Antidepressants Worsening Bipolar – Getting Off Antidepressants
As I mentioned last time, many doctors feel that antidepressants actually make bipolar disorder worse. Some specialists, in fact, will routinely take people with bipolar disorder off of antidepressants when the bipolar is doing well. Like I said, it’s a matter of perspective.
And I get asked all the time about getting off of antidepressants and other medication. So, exactly how should you get off an antidepressant and what should you worry about when doing so?
Getting Off an Antidepressant is Serious
Getting off an antidepressant is serious stuff. Do not even think about trying it alone.
I’m going to repeat that in case you missed it – do not even think about trying to get off an antidepressant without a doctor’s oversight. Bad things can happen to you when you don’t know what you’re doing.
How to Get Off an Antidepressant
Slowly. Really. If there’s one word to remember it’s slowly, followed closely by the world gradually. You want to decrease the dosage of the antidepressant as gradually as you can over the longest period of time.
For example, if you’re on 200mg of drug A, you wouldn’t simply cut the drug in half and go to 100mg. You would talk to your doctor, find out that 25mg tablets are available, and decrease from 200mg to 175mg.
Recommendations for Antidepressant Discontinuation
Here are some things to consider:
- Never consider getting off an antidepressant before a holiday or any other period of stress
- Generally don’t get off an antidepressant when you’re unstable (there are exceptions to this)
- Get educated about what to expect when getting off the drug
- Go Slow. You might wait 6 -8 weeks or more between dosage decreases. Really. You’re in control here; don’t decrease a drug dosage just because a doctor tells you to. Go at your own speed.
- Reduce in the smallest possible dose. This can be hard for some drugs. Sometimes you have to remove tiny beads from capsules, but it can be done.
Also, chart your mood and wellness as frequently as possible, daily is ideal (doctors sometimes use the Global Assessment of Functioning GAF). This is so you can chart at what dose you feel best, if any. Perhaps you feel best at 100mg of the drug and that level is best for you rather than removing the drug completely. That knowledge is your very best friend.
What Can Go Wrong When Getting Off an Antidepressant?
As I mentioned, this is serious stuff. Things you absolutely must watch for:
- Becoming manic or hypomanic – see you doctor at once
- Becoming (more) depressed
- Suicidal Thoughts
- Cycling
- Mixed-moods
- Yes, there are others; ask your doctor
Remember, you went on an antidepressant for a reason in the first place.
None of those might happen to you, but you need to be aware and watch. Sometimes you have to go back up to the previous dose to fix the problem. This might just mean you tapered too quickly. It’s OK. Work with your doctor to find the strategy that works best for you.
Getting Off an Antidepressant (or other drug) Can Be Hard
I understand that this seems protracted and painful, but understand these recommendations are designed to take a person off an antidepressant with the least disruption to their life possible. These recommendations are to prevent things like manic episodes, depression or other nastiness. Could you go faster? I have no doubt. Once you start you’ll be able to figure that out. If you feel great after only one week on a lower dose then maybe you’re lucky and will be able to decrease faster. It’s a personal thing.
Particularly Nasty Antidepressants
One more note, it's easier to get off of some antidepressants than others. Short half-life drugs (like Pristiq and Effexor) are much harder to get off of while long half-life drugs (like Prozac) are generally easier. A doctor might replace a dose of a shorter half-life drug with a longer half-life drug and then taper the longer half-life drug. This is a medical consideration for your doctor. (I only mention it here because it’s a major problem for some people and I really think people need to know of this option.)
More on recommendations on when to discontinue antidepressants and how to do it.
Talk to a doctor about any and all concerns and do not undertake any treatment changes on your own.
APA Reference
Tracy, N.
(2011, January 10). Antidepressants Worsening Bipolar – Getting Off Antidepressants, HealthyPlace. Retrieved
on 2024, November 14 from https://www.healthyplace.com/blogs/breakingbipolar/2011/01/antidepressants-worsening-bipolar-getting-off-antidepressants
Author: Natasha Tracy
I once ran out of Effexor on Sunday. I didn't refill it because I had an appointment on Wednesday and intended to tell my dr it wasn't working and expected him to put me on something else (again). By Wednesday, I felt Absolutely. Horrendously. Awful. Turns out he increased my dose and wrote me a new script, which I filled as soon as possible after doing a little research on potential withdrawal effects. I hope they never stop making this crap because if they do, I'm up a creek.
