SSRI withdrawal syndrome, a specific withdrawal syndrome, occurs during discontinuation, dose reduction, or after stopping antidepressant medication (SSRI). It is characteristic of the SSRI withdrawal syndrome that certain physical or psychological withdrawal symptoms develop. Both are also possible. If you take the antidepressant again in the usual amount, the symptoms quickly subside.
What is SSRI Withdrawal Syndrome?
The SSRI withdrawal syndrome is a symptom complex that occurs when the SSRI, a selective reuptake inhibitor, is suddenly discontinued. Due to the long-term administration of SSRI, the most commonly used antidepressant, there is an increased concentration of serotonin in the cerebrospinal fluid. A tolerance develops in the body because the organism adapts to the increased serotonin levels accordingly. See wholevehicles for What are the Meanings of Altitude Retinopathy.
Suddenly stopping taking the SSRI leads to a serotonin deficiency. As a result, the symptoms arise, but they cannot be compared to an addiction reaction, since SSRIs are not addictive. A new equilibrium is established during the transition phase, in which the withdrawal symptoms appear. This phase can be of different lengths and the symptoms are also differently pronounced.
How exactly the SSRI withdrawal syndrome is triggered has not yet been sufficiently clarified. A homeostasis disorder is suspected, i.e. that an artificial stable state arises due to the permanent intake of the SSRI. However, if the antidepressant stops, the body becomes imbalanced. The trigger for the symptoms is the disruption in the hormonal balance caused by the withdrawal of the SSRI.
Serotonin, the messenger substance, and its receptors have numerous functions in the body, which explains the many different withdrawal symptoms. The serotonin transporter is no longer blocked after stopping the drug, so that the serotonin is again increasingly absorbed into the nerve cell and the serotonin concentration drops relatively suddenly. The receptors do not change immediately because these processes take days to weeks.
As a result, an imbalance develops, which leads to the symptoms. The sufferer’s expectations and fears do not play a role as triggers, but they do influence how the SSRI withdrawal syndrome is experienced, felt and managed. The duration of taking the antidepressant can also promote the development of the SSRI withdrawal syndrome. From four weeks there is a risk that the SSRI withdrawal syndrome will develop when the supply of the substance has ended.
Symptoms, Ailments & Signs
SSRI withdrawal syndrome is associated with various physical and/or psychological symptoms. These include sleep disorders, because serotonin regulates sleep. Since the messenger substance serotonin also affects the gastrointestinal tract and there are numerous serotonin receptors in the intestinal mucosa, diarrhea or constipation can also occur if the antidepressant is suddenly discontinued.
Other symptoms that can occur with SSRI withdrawal syndrome are circulatory problems, dizziness, balance disorders, sensory disturbances, physical discomfort, mood swings, muscle cramps, aggressive behavior, severe depression, mania and even suicidal thoughts.
In addition, some patients, particularly those on long-term medication or high doses, may experience long-term symptoms, such as easier confusion, poor short-term memory, difficulty concentrating, and tinnitus, even after SSRI withdrawal syndrome has resolved.
Severe symptoms such as psychomotor restlessness, depersonalization, sexual dysfunction and extreme anxiety are also possible. Patients have reported that long-term symptoms of SSRI withdrawal syndrome usually improve significantly within two years of SSRI discontinuation.
Diagnosis & course of disease
If SSRI withdrawal syndrome is suspected, it is possible to confirm the diagnosis with the help of a validated symptom checklist (DESS). This was developed in clinical studies and effectively helps to correctly record the withdrawal symptoms. It is advisable to work through the list before the SSRIs are discontinued.
The statements can then be easily compared with the symptoms that occur after stopping the antidepressant. The purpose of this is to avoid bias caused by the patient’s lack of memory. If at least three withdrawal symptoms appear or worsen, SSRI withdrawal syndrome is present.
SSRI withdrawal syndrome causes various physical and psychological symptoms. Due to the lack of serotonin, many people can experience insomnia and sometimes gastrointestinal problems, such as diarrhea or constipation. In the further course, circulatory problems as well as balance and sensory disorders can also occur, which increase the risk of accidents and falls.
Possible psychological complications range from mood swings to manic depression and suicidal thoughts. Extreme anxiety, depersonalization, and sexual dysfunction are also possible. In some patients, SSRI withdrawal syndrome has long-term effects such as concentration problems, tinnitus and poor short-term memory. These long-term symptoms usually last for one to two years before gradually disappearing.
