Withdrawing from SSRI antidepressants: advice for primary care

I am so glad that this article has been published.¹ For some years I was saddled with a poor prognosis, told that I had a recurrent depressive disorder, and advised to take antidepressants for life. As I became more confident after the crisis had passed, returned to work, and was completely well, the side effect burden became too much. I did not know anything about tapering or that ‘withdrawal’ was a recognised entity, nor did my GP. However, I was very aware of the effects of missing a dose, which led to what are known as ‘brain zaps’, and so I cut down on venlafaxine and trazodone slowly. It was fairly easy at first, but, as I got to lower doses, I was surprised at how difficult it became. Unknowingly I ‘tapered’ because I had to cut up tablets into tiny, tiny pieces and take just enough to deal with the symptoms. It took me 2 years in all to withdraw from venlafaxine. Trazadone was harder. After the last dose, I had severe rebound insomnia and after 3 nights with no sleep at all and a restlessness, which I assumed was restless legs syndrome, I couldn’t bear it any longer and put myself back on a small dose. When I finally took the last dose, I immediately developed what is now diagnosed as a ‘small fibre neuropathy’ and there are others who have similar symptoms — thought to be a protracted withdrawal syndrome. It has lasted years. However, my mental health hasn’t been better. If I had known any of this, before I agreed to take antidepressants for what in retrospect was a very reasonable ‘emotional crisis’ provoked by a conglomeration of extreme stress within difficult circumstances, I would never have agreed. But, at the time, the chemical imbalance theory of depression was widespread and pervasive. Unfortunately, I believed what I was told and thought that the experts knew best. This is a cautionary tale in the hope that it may give pause for thought. It is easy to write the first prescription, but, for the patient, it can have profound and long-lasting consequences.

• © British Journal of General Practice 2023