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Phases of SSRI Withdrawal: What You Need to Know

Phases of SSRI Withdrawal: What You Need to Know

Abruptly quitting an SSRI can cause you to experience both physical and psychological discomfort. If you have been thinking about ending your use of an antidepressant from this category, it is important to do so gradually, under the supervision of a qualified professional who is familiar with the phases of SSRI withdrawal. 

What Are SSRIs?

Before we delve into the phases of SSRI withdrawal, let’s take a moment to review what these medications are, who they can help, and how they work.

SSRIs (selective serotonin reuptake inhibitors) are a class of prescription medications that are most commonly used to alleviate the symptoms of depression. They have also been approved by the U.S. Food and Drug Administration (FDA) to treat people who have the following conditions:

  • Generalized anxiety disorder (GAD)
  • Panic disorder
  • Social anxiety disorder
  • Bipolar disorder
  • Premenstrual dysphoric disorder
  • Posttraumatic stress disorder (PTSD)
  • Bulimia nervosa
  • Obsessive-compulsive disorder (OCD)

The first SSRI to earn FDA approval was fluoxetine. This medication was approved in 1987, and it began to be sold in the U.S. (under the brand name Prozac) in 1988. Today, the category of SSRIs includes several other medications, including:

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

As the category name suggests, SSRIs alter levels of serotonin, a naturally occurring neurotransmitter (or chemical messenger) that is associated with functions such as mood, the sleep/wake cycle, and sex drive.

Here’s a quick look at how SSRIs work:

  • When a neuron (nerve cell) releases serotonin, the chemical enters the synapse, which is the gap that separates one neuron from the next. 
  • Once the serotonin delivers its message to the receiving neuron, special proteins called serotonin transporters absorb it so that it can be recycled and reused.
  • SSRIs attach to these transporters, which prevents them from absorbing serotonin. This leads to a buildup of serotonin in the synapse, which has the effect of amplifying the message that the neurotransmitter is delivering.
  • For some patients, elevated serotonin levels lead to improved mood and energy, as well as a decrease of other symptoms that are associated with depression and other mental health concerns.

SSRIs are safe for long-term use. However, there are many reasons why people may decide to stop taking them. Some people may end their SSRI use because the medication doesn’t ease their symptoms, others may do so because of side effects, and still others may choose to stop using them once they feel they are better prepared to manage their symptoms without pharmacological assistance.

Regardless of why a person decides to discontinue their SSRI use, it is important for them to do so slowly, under the guidance of a qualified healthcare provider. As we will discuss in the next two sections, people who abruptly stop using SSRIs can experience a variety of potentially distressing withdrawal symptoms.

Why Do SSRIs Cause Withdrawal Symptoms?

When someone uses a substance for an extended period of time, their body adapts to its presence. When that substance is suddenly no longer in the person’s system, their body may react with a variety of unpleasant symptoms. This is known as withdrawal.

Withdrawal is often associated with addictions to recreational drugs such as alcohol, cocaine, and heroin – but it can also impact people who take SSRIs and other prescription medications.

In the case of SSRIs, withdrawal symptoms are related to how they interfere with the reabsorption of serotonin. 

When a person stops taking an SSRI, serotonin transporters on neurons throughout the central nervous system can once again function at full capacity. But the previous buildup of the neurotransmitter may have led to diminished serotonin production. This can cause a rapid drop in serotonin levels, which can lead to low mood, decreased energy, and other symptoms.

Phases of SSRI Withdrawal

The onset, intensity, and duration of SSRI withdrawal symptoms can be influenced by several factors, including the type of medication someone has been taking, their dosage level, and how long they had been taking it.

In general, though, there are two distinct phases of SSRI withdrawal, acute and protracted:

Acute SSRI Withdrawal

The acute phase of SSRI withdrawal can begin within a day or two after a person’s last dose. For some people, the acute phase is over within a few days. For others, this phase can take up to eight weeks. 

Common symptoms during the acute phase include elevated anxiety and depression, disrupted concentration, dizziness and lightheadedness, nausea, excessive perspiration, blurred vision, headaches, and a disconcerting experience known as “brain zaps.”

Protracted SSRI Withdrawal

The protracted phase of SSRI withdrawal is also sometimes referred to as protracted withdrawal syndrome (PWS) or post-acute withdrawal syndrome (PAWS). 

Not everyone goes through this phase, but who do may have episodes of depersonalization (the sense of being detached from their thoughts and feelings), disorientation, dysphoria (difficulty experiencing joy), and suicidal ideation. Some physical symptoms, such as headaches and insomnia, can also persist. 

Protracted SSRI withdrawal can range from a few months to a few years. 

The Value of Professional Oversight

The possible severity of SSRI withdrawal underscores the importance of consulting with your physician before you try to end your medication use. 

Your doctor may be able to help you avoid most of these symptoms by developing a plan for gradually reducing your dosage over an extended period. If you do develop SSRI withdrawal symptoms, your treatment provider may be able to offer medical and/or therapeutic support to help you manage your symptoms.

Learn More About Depression Treatment in Atlanta

SSRIs are just one of many elements that can be incorporated into an effective depression treatment plan. If SSRIs haven’t produced the results you had hoped for, or if you are interested in pursuing other avenues for achieving relief from the symptoms of depression, Atlanta Integrative Psychiatry is here for you.

Our depression treatment center in Atlanta is a welcoming and supportive place where you can take part in a dynamic array of customizable outpatient services. We understand that each person who lives with depression or other mental health concerns is impacted in a unique manner, and we are committed to providing you with a truly personalized experience throughout your time in our care.

To learn more or to schedule a free assessment, please visit our Appointment page or call us today.

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