In the context of treatment, serious complications are rather unlikely. However, the typically prescribed drugs occasionally cause side effects. For example, benzodiazepines can lead to impaired memory, cognition and responsiveness. Headaches and drowsiness are also typical symptoms.
There is also a risk of drug dependency. Stopping the medication quickly can cause mental disorders such as depressive moods or mania. Antidepressant use can cause fatigue, personality changes, and occasionally gastrointestinal distress.
When should you go to the doctor?
Treatment by a doctor is always necessary for SSRI withdrawal syndrome. It cannot heal itself, so treatment by a doctor is essential. This is the only way to prevent and limit further complications. A doctor should be consulted if the person concerned shows the usual withdrawal symptoms from the drug. This often leads to diarrhea or constipation, which can also lead to severe sleep problems. If these symptoms occur, you should definitely consult a doctor.
Dizziness or cramps in the muscles can also indicate SSRI withdrawal syndrome and should be examined by a doctor. It is not uncommon for those affected to have confusion or tinnitus. Anxiety can also indicate the syndrome and must be examined by a doctor.
The diagnosis and treatment of SSRI withdrawal syndrome is usually carried out by a psychologist. It cannot be universally predicted whether this will lead to complete healing. However, life expectancy is usually not reduced.
Treatment & Therapy
Treatment of symptoms depends on the severity of SSRI withdrawal syndrome triggering withdrawal symptoms. It also plays a role whether further treatment with antidepressants is planned after stopping the SSRI. In the latter case, reintroduction of the medication usually leads to success.
In patients who are no longer taking antidepressants, treatment depends on the severity of the symptoms. For mild cases, sedation and relaxation can be helpful. Moderate withdrawal symptoms are often treated with benzodiazepines.
In cases where SSRI withdrawal syndrome causes severe symptoms, restarting the medication and later tapering off the SSRI in smaller increments may be beneficial. Switching to a long-acting SSRI that is easier to discontinue is often helpful.
The SSRI withdrawal syndrome can be prevented by the fact that antidepressants should generally never be discontinued abruptly. Basically, the treatment with the drug must be gradually ended. This means that the dose should be gradually reduced before stopping.
A minimum of two to four weeks for tapering SSRIs is generally recommended. This phasing out reduces the likelihood of SSRI withdrawal syndrome occurring, but it’s not a surefire way to prevent it.
Follow-up care for SSRI withdrawal syndrome depends on the severity of the withdrawal symptoms. If these are only easy, relaxation methods can help. For moderate severity, patients should follow physician recommendations for taking benzodiazepines. In severe cases, doctors often recommend taking the medication again. It is very important to follow the recommended medication exactly.
Subsequent deductions are made in small increments. If necessary, the doctor may suggest follow-up treatment with antidepressants. Abrupt discontinuation is generally not advisable, so that patients must expect a discontinuation phase of two to four weeks. So you need patience to reduce the syndrome if possible. Through physical activity, preferably outdoors, they feel distracted and no longer perceive the symptoms as clearly.
Sport also helps to regulate the metabolism. The activation of serotonin leads to a better mood in those affected, at the same time they regain more control over their bodies. Patients often suffer from a lack of sleep, but activities in the fresh air tend to make them tired and make it easier for them to rest and fall asleep. Regular rest periods promote a regular sleep rhythm.
You can do that yourself
In the case of a clearly diagnosed SSRI withdrawal syndrome, the treating doctor or psychologist will treat the symptoms in a symptom-oriented manner and, depending on the severity of the symptoms, prescribe medication. He may also recommend an SSRI again, which is easier to stop after a certain period of treatment.
However, patients who consistently want to do without an SSRI in the future should bring a lot of patience with them, since it can take a relatively long time for the serotonin balance in the body to be balanced again without the influence of medication. The most helpful things to do with SSRI withdrawal syndrome are exercise and lots of exercise in the fresh air. On the one hand, sporting activities distract from the symptoms, on the other hand, sport regulates the metabolism and activates serotonin production. This improves both mood and body awareness.
At the same time, sufficient exercise makes you tired, which is particularly helpful for patients who suffer from lack of sleep as a symptom. It is also important for them to establish regular rest periods and always go to bed at the same time. In this way, your body will find its way back to a regular sleeping and waking rhythm after a while.
According to the latest research, a healthy diet also helps with disorders in the serotonin balance and the resulting tendency to depression.