Stopping an Antidepressant cold turkey
- Sara L
- Feb 18, 2024
- 6 min read
Concerns regarding children stopping antidepressants suddenly is a question that I see a lot. Typically a mother asks:
"My child doesn't want to be their antidepressant anymore, so they just stopped taking it without going down slowly like the MD suggested. Now I’m worried."
Stopping antidepressants cold turkey can make your child feel pretty crummy. They can feel symptoms shown in the handy mnemonic below called "FINISH"¹;
Flu-like symptoms (lethargy, fatigue, headache, achiness, sweating)
Insomnia (with vivid dreams or nightmares)
Nausea (sometimes vomiting)
Imbalance (dizziness, vertigo, light-headedness)
Sensory disturbances (burning, tingling, electric zaps, rushing noise in head)
Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness)
That is why your child’s healthcare provider will typically suggest slowly decreasing the dose over a few weeks. This gives their brain and body time to adjust to the reduced dose of the antidepressant that they have become accustomed to.
Accustomed to? Hold up. Are these like, withdrawal symptoms? Does it mean that my child’s body is addicted to the antidepressant?
No. Antidepressants are not addictive or habit forming. No one is getting "high" from an antidepressant. Once your child is off the antidepressant they won't crave it as they would an illegal drug, for example.
The symptoms of Discontinuation Syndrome are caused by adjustments happening in the body when the antidepressant is removed. It's due to the changes in the body that happen when stopping any medicine, like when someone with hypertension stops taking their antihypertensive medication.
The reason they feel lousy when they stop taking the antidepressant suddenly is that their brain and body no longer have a nice supply of serotonin. The brain has been pulled out of a warm jacuzzi and thrown into a cold shower. The body and brain are going to react to that. There was no gradual easing out of the hot tub. It’s kind of a shock to the system and will take the brain and body a little time to get back to baseline again.
Is Discontinuation Syndrome dangerous?
No, just uncomfortable. They will feel like they have the flu or a stomach bug for
a couple of weeks (typically by the 10th day) before feeling like they felt before starting the antidepressant again. In rare cases the symptoms can last for several weeks to months. During this process, keep your child's healthcare provider up to date regarding your child's symptoms and progress so that they can give you advice and help out if your child is having a difficult time.
I’d say the bigger concern is if your child had moderate–severe depression requiring the antidepressant in the first place—which is now not controlled because they have stopped their antidepressant with no plans to start a different one. This could cause them to hurt themselves. So it's always best to loop in your child’s healthcare provider so that there is a plan in place if and when your child suddenly stops taking their antidepressant.
What would make the Discontinuation Syndrome worse for my child?
There are 3 factors that impact the severity of discontinuation syndrome:
The amount of time your child has been on the medication. Usually if they have been on the antidepressant for a month or more, they can expect to experience uncomfortable symptoms.
How high the dose of the antidepressant is. Higher doses mean higher likelihood of discontinuation symptoms. Think about driving a car at 60 mph then slamming on the breaks. You're going to feel that versus creeping along at 10mph them rolling to a stop.
Half life of the drug. The half life is the time it takes for the body to remove half of the antidepressant. For example, the half life of Zoloft is 24 hours. Therefore it takes a whole day for your body to remove half of whatever dose you took.
For antidepressants with short half lives, your body is going to get rid of it pretty quickly. Therefore if it is stopped suddenly and you don't give your body another dose, you are going to feel the symptoms of Discontinuation Syndrome. This happens most often with Paxil and Effexor given their short half lives.
By comparison, Prozac has a half life of 7 days, so it works its way out of the body very slowly.
What can I do to make it easier to handle for my child during this time?
Make them as comfortable as possible. They are probably not going to school at this time, especially if they have flu-like symptoms (the school won't want them there anyway if they sound ill).
Help them rest as much as you can. Encourage a balanced diet free of artificial colors or flavors, as these might make them feel angsty and irritable. Get them outside for some light exercise to move their bodies and release "feel good" chemicals to help with the lousy feeling.
For any aches and pains it is best to use hot/cold compresses. Avoid ibuprofen as this could upset their tummy and, depending on which antidepressant they were taking, could cause bleeding in their stomach. Discuss other pain medication options with your child's health care provider.
How long will it last? Will it go away?
Symptoms typically start 2–4 days after the medication has been stopped and can last 1–2 weeks. In rare cases the symptoms can actually last up to one year¹. Therefore it is important to talk to your child about coming down off the medication slowly.
Their healthcare provider should be able to provide you with something called a tapering schedule. It gives clear instructions on how to decrease the dose of the medication slowly to limit discontinuation symptoms.
Does following a taper schedule guarantee that my child won't feel the effects of Discontinuation Syndrome?
Unfortunately, no. Even coming off the medication slowly they still might feel lousy and have side effects but they should be less severe than if they were to stop suddenly. If they don't feel great during the taper, tell your child’s healthcare provider so that they can increase the dose back up a little bit. This gives the brain and body time to adjust to the lower dose, like taking a pit stop, before the dose is decreased again.
Another option would be switching the antidepressant out for something like Prozac, with its super-long half life, which works its way out of the body gradually over weeks. This would be a gentler off-ramp from the antidepressant medication.
If my child is going to experience symptoms either way, why not just stop cold turkey?
Because, they will feel way worse if they stop suddenly. Decreasing the dose in a stepwise manner is less of a shock to the brain, so while they still might not feel great, they will feel better than if they stopped suddenly.
In conclusion
Going cold turkey off the antidepressant is very unlikely to cause any serious, permanent damage to your child, directly, but they will feel worse than if they had reduced the dose of their medication gradually over multiple weeks. If they do stop suddenly they can expect to feel pretty lousy for a couple of weeks. You can help by keeping them comfortable, letting them rest, encouraging a balanced diet and light exercise.
Indirectly, stopping antidepressants may lead to an episode of self-harm so it's never something to be done lightly.
If your child says they want to come off their antidepressant, explore reasons with them. It's a great idea to include your child's healthcare provider in this conversation to see if there's anything that they can do on their end to help address your child's concerns.
Examples would include decreasing the dose of the current antidepressant if they are having problems with side effects, or switching it out for a different antidepressant that works differently and won’t cause as many issues as the first one.
If your child is wanting to stop the antidepressant because of side effects, genetic testing is a good option to help narrow in on what antidepressants would be a better fit for their bodies and cause them fewer problems. I covered genetic testing here.
If they have moderate to severe depression then more than likely they are still going to need another antidepressant to control these symptoms once they stop taking the original antidepressant. Again discuss this with your child’s healthcare provider.
If your child still decides that they would like to come off their antidepressants, get a tapering plan going with their healthcare provider. They should be able to write out day-by-day instructions on dosing to limit the crumminess your child will feel coming off the antidepressant. This could include slow dose adjustments week by week or even switching out for something longer acting like prozac with a gradual off-ramp effect.
In the hand out for this week here I have included a visual summary of what Discontinuation Syndrome looks like, and an example of a taper schedule for an antidepressant.
Do not attempt a taper schedule on your own, your child's healthcare provider will need to monitor your child and provide adjustments and advice as needed to keep them comfortable.
This site is for general informational purposes only and does not constitute the giving of medical advice. The contents do not constitute the practice of medicine, nursing, or other professional health care services. No provider–patient relationship is formed.
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