How to Prevent SSRI Withdrawal Syndrome

In response to my recent about emotional stress experienced by care-givers of the chronically ill or disabled, someone posted a question about SSRIs (Selective Seratonin Reuptake Inhibitors). Specifically, the question focused on symptoms occurring when people discontinue taking their prescribed SSRI.

Before I respond, it is important for me to state that I am not a doctor and I do not have prescription authority. However, I do have knowledge of SSRIs, as I work closely with physicians who prescribe these medications to my clients. I am ethically obligated to keep myself informed on the variety of resources that are available to my clients as they seek symptom relief.

Having said that, let’s start with looking at how, exactly, SSRIs are supposed to work in the brain. Seratonin is a neurotransmitter that is responsible for a sense of well-being. You may be surprised to know that it is chemically kin to tryptophan, the chemical in turkey that induces sleepiness after our Thanksgiving feast. In contributing to a general sense of well-being, serotonin impacts mood, sleep, and appetite.

Typically, someone is prescribed an SSRI by their physician in order to alleviate feelings of anxiety or depressed mood. Some symptoms of anxiety include irritability, sleep disturbance, uncontrollable racing thoughts, and difficulty concentrating. Depression is often the consequence of prolonged periods of anxiety—in addition to the symptoms of anxiety described above, depression can include symptoms such as a sense of hopelessness and helplessness, increase or loss of appetite resulting in dramatic weight gain or loss, and possible thoughts regarding the futility of life. SSRIs are thought to alleviate the symptoms of anxiety and depression by altering the amount of serotonin between the neurons of the brain: one neuron releases the serotonin to the next neuron, and an SSRI delays the second neurons absorption of it. What happens is that the serotonin kind of hangs out in the space between the neurons (which is called a synapse) and results in the person feeling better.

So back to the question of SSRI discontinuation and any related symptoms. Most symptoms reported to clinicians as patients commence or discontinue taking an SSRI are the result of not titrating, or tapering, the dosage. Titration is a process in which the full dosage is not taken immediately, but rather the patient begins with a fraction thereof and slowly increases to the full prescribed amount. For example, if I were prescribed 100 mg daily of an SSRI, I would titrate “up” to that dosage: depending on what my doctor suggests, I could start at one-quarter of that (25 mg) daily for two weeks, then one-half (50 mg) daily for a week, then three-quarters (75 mg) daily for a week, then full dosage. Again, the prescribing doctor should provide detailed information regarding how to titrate properly for the prescribed SSRI. As for discontinuing SSRI usage, it is imperative that the dosage be titrated “down” as well. From the example above, I could step the dosage down to 75 mg daily for two weeks, then 50 mg daily for a week, then 25 mg daily for a week.

When we do not titrate the SSRI dosage up (when beginning) or down (when discontinuing), we run the risk of some pretty uncomfortable and potentially dangerous symptoms. Fundamentally, you are altering the chemical level in your brain, and specifically the level of the neurotransmitter related to feeling good, sleep regulation, appetite regulation, etc. Rapid and dramatic alterations in the level of serotonin can result in what’s called SSRI withdrawal or discontinuation syndrome. It includes the disruption of all of the areas impacted by serotonin:

• Flu-like symptoms, including aching body, gastrointestinal distress, and headache;
• Physical weakness, including faintness; and,
• Alterations in visual or physical sensations that may seem like hallucinations.

The important thing to remember is that using an SSRI alters the “feel-good” chemical in your brain: altering the level of it by immediately taking the full dosage or by abruptly discontinuing use of it can result in extremely unpleasant symptoms. Typically the symptoms disappear after about two weeks without additional intervention. However, if the symptoms persist, or if thoughts of helplessness and despair include thoughts of harming yourself or others, please consult with your physician immediately or call the Georgia Crisis & Access Line at 1-800-715-4225.

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Brandy Smith is a Licensed Professional Counselor at Avanti Counseling Services, Inc. in the Oakhurst District of Decatur.  For additional information about this post or about services available, please visit www.AvantiCounselingServices.com.