Antidepressants are among the most commonly prescribed medications in the United States, and most people who take them do so safely under a doctor’s care. They are not addictive in the clinical sense. However, taking them for more than a few weeks can lead to physical dependence, which means stopping suddenly can trigger uncomfortable and sometimes serious withdrawal-like symptoms known as antidepressant discontinuation syndrome.
Read on to understand how antidepressants work, what discontinuation syndrome looks like, and how a medically supervised taper can help you come off these medications safely if you and your doctor decide it’s time.
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Understanding How Antidepressants Work
Antidepressants are typically prescribed to treat depression. In some cases, however, a doctor might give antidepressants for ADHD, anxiety disorders, PTSD (post-traumatic stress disorder), major depressive disorder, and OCD (obsessive compulsive disorder).
Since antidepressants work on such complex mental illnesses, studies on their effectiveness and how they work are still not exclusive. Theories differ because the causes behind each of these mental issues are complex and we’re yet to fully understand them.
That said, the most prevalent theories on how antidepressants work are:
Theory 1
Antidepressants help patients process more positive information than negative. Patients will recall more positive memories, notice the silver lining in situations more often, and read positive social cues and facial expressions better.
Theory 2
Antidepressants cross the blood-brain barrier to reach the brain circuits and chemicals they target. They increase the availability of certain neurotransmitters, such as serotonin and norepinephrine, by slowing how quickly the brain reabsorbs them. Over time, this shift in brain chemistry is thought to support more stable mood.
Theory 3
The aforementioned mental illnesses can cause increased levels of stress, affecting both a patient’s body and brain. This stress will damage the brain and how it functions. Antidepressants work on repairing that damage by forming new synapses instead of the ones lost to stress.
Types of Antidepressants With Examples
Contrary to popular belief, not all antidepressants are created equal or can be used to treat the same issue. Different antidepressants target your brain in unique ways, each leading to distinctive results.
Here’s another interesting fact: there are both old and novel antidepressants. In this section, we focus mainly on the newer ones as few doctors continue to prescribe old antidepressants (like MAOIs). That’s mainly because of their risky side effects and high potential for overdose.
Note: The following types of antidepressants are known as reuptake inhibitors (RIs). They ‘inhibit’ the brain’s natural process of ‘reuptake’ or reabsorption of neurotransmitters after they’re released. By inhibiting their reuptake, these neurotransmitters stay in your system longer.
SSRIs
SSRIs stand for selective serotonin reuptake inhibitors. As such, this class of antidepressants increases the level of serotonin (a mood-regulator neurotransmitter) in your system upon taking. It’s also why they’re the most commonly prescribed presently.
SSRIs are a newer class of antidepressants, and researchers are still studying exactly how they produce their effects. Most are FDA-approved and prescribed beyond depression alone, including for anxiety disorders, OCD, PTSD, panic disorder, and certain other conditions as determined by a physician.
Examples of SSRIs include the brand names Prozac, Lexapro, Celexa, Zoloft, and Paxil.
Important safety note: SSRIs carry an FDA boxed warning for an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults under 25, particularly during the first few months of treatment or after a dose change. Anyone starting an antidepressant should be monitored closely by their prescriber, and worsening mood or suicidal thoughts should be reported to a doctor right away.
SNRIs
Serotonin and norepinephrine reuptake inhibitors (SNRIs) much like SSRIs work on serotonin.
The only difference is that they target the levels of norepinephrine in your system as well. This neurotransmitter, norepinephrine, doesn’t just regulate mood like serotonin, but it also helps with arousal, stress regulation, cognitive function, and attention.
As such, SNRIs are typically given to people with more than depression, like anxiety disorders and chronic nerve pain. Some SNRI examples are Fetzima, Effexor, Pristiq, and Cymbalta.
NDRIs
NDRIs are norepinephrine and dopamine reuptake inhibitors. They target norepinephrine (the aforementioned mood regulator) and dopamine, a neurotransmitter that prompts feelings of pleasure and satisfaction.
