If you’re one of the 1.7+ million Aussies on antidepressants, you may be thinking about eventually coming off them. For some, it may seem like an obvious decision to make; you’re feeling on track and you’d like to see how you go without medications.
No matter the situation, this is a decision that should be considered carefully with the support of a doctor or specialist. Depression can be recurring, with studies showing 80% of those with a history of two depression episodes having another episode. It’s important to understand the risks of coming off your medication and the steps you can take to minimise them.
What are antidepressants and how do they work?
To understand what happens to our body when we come off antidepressants, we first need to look at how antidepressants actually work. It’s often said that antidepressants are used to treat a “chemical imbalance”, but that term doesn’t capture how complex depression is. Unsurprisingly, our brains are a little trickier to understand.
To start, research shows that severe depression is linked to certain changes in the brain, including changes to a person’s hormones and ‘chemical message systems’. For every individual, there are millions, even billions, of chemical reactions working together to shape our moods, perceptions, and experiences in life. With this level of activity, you can see how two people might show similar symptoms of depression, however the problem on the inside — the exact source and what treatments will work best — may be entirely different.
For this reason, there are a range of antidepressants that are prescribed according to each individual’s circumstances. While each antidepressant works a little differently, they all target chemical messaging systems in the brain that help regulate mood; the most common type being selective serotonin reuptake inhibitors, or SSRIs, which tend to have fewer side effects.
What will happen to my body when I come off antidepressants?
It’s important to speak to your doctor or specialist if you are thinking about coming off antidepressants. They’ll be able to guide you throughout the journey and monitor your withdrawal.
Certain antidepressants, including SSRIs, are associated with a number of withdrawal symptoms. This is not a sign of addiction, it’s simply a process of your body re-adjusting after being on medication for a period of time. Your doctor will most likely advise you to reduce your dose gradually instead of stopping immediately.
Withdrawal symptoms may often look like anxiety or mild depression, so it’s important to discuss what these symptoms could look like with your doctor first. You may find:
- Withdrawal symptoms may emerge within hours to days of stopping the medication or lowering the dose, depending on the type of antidepressant.
- Withdrawal symptoms may differ depending on the type of antidepressant you are on and may include physical signs that aren’t commonly linked to depression, such as dizziness, nausea, flu-like symptoms, vivid dreams and irritability.
If you notice any withdrawal symptoms that persist over several months, have feelings of wanting to self-harm or thoughts of suicide, don’t keep this to yourself — speak to your doctor or specialist immediately as stopping antidepressants or reducing the dosage may cause a relapse or exacerbation of your mental health condition.
So where to from here?
Commenting on the importance of seeking support when coming off antidepressants, Medibank’s National Director of Telehealth and General Practitioner Georgia Karabatsos said:
“Coming off antidepressants is a decision that should be considered carefully with the support of a doctor or specialist. They will help you understand the risks of stopping the medication, including the risk of recurrence and any withdrawal symptoms so you can make an informed choice. If you choose to stop the medication they will guide you with a suitable plan for the medication you are on. Your doctor is also the best placed to monitor your progress and assist with the management of any symptoms you experience. Support from other mental health professionals and family can also assist in the adjustment and coping with symptoms.”
If you’re considering coming off your medication, Georgia offers some practical steps you can take at this stage:
- Speak to your doctor or therapist
- Ask them whether you should consider reducing your medication over a period of time
- Have a list of questions that you have about your medication and stopping it
- Draw up a chart listing the possible advantages and disadvantages of coming off
- Talk through with a close friend of family member, ideally someone who has previously come off antidepressants themselves
- Read more about antidepressants from a trusted source such as NPS Medicinewise.
For more information and advice on mental health, the beyondblue Support Service is available 24 hours a day via an online live chat or on 1300 22 4636.