctor?

It is advisable to consult the doctor if experiencing any of the following severe side effects of SSRI medications. Some of the notable side effects of the drugs include:
  • Weight changes (some also report weight loss after stopping SSRI use)
  • Sleep disturbances
  • Dizziness
  • Headache
  • Anxiety
  • Dry mouth (Xerostomia)
  • Gastrointestinal issues
  • Lowered libido and sexual issues

SSRI Discontinuation Syndrome

A common term to describe SSRI discontinuation syndrome is “antidepressant discontinuation syndrome.” The syndrome occurs in approximately 20 percent of individuals after abrupt discontinuation of SSRIs taken for a minimum of six weeks. The condition is common due to the development of SSRI dependence.
Typical symptoms of the syndrome include insomnia, imbalance, sensory disturbances, hyperarousal, and flu-like symptoms. It’s important to consult a doctor when experiencing such symptoms during the SSRI timeline.
Here’s a detailed symptom breakdown:

Sensory Symptoms

Some individuals experience paresthesia (burning in the appendage). Other common symptoms include rushing noises in the head and electric shock sensations.

Disequilibrium

The most common symptoms of the disease include vertigo, dizzy spells, and light-headedness.

General Somatic Symptoms

These flu-like symptoms typically include sweating, headaches, fatigue, lethargy, and tremors.

Affective Symptoms

Individuals experiencing affective symptoms observe a change in their outward demeanor. High levels of irritability and anxiety are commonly reported affective symptoms. It is also not uncommon for people to display low moods and fall into tears.

Gastrointestinal Symptoms

Some of the common signs of gastrointestinal issues include nausea, which may cause vomiting. Diarrhea may occur in some individuals.

Sleep Disturbances

SSRI discontinuation syndrome may cause individuals to experience insomnia.4 In some cases insomnia is followed by excessive dreaming and vivid nightmares. Individuals who combine SSRIs with alcohol may also experience more severe effects.

How to Spot Discontinuation Symptoms

If you or a loved one have recently stopped using SSRIs and are concerned over the risk of discontinuation syndrome, FINISH is a mnemonic device to help recall the symptoms. It stands for:

Flu-Like Symptoms

Symptoms like headaches, tremors, colds, and sweats can be a sign of discontinuation syndrome. Individuals may also experience symptoms of reduced appetite or nausea. Other common symptoms associated with the flu are also associated with SSRI discontinuation.

Insomnia

Lack of sleep and sleep disturbances are the most common SSRI discontinuation syndrome symptoms. If someone has difficulty sleeping or frequently wakes up in the night, it may be a sign of discontinuation. Insomnia is one of the most easily identified symptoms.

Nausea

Nausea typically comes before other gastrointestinal issues develop in SSRI discontinuation syndrome. In extreme cases, sufferers may also experience vomiting. Many times, nausea may cause a reduction in appetite, resulting in weight loss. Unpleasant bowel movements have also been reported.

Imbalance

Imbalance is similar to disequilibrium and refers to general dizziness due to withdrawal. Noticeable signs include vertigo and light-headedness.

Sensory Disturbances

Sensory disturbances may manifest as burning sensation around appendages, shocks, and blurry vision with visual trails. In rare cases, some may hear rushing noises inside of their heads.

Hyperarousal

Most individuals experiencing SSRI withdrawal may feel excessively alert without cause. People often experience other problems with sleep, agitation, irritability. Hyperarousal is common in individuals experiencing post-traumatic stress disorder (PTSD).

Why SSRI Withdrawal Symptoms Occur

SSRI medications have a short half-life compared to similar medications. That is because it requires frequent dosing to maintain a consistent blood concentration level. Hence, severe withdrawal symptoms from SSRI medications may occur due to sudden discontinuation and sudden drop in blood concentration levels of SSRIs.

Changes in the Brain

Continuous use of SSRIs causes changes in the brain’s serotonin receptors. Due to these changes, the brain begins to down-regulate the number of receptors it produces due to higher volumes of available serotonin. It is imperative that the brain maintain the right levels of serotonin and serotonin-receptors very carefully to prevent brain cell overstimulation.

Another notable aspect of SSRI consumption is that, after treatment, the body has fewer receptors than before and a serotonin deficiency. This can pose its own subset of side effects on the mind and body. The body usually corrects it, but there is always an adjustment period before normal functioning resumes.

Prevention of SSRI Discontinuation Syndrome

When ending SSRI intake, it’s crucial to take steps to promote SSRI withdrawal relief and avoid recurring symptoms. Here are some two key steps to keep in mind:
Prevention of SSRI Discontinuation Syndrome

Gradual Weaning

To prevent or reduce the severity of SSRI withdrawal syndrome symptoms SSRIs need to tapered off gradually. Doses are commonly reduced in intervals until eventually stopped entirely.

Tapering is important for warding off side effects of SSRI discontinuation helping avoid severe SSRI withdrawal symptoms. When tapering off SSRI medications, timing is important. 5 It is commonly advised not to reduce the dose more than once every two weeks to six weeks, depending on the medication’s strength.

Professional Guidelines

Speak to a licensed medical expert for a comprehensive treatment plan for SSRI withdrawal relief. Professional guidelines, clinical experience and training help physicians develop appropriate dosage reduction plans on a case-by-case basis. Individual plans may consider how long a patient has been using that SSRI medication, previously documented symptoms, and the currently prescribed dosage.