Interestingly, NDRIs aren’t as widely prescribed as SNRIs and SSRIs. Currently, the only medicine that’s FDA-approved is Wellbutrin (bupropion). It’s used to treat depression, seasonal affective disorders, and smoking cessation.
Common Side Effects When Taking Antidepressants
Antidepressant medication, while effective in treating mental health conditions, comes with its fair share of side effects.
Note, however, that different classes of antidepressants lead to different side effects, depending on how they work and their dosage. That said, SNRIs and SSRIs share the most side effects.
So, common side effects when taking antidepressants include:
- Indigestion, diarrhea, and constipation
- Loss of appetite leading to weight loss
- Dry mouth
- Excessive sweating and the shakes
- Dizziness or blurry vision
- Insomnia or drowsiness
- Severe headaches
- Compromised sex drive
- Nausea or the feeling of being sick
- Fever or overheating
- Low blood pressure
Note: When the side effects start to show, their severity varies according to your body composition and the antidepressant you’re taking. Usually, side effects are worse within the first to second week of being on the meds before they fizzle out.
Stopping an antidepressant abruptly after taking it for more than a few weeks can cause a condition known as antidepressant discontinuation syndrome (ADS). The next section covers what it is in detail.
What Antidepressant Discontinuation Syndrome (ADS) Is
Antidepressant discontinuation syndrome is the body’s response to a sudden drop in medication levels after the brain has adapted to the drug’s presence. It is a sign of physical dependence, not addiction, and it’s the main reason you should never stop an antidepressant abruptly or without guidance from a medical professional.
Keep in mind: ADS is uncommon in people who have taken an antidepressant for a short time, typically less than six weeks.
Common ADS symptoms include:
- Flu-like fatigue and achiness
- Headaches
- Vivid dreams or nightmares
- Nausea and sweating
- Dizziness or vertigo
- Mood changes and irritability
- Sensory disturbances, such as tingling or brief “electric shock” sensations
Less commonly, people may experience:
- A return or worsening of depression or anxiety
- Mania or hypomania (more likely in people with bipolar disorder)
- Suicidal thoughts
For most people, ADS symptoms begin within a few days of stopping and resolve within one to two weeks. A smaller number of people experience protracted symptoms lasting months, which is more likely after long-term use or with medications that leave the body quickly, such as Paxil and Effexor. If symptoms are severe or a low mood returns, contact your prescriber; restarting the medication and tapering more gradually usually relieves symptoms.
It can also be hard to tell ADS apart from the return of the original condition the medication was treating. This is another reason any decision to stop should be made together with a doctor.
Treating Antidepressant Dependence
To clarify, antidepressants don’t lead to addiction the way substances like opioids or alcohol can. Instead, long-term use creates a physical dependence, which means the body needs time to readjust when the medication is reduced. The safe way to manage that adjustment is a gradual, medically supervised taper.
Medically Supervised Tapering
Rather than stopping all at once, your prescriber lowers your dose in small steps over weeks or months, giving your brain time to adapt at each stage. The right pace depends on the medication, how long you’ve taken it, and how your body responds. In some cases, a doctor may switch you to an antidepressant that leaves the body more slowly, such as Prozac, to make the taper smoother.
Tapering can still be a demanding process. The symptoms your antidepressant was managing may resurface, which is why medical supervision matters: your care team can monitor your mental health, adjust the taper schedule, and step in quickly if symptoms of depression or anxiety return.
Therapy
Therapy plays an important role while coming off an antidepressant. It helps you build coping skills for the symptoms the medication was managing and gives you a supportive setting to work through the underlying causes of depression or anxiety.
Individual, one-on-one therapy isn’t the only option either. Group therapy connects you with people navigating similar experiences with mental health and medication changes. Through shared experiences, you see that you’re not alone in this.
Seek Our Services at Garden State Treatment Center
Antidepressants are important, often life-changing medications for many people, and deciding whether to stay on them, adjust them, or taper off is a decision to make with a doctor, not alone.
If you’re experiencing discontinuation symptoms, struggling with a medication change, or managing antidepressant dependence alongside another substance use or mental health concern, the team at Garden State Treatment Center can help. Contact us today to learn more about antidepressant tapering support and co-occurring treatment near you.
