Stopping Antidepressants ?

Q: Americans taking antidepressants to be on the lookout for potentially harmful side effects, including severe restlessness and suicidal thinking, some people may end up stopping the drugs. But going off antidepressants can bring its own problems.

A:Stopping cold turkey can cause an array of troublesome symptoms, the most common being dizziness, which can last for days on end. Flu-like feelings, including nausea, headache and fatigue, are also common, as are intense feelings of anxiety, irritability or sadness. Some patients experience alarming sensations of tingling or burning in various parts of the body, ringing in the ears, blurred vision or flashing lights before the eyes. Some people even describe a feeling of shock waves pulsing through their arms and legs, as if they had been zapped with a jolt of electricity, a condition sometimes called lightning-bolt syndrome. To avoid such symptoms, or at least hold them to a minimum, the drugs need to be tapered off gradually in most cases, and that means quitting under a doctor's supervision. Psychiatrists say it is unwise for people who are taking antidepressants simply to quit on their own. In its warning in March, the food and drug agency urged doctors to closely monitor patients taking antidepressants, especially during the first weeks of therapy or when changing dosage. Though an association between antidepressants and suicidal thinking or behavior has not been proved, unpublished studies suggesting the possibility of such a link in children and adolescents have caused concern. The agency is still investigating the issue. The withdrawal symptoms do not mean that antidepressants are addictive, experts say. People who are coming off the drug do not crave it, as addicts might crave heroin or cocaine, and they do not seek higher and higher doses over time. "There's a lot of misperception about that," said Alan Schatzberg, a psychopharmacologist who is chairman of psychiatry at Stanford University School of Medicine. So, many doctors describe the effects produced by stopping antidepressants as a "discontinuation syndrome" rather than as withdrawal. Yet the symptoms can be troublesome enough to prompt some patients to go back on their medications. To help patients stop taking an antidepressant, most doctors use a strategy of gradually tapering down the dosage. Shelton said he often brings his patients down from the drugs in five-milligram increments, with each stage lasting from five days to a week. The riskiest period, Schatzberg said, comes at the end, when even small increments of tapering can have a big impact on serotonin. "The taper at the bottom end often needs to go slower than it does at the top end,"

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