Hi Angela,
Yes. Sorry to tell you, Effexor is known for that. Pristiq too. I'm on Pristiq and have the unenviable task of trying to get off of it. If I miss a Pristiq dose I'm suicidal in less than a day. It's more dramatic than I ever thought possible. I've never seen anything like it.
There are a couple of known tactics to get off Effexor (check the link at the bottom of my post). If you're interested. Or not.
And in my case it's possible that the Pristiq is actually helping and if I got off it I would get worse. Defeating the entire purpose. Rock, meet hard place.
So I definitely feel for you. I will say that the mechanism that makes Effexor and Pristiq work is fairly unique and these drugs work for people where no others do. If that makes you feel better. http://en.wikipedia.org/wiki/Serotonin-norepinephrine_reuptake_inhibitor
(Note there are a few in this class being developed. Perhaps one of them will have a better withdrawal profile. Who knows?)
- Natasha
I have had a remarkably similar experience with Effexor withdrawl as Angela. It is so incredibly bad that the experience can haunt you every time you pop this damn drug. I have been told that discontinuation is possible only after a long period of med. reduction. I personally don't care to try this. I feel that this antidepressant would have to be replaced, and probably with some other medication just as addictive, because I do need mood adjustment. I question the big rush to put a person on these meds in the first place while accepting the fact that they are a permanent part of my life now. If they stop making this crap as mentioned by Angela, above, we are indeed up the creek. I wonder if Heroin would make a good replacement therapy, (sorry, bad joke, but its no joke the 'crap' we will consume to be sane for our loved ones and friends.) It's worth It though. Just keep hope alive. Jeff
Hi Jeff,
Honestly, if the med works for you, then there's no real reason to change (you haven't mentioned your reason). If you did need to change for some reason the swap to a longer half-life drug does work (I'm told) and it's not nearly the protracted method of attempting to taper Effexor itself. (Check the link at the bottom of the article.)
I actually have an issues with doctor prescribing Effexor, Pristiq and Cymbalta without serious warnings about withdrawal. These medications help many people but gosh, they should be made aware of how hard they are to get off. Other meds aren't like that. Seriously. I've been on and off many meds and I've seen nothing anywhere near as nasty.
Doctors can definitely do better on that end.
(FYI, the doctor I currently go to almost never prescribes Pristiq for that reason. I wish more doctors would be a little more cautious.)
- Natasha
My pdoc had me on Depakote and Buspar for a bit but the Buspar wasn't helping much. He took out the Buspar, and he added in 10mg of Celexa and it's the perfect mix. At this point I definitely don't want to stop taking the Celexa.
I have been on antidepressants since 2007. I wish I'd never gotten up on this horse, BUT that being said my life has calmed down a lot so I guess they help. I take 10 mg Celexa in am and 50 mg Seroquel pm. I've tried everything out there, and these are the only drugs I can tolerate. I tried the Effexor, it raised my BP and anxiety, I decided to stop abruptly since I hadn't been on it for long and wound up having to go to the hospital. I got severe vertigo. That was a mess and totally embarrassing as it happened at work. It took 2 days to even be able to stand up. Then there was Zoloft I stopped that abruptly and it was horrible. I've titrated off the Celexa/Seroquel combo before, very slowly, like 5mg at a time, and got off, but after a month my psych symptoms returned and I had to start back. I still try to take the lowest dose of each med I can just to keep my symptoms in the manageable range. Good luck to my fellow sufferers, glad to know I am not alone.
Hi Kate,
May I ask why you wish you hadn't started taking antidepressants if they are helping you?
Yes, stopping any medication cold-turkey is a very bad idea and not one anyone would recommend. Slow reduction is the only way to go.
I guess I'm just confused because it seems like you're in a pretty good place, you've found drugs you can tolerate that help you.
- Natasha
Hi Patrick,
Yes, it's the best thing in the world to feel relief from your symptoms because you've found the right medication.
I'm not suggesting people stop taking their antidepressants, I'm just making some suggestions for those who do.
- Natasha
Bipolar disorder disarranges the ability to feeling the common deviation of mood, that has tendency of circular remissions and exacerbations. The main therapeutic purpose is the stabilization of deviations of emotional state. In this direction the role of antidepressant medication is important and it depends of clinical phenomenology of this disorder. If dominate depressive picture of illness, then antidepressant therapy remain the primary goal of psychiatric treatment. Meanwhile, the way to getting off antidepressant generally is individual, where the usage of new psychostabilizators is mandatory issue.