The hardest antidepressant to come off of is one that has been prescribed for a long time and/or at high doses. Antidepressants can cause physical and psychological dependence, so it is important to taper off slowly under the care of a doctor. The withdrawal process can be difficult, and symptoms may include flu-like symptoms, anxiety, insomnia, and irritability.
Citalopram) (Celexa)
Citalopram is an antidepressant medication that belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs). It is typically used to treat depression and anxiety disorders.
Like all antidepressants, citalopram comes with a risk of side effects and withdrawal symptoms. These can be especially severe when the drug is abruptly stopped or tapered off too quickly. For this reason, it’s important to work with a doctor if you plan to discontinue citalopram.
Citalopram works by increasing levels of serotonin in the brain. This can help improve mood and relieve symptoms of depression and anxiety. However, it can also cause a number of side effects, including:
Nausea
Headache
Dry mouth
Drowsiness or fatigue
Escitalopram (Lexapro)
The first thing to know about coming off escitalopram is that, like all antidepressants, it can be associated with withdrawal symptoms. These may include flu-like symptoms, headaches, nausea, changes in mood and sleeping patterns, and others. It is important to be aware of these potential symptoms before you start tapering off the drug.
There are two different ways that people typically taper off escitalopram. The first is by slowly decreasing the dose over time. This method may take weeks or even months, depending on how long you have been taking the drug and your individual response. The second method is known as “cold turkey” where you stop taking the drug abruptly. This approach can lead to more severe withdrawal symptoms and so it’s generally not recommended unless you are under close medical supervision.
Whichever method you choose, it’s important to be patient and go slowly. Sudden discontinuation of any antidepressant can cause serious side effects so it’s important to work with your doctor to find a plan that’s right for you.
Paroxetine (Paxil)
20.8 percent
Paroxetine, also known by the trade name Paxil, is an antidepressant in a class of drugs called selective serotonin reuptake inhibitors (SSRIs). It is considered one of the more difficult SSRIs to discontinue because of its short half-life and strong association with withdrawal symptoms.
A study published in 2008 in The American Journal of Psychiatry found that 20.8 percent of patients who attempted to discontinue paroxetine experienced at least one symptom consistent with moderate or severe antidepressant withdrawal2. The most common symptoms were dizziness, lightheadedness, paresthesia (tingling or prickling sensations), agitation, and flu-like symptoms. Symptoms typically began within two days of discontinuation and peaked within four to seven days2.
The short half-life of paroxetine may contribute to its high incidence of withdrawal symptoms. A drug’s half-life is the time it takes for the concentration of the drug in your body to be reduced by half3. Paroxetine has a relatively short half-life compared to other SSRIs, which can range from 24 hours (escitalopram) up to 168 hours (fluvoxamine)4. This means that when you stop taking paroxetine suddenly, levels of the drug drop quickly in your body leading to withdrawal reactions2.
If you are considering stopping paroxetine, it is important to work with your doctor to taper off the medication gradually rather than stopping suddenly5. This will give your body time to adjust and may help lessen withdrawal symptoms2,5 .
Sertraline (Zoloft)
The most common side effects of sertraline are: nausea, diarrhea, vomiting, dry mouth, increased sweating, headache, drowsiness or fatigue. These side effects typically go away after a few days. If they persist or become bothersome, contact your doctor. Rarely reported side effects include: mania/hypomania and increase in suicidal thoughts or actions. If you experience these side effects or notice them in a family member who is taking this medication contact your doctor immediately. Sertraline can interact with other medications so be sure to tell your doctor about all the prescription and over-the-counter medications you are taking including vitamins and supplements. Do not start or stop any medications without first talking to your doctor.
Sertraline should be taken exactly as prescribed by your doctor. The usual starting dose of sertraline for adults with depression is 50 mg once daily; however some patients may benefit from doses of 100 mg per day given in divided doses. Treatment with sertraline may be started at a lower dose and gradually increased as needed to achieve clinical response; however treatment should not exceed 200 mg per day given in divided doses unless specifically directed by your physician based on clinical evaluation. It may take several weeks for the full therapeutic effect of sertraline to be seen so do not give up too soon if you don’t see results immediately – stick with it!