Thinking about getting off antidepressants? Here’s what experts have to tell you about doing so safely

Winnipeg resident John Ruhland first started taking medication for his depression in 2000, when periods of intense stress in both work and personal life landed him in hospital.

“I needed antidepressants to get me to a comfortable level of coping with the overall situation,” Ruhland said.

His condition improved, requiring him to stop taking the drug for about a year before his symptoms returned.

When his condition improved again about 15 years later, Ruhland stopped taking the drug under the supervision of his doctor.

However, Ruhland’s symptoms returned once again and it became clear that he needed to restart treatment.

“I just brought myself to the hospital and said, ‘Here’s what’s going on and I’m pretty sure I need to get off the medication,'” he said.

Roughly speaking 6.6 million Canadians Prescriptions filled for antidepressants are projected to increase from 5.8 million in 2019 to 1.8 million in 2023, according to data from health research firm IQVIA.

These medications – the most common of which are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) – are well established as treatments for depression.

The Center for Addiction and Mental Health (CAMH) recommends consulting a physician after experiencing “feelings of sadness, hopelessness, and despair, or excessive anxiety that is difficult to control” for more than two weeks.

But it’s not always clear how long patients should stay on these drugs — and what role therapy can play in the process of safely weaning them off.

Although everyone’s case is different, and medication changes should be made under a doctor’s close supervision, here are what the experts CBC spoke with diet What do you want to know about getting off antidepressants?

First, you have to give the medicine a chance to work

According to CAMH, for patients experiencing their first depressive episode, an antidepressant is considered to be working if symptoms improve within two to four weeks, with full remission seen around six to 12 weeks.

If a patient’s symptoms do not improve, doctor may recommend A different medicine, or a combination of medicine and therapy.

Psychiatrist Dr. Ishrat Hussain is a senior scientist at CAMH in Toronto, who also leads the centre’s mood disorders service.

“The instructions are to continue it for nine months after the person’s recovery from the drug,” Hussain told host Dr. Brian Goldman. diet,

Psychologist Joel Lemoult, associate professor at UBC and director of the Depression, Anxiety and Stress Laboratory there, says cognitive behavioral therapy (CBT) and exercise can also help in conjunction with medication.

As Hamilton psychiatrist Dr. Benicio Frey says, antidepressants come with side effects sexual dysfunction or decreased libido , weight gain , decreased bone density as well as emotional frustration Where people report being unable to feel strong positive or negative emotions.

Other side effects include dry mouth, as well as gastrointestinal upset, says Hussain.

He says these side effects are mild and often go away as patients adjust to the medication.

If a patient really can’t tolerate a medication, a doctor may suggest changing or discontinuing it, but only under medical supervision, says Hussain.

Medical supervision is required when tapering off

If a patient responds well to treatment – ​​and this is their first episode of depression – some guidelines Clinicians suggest that patients should stop the medication about six to nine months after feeling beneficial effects, to ensure that depression does not return.

“If the symptoms don’t come back, they can probably stop the medication,” Hussain said.

Lemoult says she “encourages some type of therapy to better prevent recurrence should (patients) stop taking the drug… even to give them an idea of ​​what other options might be.”

New findings from meta-analysis Published in The Lancet Psychiatry magazine Support that approach this week. Looking at more than 17,000 patients whose symptoms were improving, the co-authors found that gradually reducing antidepressant medications, combined with therapy such as psychological support, was as effective as staying on the pills.

Frey says there is little evidence that antidepressants cause any kind of addiction after long-term use.

However, patients who stop taking antidepressants may experience withdrawal symptoms, a condition known as antidepressant discontinuation syndrome (ADS).

“A feeling of tingling, numbness, dizziness, increased irritability can occur when people try to come off antidepressant medication,” Frey said.

A 2024 meta-analysis 79 studies of 21,000 patients found that about 15 percent experienced antidepressant drug withdrawal symptoms.

Depression can be a lifelong illness

But as John Ruhland discovered, there is a segment of the population for whom depression is a lifelong illness—including himself.

Apart from brief periods of improvement in his symptoms, Ruhland has been taking antidepressant medications for more than two decades.

“Due to the severity of my symptoms I was told it would probably last a lifetime,” Ruhland said.

Today she is a mental health advocate and peer support worker. Based on his experiences, he helps others overcome their depression.

Whether this is your first bout of depression or not, he says it’s important not to suffer alone.

“If you feel like you’ve reached a tipping point of stress and you can feel that things aren’t feeling right, talk to your doctor and say, I’m struggling,” she said.

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If you or someone you know is struggling, look here for help:

The Canadian Association for Suicide Prevention says if you’re concerned that someone you know may be at risk of suicide, you should talk to them about it. Here are some warning signs:

• suicidal thoughts.
• Substance use.
• Purposelessness.
• Worry
• Feeling trapped.
• Despair and helplessness.
• withdrawal.
• Anger.
• Negligence.
• The mood changes.