SSRI Withdrawal

[Nocd39]

I’ve had problems with 2 different SSRIs and am currently tapering down my dose with a view to coming off my current SSRI completely. Had an awful time getting off the last one, and this time I’ve been having awful headaches and nausea with a lot of tapering off still to go. Anyone else had similar issues? Feeling a bit awful and could do with a handhold.

Onto my AIBU… for this SSRI I was very lucky to have a consultant to discuss it all with so was aware there could be issues if I did come off it, and I’m being supported with a liquid version so can taper slowly. (Only went back on an SSRI as I have severe OCD and there don’t seem to be other good treatments.) However I understand this level of support is unusual and often a liquid isn’t offered leading to people having to divide up tablets to taper off (which I’ve been advised is bad because the medicine isn’t always evenly distributed in the tablets.) Luckily not for everyone but withdrawal from SSRIs is a known serious issue for a significant number of people and anecdotally I know a few people who have given up on coming off them because the withdrawal was so bad.

Especially as so many people take SSRIs, I feel GPs should be warning people of the potential for withdrawal effects, and letting people know the risks and likelihood of this happening. Also, as part of their contracts with the NHS, drugs companies who make huge profits from these drugs should do more research into withdrawal/helping people come off the drugs when no longer needed, and should make liquid products more available and affordable (they can be super expensive.)

Am I being reasonable or unreasonable?!

Would especially be interested in views from HCPs and those taking/who have taken SSRIs.

I asked the GP for liquid Seroxat to make the last 6mg easier to come off of. I tapered down very gradually and took a good 6 months, slowly slowly is the way to go and that way you get fewer withdrawal symptoms.

drugs companies who make huge profits from these drugs should do more research into withdrawal/helping people come off the drugs when no longer needed.

The drug companies don't want people to come off the drugs - there's no cash in it for them!

I’m currently going through this. Except I’m having to do the cutting up tablets. I’m now down to quarter cutting a 10mg citalopram tablet and tablet one quarter every other day. Ive had severe dizziness at times and bad headaches. The withdrawal period is horrible. Not sure how long it’s supposed to take but I’ve been cutting down for the last 6 months and even still missing a quarter tablet makes me feel so dizzy and ill.

Yes totally agree. I’m a couple of months in and have many more months to go. I’m glad your GP was supportive on the liquid. The first time round my GP really pushed back and I had to fight hard to get it (I assume because it’s expensive.)

I took Sertraline and paroxetene (not together) before. I thought coming off Sertraline was bad but had to reevaluate because paroxetene withdrawal was horrendous. I didn't get much support coming off them, other than being asked if I wanted to taper it, getting another prescription and being told to buy a pill cutter. I was fairly young and had no idea about liquid versions, I had to just do my best tapering it with the tablets. I would never go on an SSRI again.

I take amitriptyline now though.

I take Sertraline and I have to say, it's at least good at it's job. I'm wary of upping my dose which I probably should, but it's no small deal to have another couple of weeks feeling crap while the dose adjusts.

I have panic disorder and I freak out a bit at the thought of missing a day too, which when you're taking 50mg is less of an issue than 150mg. I don't take any of it lightly.

I think I'll be on them forever, partly because the thought of tapering off is horrifying.

I’m sorry that sounds rough. I wonder if the every other day is making it worse as the amount in your system will be fluctuating so much. Did your GP advise this?

Yes of course they are reluctant, so I think they should be made to do this as a condition of their supplying the drugs to the NHS

I never did every other day, just every 4-6 weeks I would taper down.

what you would find if that was made a condition is that they'd sell their drugs elsewhere and there just wouldn't be anything available 'on the NHS'.

But they would be missing out on a huge market? You could be right, I’d be very interested to know if conditions like these are ever attached to drugs supply

Erm... the withdrawal symptoms are actually widely known and publicised. It's been a while since I was on them but I would be majorly surprised if they are not outlined in the patient information leaflet which comes in the packet. Your GP surgery probably has it's own PIL with the same information. We certainly did in the CMHT I was working in. So it's not a secret at all.

Yes agree they will be in the leaflet but those aren’t usually very accessible. I think GPS should at least flag to people about withdrawal and direct them to further info if they want it. Definitely didn’t happen the first time I was given them

That's probably more of a GP problem than the "big pharma" problem. When I was working in CMHT, the standard practice was to give information about medication, including tapering off, provide the patient with the leaflet to read and give them another appointment in a few days once they had a chance to make an informed decision. Only then, it would be prescribed.

I totally agree OP. Most people are okay coming off them but an unlucky few get bad withdrawal. They need to be much clearer about this - and much more supportive of slow tapering.

The withdrawal effects are very well and clearly publicised IMO. I was warned by both the GP and pharmacists.

When I somehow managed to miss a week (I make up a dosset box for myself) it was awful so when I did finally come off them I came down very slowly.

I think most people know they can't just stop.

Sounds like your team were very good about this-was this child mental health services? I think you’re right there may be a problem with how people are warned/supported by GPs. I think there is an issue with a lot of people, including PPs being fobbed off with cutting pills when liquids should be made available. GPs may be reluctant to provide these due to cost

I’m glad you were pre-warned, I definitely wasn’t the first time. I think part of the issue is that withdrawal is either not specifically mentioned or downplayed but for sine people symptoms can go on for months

I’ve never taken antidepressants so can’t comment from that point, but did prescribe and monitor their effects and help with stopping for many years, paroxetine definitely the worst, to such an extent that, certainly where I worked, it just wasn’t prescribed, the others varied, some people stopped them easily, others struggled and had to taper them slowly, which does seem to be the best option

Hmm, people who are prescribed SSRI's should have, imo, exhausted other holistic treatment options. In this respect such medication can save lives. The issue of coming off if them is then definitely the lesser of two evils.

Well my GP surgery told me I was wrong and withdrawal didn't exist.

The mental health nurse told me I was wrong and that it was all in my head.

Many, many people have similar stories.

I feel absolutely horrendous if I miss a pill- sertraline, 100mg. I hate being dependent on them and would dearly love to stop, but I am terrified of the withdrawal. I didn’t realise liquid was an option. I’m planning on making an appointment with my GP who previously has discouraged me from coming off them. Yanbu!

Also withdrawals all depends on the half life of that particular antidepressant,
When I came off fluoxetine it wasn't bad as that has a long half life, paroxtine was the worst thing in existence.
I'm now on duloxetine and if I take it later in the day rather than the morning I feel withdrawal effects. It's awful.
I take SSRIs in conjunction with other mental health medication for severe mental health conditions.

Years ago I was on seroxat and by the end of tapering off I was cutting up pills and having crumbs only. It made me feel like a drug addict and I kind of was. It was horrific and just couldn't get off of them.

My psychiatrist then had a lightbulb moment and switched me to a very low dose of mirtazapine and that was so easy to come off in comparison. It saved my life and will always be grateful to it.

Fast forward 20 years and developed anxiety in peri and my GP looked at me like I was crazy saying no to an SSRI. I will never take those again. Ever.

This is interesting. Were you able to prescribe liquids for tapering?