Many people experience withdrawal symptoms when they try to stop antidepressants. So how can you stop safely?

About one in seven Australians takes antidepressants. The decision to start is often made in a time of crisis, with the thought that it might help for a period and then stop. Most people don't start on antidepressants thinking they'll be on them for life.

Clinical guidelines recommend only six to 12 months of antidepressant therapy for a single episode of moderate to severe depression.

However, about half of people taking antidepressants have used them for more than 12 months. People may experience unpleasant withdrawal symptoms when they try to stop antidepressants, leading to restarting or continuing antidepressants.

A recent Lancet systematic review found that about one in six to seven people experienced withdrawal symptoms when they stopped antidepressants. This is likely an underestimate, as most of the people in the studies had been taking antidepressants for only a few months.

What did the researchers find?

The Lancet review, which included 79 studies and 21,000 people, found that 15% of antidepressant users experienced withdrawal symptoms after they stopped taking the drug. Common symptoms included dizziness, headache, nausea, insomnia and nervousness.

Withdrawal symptoms are more common in people who have taken antidepressants for a long time. But the Lancet study mostly included people who took the antidepressants for only a short time – mostly for about three to six months, but sometimes as little as a week.

So the finding that one in six people who stop taking antidepressants experience withdrawal symptoms is likely an underestimate; this figure only applies to a small subset of people who took antidepressants.

The Lancet review also found that around 3% of people experienced severe withdrawal symptoms, including suicidal thoughts. Again, this is likely an underestimate, as it does not include long-term users who are more likely to experience withdrawal symptoms and experience more severe withdrawal symptoms.

Working out what is actually causing the symptoms

Some people continue to take antidepressants for a long time in the belief that they are treating or preventing symptoms of anxiety or depression, but since many of the symptoms are similar, they may only be treating or preventing withdrawal symptoms.

However, long-term use (more than 12 months) of antidepressants is not harmless. Taking antidepressants for more than 12 months can cause:

• emotional numbness
• sexual dysfunction, which may be long-term, including low libido and difficulty reaching orgasm in both men and women
• weight gain
• lethargy or fatigue
• increased risk of falls in the elderly.

Low awareness and recognition of withdrawal symptoms has resulted in both doctors and patients misinterpreting withdrawal symptoms as a "relapse" of anxiety or depression and the continued need for medication.

The confusion is easy to understand since some of the withdrawal symptoms are also symptoms of anxiety and/or depression.

Symptoms of retreat include irritability, nervousness, insomnia, fatigue, and agitation.

Symptoms of nightmarish include "feeling nervous, anxious or on edge" and "getting upset or irritated easily".

Symptoms of DEPRESSION include "trouble falling or staying asleep," "feeling tired or low on energy," and "being restless or restless."

But it is possible to distinguish withdrawal from relapse. In addition to feeling anxious and nervous, people experiencing withdrawal may also experience:

• dizziness, vertigo (spinning sensation) or lightheadedness
• Sensations of electric shock (brain shocks)
• imbalance
• increased sensitivity to light or noise
• tinnitus
• nausea, diarrhea or upset stomach
• muscle spasms or cramps
• vivid dreams or nightmares
• tremors
• Turmoil
• sweating.

How did people stop antidepressants?

Until recently, information on how to minimize withdrawal symptoms to enable people to safely stop antidepressants has been limited.

Previous advice was often to halve the dose, halve again and then stop; or to take antidepressants on alternate days; or switch to a different antidepressant.

But while intentional, these methods are likely to result in withdrawal symptoms.

Withdrawal symptoms tend to begin within hours, days, or sometimes weeks of stopping or reducing the dose of the antidepressant and can last for weeks or more.

So how can I safely stop?

Brain imaging techniques support a slow tapering of the antidepressant drug to provide a lasting change in the brain to minimize withdrawal symptoms.

"Hyperbolic Rejuvenation" uses progressively smaller decreases in drug doses. For example, a tapering schedule of 50 mg, 25 mg, 15 mg, 10 mg, 6 mg, 4 mg, 2 mg, 1 mg, then 0 mg (stop) gives a lasting change in the brain.

A slow, hyperbolic tapering of the drug can minimize withdrawal symptoms, giving the brain time to adjust to being off the antidepressants and stopping safely.

Updated clinical guidelines now recommend this hyperbolic slow-tapering antidepressant approach.

At the University of Queensland, we are conducting a randomized controlled trial in general practice, testing the effectiveness of specific hyperbolic tapering schedules of antidepressants, developed to support people to stop antidepressants safely.

The mini-doses of antidepressants required to taper them off are not readily available in Australia. But people can access mini-doses of antidepressants through a compounding chemist (or for some antidepressants, by crushing a tablet and mixing it with water or diluting a liquid formula, in consultation with your doctor).

If you're considering coming off antidepressants, talk to your doctor, who can support and monitor you through the safe stopping process.