Coming Off an Antidepressant: Withdrawal, Relapse, and Tapering Safely

For Patients & Families
Written By Sonia Mia Diaz, MD

Many people can stop an antidepressant successfully, but how they stop matters. Stopping suddenly or over just a couple of weeks raises the chance of withdrawal symptoms and of depression coming back. A slow, gradual taper, planned with a prescriber and paired with support, gives the best odds.

Is It the Right Time?

Coming off an antidepressant is a reasonable goal for many people who have been well for a while. A recent analysis of 76 trials found that a slow taper combined with psychological support prevented relapse about as well as staying on the medication. Abrupt or fast stopping did worse.

It may be worth waiting if you:

In a large primary care trial, more people relapsed within a year after stopping than after continuing (56% vs 39%). But nearly half of those who stopped stayed well. The goal is to find out, carefully, which group you are likely to be in.

How Common Is Withdrawal?

Estimates vary widely, and researchers disagree about them. One large review found that about 31% of people had at least one withdrawal symptom after stopping an antidepressant, compared with 17% after stopping a placebo. Severe symptoms affected about 3%. Other researchers argue the true rate is higher, especially after long-term use.

What is clear: withdrawal is more likely after longer use and higher doses, and with some medications. Paroxetine and venlafaxine are linked to withdrawal more often than others.

Common symptoms include:

  • Dizziness or a spinning feeling

  • Brief "electric shock" sensations, often called brain zaps

  • Nausea or flu-like feelings

  • Trouble sleeping or vivid dreams

  • Irritability, anxiety or tearfulness

  • Feeling unsteady or "off"

Withdrawal or Relapse?

Telling the two apart is the most important part of a taper. Mistaking withdrawal for relapse can keep someone on a medication they no longer need. Mistaking relapse for withdrawal can delay needed treatment.

Medication withdrawal

  • When it starts: usually within days of a dose change

  • What it feels like: often physical and new: dizziness, brain zaps, nausea

  • If the dose is held or slightly raised: often eases within days

Relapse of symptoms

  • When it starts: usually weeks to months later

  • What it feels like: usually the original symptoms returning

  • If the dose is held or slightly raised: improves more slowly, if at all

These are patterns, not rules. Withdrawal can sometimes start late or last longer, and the two can overlap. That is why check-ins during a taper matter.

What a Careful Taper Looks Like

Older guidance suggested cutting the dose in half for two weeks and then stopping. For many people, that is too fast.

Newer approaches, including the Maudsley Deprescribing Guidelines, use proportional (hyperbolic) tapering. Each step reduces the dose by a percentage of the current dose, so the steps get smaller as the dose gets lower. The reason is that the last few milligrams of many antidepressants still have a large effect on the brain.

In practice, that means:

  • Small, steady steps, often a 10% to 25% reduction of the current dose, held for weeks before the next one

  • Doses that make small steps possible, such as liquid formulations, lower-strength tablets, or compounded doses

  • Pausing or stepping back if withdrawal symptoms appear, then going more slowly

  • Support alongside the taper, such as therapy, which improves the odds of staying well

  • A plan for what to watch for, and who to contact

Many tapers take several months. Some take longer, especially after years of use. Speed is not the goal.

Don't skip doses or switch to every other day as a way to taper. Uneven blood levels can make withdrawal worse.

How Welmivia Can Help

Dr. Diaz helps adults in Virginia and Florida come off psychiatric medications by video, using the Maudsley Deprescribing Guidelines. A first evaluation reviews why the medication was started, how you are doing now, and what happened with any past attempts to stop. You get a written taper plan and follow-up visits at each step. Dr. Diaz can coordinate with your primary care physician or therapist.

Welmivia sees private-pay patients and participates in Original Medicare. We are not able to see patients with Medicare Advantage or Medicaid. For private-pay visits, book an evaluation and mention that you'd like to discuss tapering. With Original Medicare, call 434-623-0003 or use our Medicare request form.

What to Take Away

  • Many people can stop an antidepressant, and a slow taper with support works best.

  • Withdrawal usually starts within days of a dose change and eases when the dose is held; relapse comes on later and looks like the original illness.

  • Plan any change with a prescriber; don't stop suddenly or skip doses.

Welmivia is not a crisis service. If someone is in danger, call 911. For a mental health crisis, call or text 988.

Sources

This guide is general information, not medical advice for your situation. Do not change any medication without talking with your prescriber.

Sonia Mia Diaz, MD

Sonia Mia Diaz, MD, is the founder and medical director of Welmivia, a physician-led psychiatric practice that cares for adults in Virginia and Florida by video, including patients with Original Medicare. Her work focuses on diagnostic clarity, careful medication management, and coordinated care with primary care physicians.

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