When Elizabeth tried to get off her antidepressants for good, she says she felt like she was in a fog.
The 29-year-old educator, who asked Global News to only use her first name, said she had six days of “serious side effects” after she stopped taking paroxetine, an antidepressant often used to also treat anxiety.
She had been on the medication for about two years, and had attempted to go off twice before, but the withdrawal symptoms were just too much.
This time, she did more research online to see what other people experienced so she was aware of what may happen.
“I prepared myself for what I expected to be a long journey,” she said. “I talked to my family and warned them of the side effects and that I would need extra support and encouragement during the withdrawal time.”
It took Elizabeth a couple of weeks before the pain subsided, and she slowly gained her energy back.
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How many people are on antidepressants
Elizabeth is not alone in her experience.
Canada is among the top counties with the highest rates of antidepressant use in the world, according to 2017 data by the Organization for Economic Co-operation and Development (OECD). Based on government data from 2011 — the most recent available — antidepressants were the most prescribed drug for men 25 to 44, and the top drug prescribed to women aged 25 to 79.
(A 2014 study out of the University of Calgary found that antidepressant use in the country may now be stabilizing.)
In the U.S., antidepressant use has almost doubled since 2010, and more than tripled since 2000, according to data analyzed by the New York Times.
And as antidepressant use has increased in recent years, so have conversations around the withdrawal.
On Thursday, the U.K.’s Royal College of Psychiatrists released a new report warning of possible side effects of antidepressants, urging health-care providers to better monitor patients who use the drugs.
The report said there should be more awareness around side effects of the medications, highlighting the fact that some people may experience “long-lasting withdrawal symptoms on and after stopping antidepressants.”
The authors recommend patients be tapered off the drugs under doctor supervision, and that researchers should “develop clear evidence-based and pharmacologically-informed recommendations to help guide gradual withdrawal from antidepressant use.”
The report echoes sentiments of what many antidepressant users have been saying for years.
In a recent op-ed in the Guardian, writer Rhiannon Lucy Cosslett described how when coming off the drugs, she experienced “panic attacks, dizziness, headaches, irrational fury, dramatic mood swings, suicidal thoughts and exhaustion.”
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“Luckily, I have a doctor in my family, who, after my ill-judged initial attempt to go cold turkey ended in hospital, recommended that I take it slowly by cutting my pills in half and reducing down to every other day, then every three days and so on,” she wrote.
“I am now drug-free and fine, but it was no picnic: not for me, and not for the people I love, who had to be around me.”
Antidepressant side effects
For some people, withdrawal symptoms are so debilitating they seek comfort through mental health support groups. On Facebook, there are public and private groups where members discuss their experiences coming off antidepressants, as well as how they feel on the drugs.
On these forums, many people describe symptoms ranging from changes in weight, irritability, nightmares and changes in sex drives. Others seek the counsel of other users because they say their doctors did not inform them of adverse side effects.
Dr. Donna Stewart, a professor of psychiatry at the University of Toronto and a senior scientist at Toronto General Hospital Research Institute, said there are two main types of popular antidepressants that are commonly prescribed for depression and anxiety disorders: selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitor (SNRIs).
These antidepressants treat depression by increasing the number of certain brain chemicals, like serotonin, which carries messages between brain cells.
Popular SSRIs include Prozac (known generically as fluoxetine), Paxil (paroxetine), Zoloft (sertraline) and Lexapro (escitalopram).
SNRIs include venlafaxine (Effexor), duloxetine (Cymbalta), levomilnacipran (Fetzima) and desvenlafaxine (Pristiq), the Centre for Addiction and Mental Health (CAMH) outlines.
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When coming off these drugs, Stewart says common side effects can include dizziness, abnormal sensations, digestive symptoms, flu-like symptoms, depression, anxiety, sweating and poor sleep.
She also says people may experience what they describe as a “brain zap,” which feels like an electric shock of sorts. “Brain shocks frighten people,” she added.
While withdrawal can be alarming, Stewart says that many people experience minimal or no side effects when coming off their medication.
But for others, the withdrawal symptoms can be so alarming that they go back on the medications or stop trying to go off them altogether. This happened to Elizabeth the first few times she tried to get off her meds.
“The first time I attempted to go off, I had dropped my dosage by half for a week, and then the next week, I tried going every other day. Unfortunately, once I was off, I started experiencing anxiety again and decided to go back on probably two weeks after,” she said.
“The second time, probably a few months later, I decided to go cold turkey and I lasted three days before I needed to go back on.”
Stewart says it’s important for patients to know the difference between withdrawal symptoms and signs of their depression or anxiety. A recent study published in medical journal The Lancet found that if withdrawal symptoms are mistaken for recurrence of a mental health issue, like depression, it can lead to “long-term unnecessary medication.”
Withdrawal symptoms typically begin within days of stopping medication and last several days to weeks, Stewart says. “They are less common if the med withdrawal is tapered,” she explained.
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Withdrawal also often includes symptoms that you normally don’t experience with your anxiety or depression, like flu-like symptoms or “brain zaps.”
A symptom of a mental health condition, on the other hand, can come on weeks or months after stopping the medication.
If you’re experiencing symptoms of your mental health condition again, or are unsure of your symptoms, it’s important to talk to your doctor, Stewart says.
What antidepressants should be used for
According to the World Health Organization, 4.4 per cent of the world’s population suffers from depression.
CAMH defines clinical depression as a “complex mood disorder caused by various factors, including genetic predisposition, personality, stress and brain chemistry.” It can range in severity, and affect people at different points in their lives.
For people with mild depression, Stewart says that antidepressants should not be first-line treatment; psychotherapy and environmental changes should be explored first.
Part of the reason why so many Canadians are on antidepressants is because there’s not enough publicly funded mental health services, Stewart said. For people with mild depression, “a good government-sponsored psychotherapy program” would be helpful, she said.
Instead, many patients are prescribed drugs for symptoms that may be manageable through therapy.
But when it comes to moderate to severe depression, antidepressants can be incredibly helpful and often a necessary part of treatment.
CAMH says that most people who use antidepressants need to take them for at least a year.
For patients with moderate to severe depression, Stewart says they may need to be on antidepressants for two years or longer, depending on their condition and how many depressive episodes they have. (It’s important to note that everyone’s treatment plan is unique to them.)
Stewart also points out that antidepressants are often used to treat anxiety disorders as well, and can be helpful in managing conditions like panic disorder or obsessive-compulsive disorder.
How to go off antidepressants
If you’re on antidepressants and want to get off them, Stewart says it’s important you talk to your health-care provider. They should be able to inform you on how to lower your dose, tapering you off the medication safely.
It can be very dangerous to stop taking prescription medication on your own, or go “cold turkey.” Apart from withdrawal symptoms, people should be educated on possible mental health concerns.
Stewart says there’s still a lot of stigma around mental health conditions, making it hard for some people to seek help. She says it’s important for anyone suffering from anxiety or depression to speak to a health-care professional.
Elizabeth says while she is off antidepressants today, the medication helped her when she needed it.
If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help.
The Canadian Association for Suicide Prevention, Depression Hurts and Kids Help Phone 1-800-668-6868 all offer ways of getting help if you, or someone you know, may be suffering from mental health issues.