Why Stopping Antidepressants Can Trigger Severe Withdrawal for Some Patients

In early 2023, Liana Shatova began a low dose of the antidepressant sertraline (Zoloft) to treat severe premenstrual symptoms. The medication initially helped her regain energy and stability, but after about 18 months she began to feel emotionally numb. When she tried to stop, she developed chronic insomnia, panic attacks, night sweats, and severe mood swings that made work impossible. A cautious, very slow taper has brought partial improvement, but she continues to reduce the dose incrementally to avoid relapse.

Antidepressants — particularly selective serotonin reuptake inhibitors (SSRIs) — are among the most commonly prescribed drugs in the U.S., taken by tens of millions of adults. Women report use about twice as often as men, and usage is highest among older women. Side effects are a frequent reason patients want to stop, yet stopping itself can cause withdrawal symptoms. Growing clinical concern has prompted a deprescribing movement in psychiatry focused on safer, evidence-based strategies to reduce or discontinue these medications.

What the research shows

A November analysis led by researchers at King’s College London and published in The Lancet reviewed 151 clinical trials and 17 FDA reports covering roughly 30 antidepressant drugs. The team found drug-specific differences in physical adverse effects — such as rapid weight gain, increases in heart rate, blood pressure changes, raised glucose, and cholesterol — highlighting that antidepressants are not interchangeable when considering long-term physical risks.

A separate U.K. survey study published in August — with a limited response rate — indicated that withdrawal effects may be more common and longer-lasting than previously believed. Among people who had taken antidepressants for more than two years, 63% reported moderate or severe withdrawal symptoms, and about one-third said problems lasted longer than three months. Reported symptoms included insomnia, electric or buzzing sensations, confusion, muscle cramps, agitation, mood swings, and derealisation.

Other reviews reinforce that withdrawal can occur even with gradual tapering. A German review concluded that up to one in three antidepressant users may experience some withdrawal symptoms, while severe withdrawal might occur in about one in 30 users. Additional studies suggest that abrupt discontinuation increases the risk of pronounced symptoms such as burning skin pain, balance problems, persistent panic attacks, and heightened light and sound sensitivity.

Why some people are affected more than others

The biological mechanisms are not fully understood. One mainstream explanation is that the brain adapts to chronic exposure to a centrally acting drug, and stopping the drug forces the brain to rebalance. Experts compare the process conceptually to withdrawal from other substances, from caffeine to opioids. Yet clinicians disagree about how often severe, long-lasting withdrawal occurs and whether other conditions may explain some reported symptoms.

“Withdrawal symptoms tell you that your brain is trying to restore a balance that it was forced to change by the presence of a drug,” said David Cohen, professor of social welfare at UCLA.

Some psychiatrists emphasize that antidepressants clearly help many patients, particularly in the short term, and note that protracted withdrawal appears to be uncommon in routine clinical practice. Others urge rigorous, nonindustry-funded research to identify who is at greatest risk and which tapering strategies are safest.

Practical guidance for patients and clinicians

Experts recommend that patients should not stop antidepressants abruptly. If patients and clinicians decide to discontinue treatment, gradual and individualized tapering under medical supervision is advised. Clinicians are encouraged to monitor physical and psychiatric symptoms, consider alternative explanations or underlying medical issues, and use large datasets and electronic health records to search for predictors of prolonged withdrawal.

Researchers call for large, independent randomized trials comparing tapering strategies with long follow-up and clear outcome measures. Better clinical guidelines and deprescribing protocols would help patients avoid unmanaged self-tapering and reduce the risk of severe withdrawal.

If you or someone you know is in crisis, call or text 988, or visit 988lifeline.org to reach the Suicide & Crisis Lifeline. You can also call 800-273-8255 or visit SpeakingOfSuicide.com/resources for additional support.