There was a time when “medicine can not stop” became a popular phrase, the subtext behind what is, we all take a look. However, to be honest, this seemingly funny words really have some truth to it. Today we will talk to you about why “you can’t stop the medicine”. A common question asked by depressed friends and their families is “I don’t want to take this antidepressant anymore, can I stop taking it?” But rarely do people ask me, “I want to stop my antidepressant, but how do I stop?” Perhaps people often focus on the fact that antidepressants are central drugs and think that taking them for a long time is bad for the brain or addictive, so they think they should stop as soon as possible, but they ignore the Withdrawal / Discontinuation Syndrome of antidepressants. What is Withdrawal Syndrome? Withdrawal syndrome, a pharmacological/pharmacokinetic term that refers to “adverse reactions caused by the sudden cessation of a drug”, is widely found in many drugs, such as cardiovascular drugs and hormonal drugs. It is also found in antidepressants such as escitalopram, a selective 5-hydroxytryptamine (5-HT) reuptake inhibitor (SSRI). Taking antidepressants for a period of time and then suddenly stopping taking them – for example, taking 20 mg yesterday (the maximum recommended daily dose of escitalopram for adults) and suddenly not taking them at all today – may trigger a range of physical discomfort or mood swings. Common adverse effects of antidepressants include: irritability anxiety insomnia, excessive dreaming (dreams that you remember or remember upon waking) or nightmares. Pain, dizziness, fatigue, flu-like symptoms such as: muscle aches, chills. Nausea, regurgitation depression symptoms reappear as excessive sweating tremors. Of course, not every antidepressant will necessarily produce the above discontinuation reactions. Even if you take the same antidepressant, not everyone will have a discontinuation reaction. Clinical statistics show that about 1 in 5 people who have used antidepressants for more than 6 weeks will have a discontinuation reaction. The timing of discontinuation reactions also varies, with some people experiencing them immediately after discontinuation, others a few days later, and some people not even experiencing them at all, depending on the elimination half-life of the drug and the individual’s ability to metabolize the drug (e.g., older adults and young adults obviously have different drug metabolism). Generally, discontinuation reactions disappear on their own about 6 weeks after discontinuation, but in some cases they last for about 1 year. After all, each person’s age, condition, physical status, presence of other diseases, genetics, and various other factors can make discontinuation reactions diverse, uncertain, and unpredictable. Why do discontinuation reactions occur? Honestly, this question is too difficult to answer. When scientists can answer it, then I guess we’re not far from conquering depression! Antidepressants work by helping the nuclei in specific areas of the brain to restore normal chemical homeostasis, where “chemical homeostasis” refers to the neurochemical transmitters associated with depression, such as 5-HT and GABA. -aminobutyric acid (GABA), norepinephrine (NE), etc. There is a current hypothesis that the sudden withdrawal of antidepressants may put cause neurochemical transmitters to readjust within a certain range, and that the brain needs a period of time to adapt to this change. But one thing to emphasize is that we often have a misconception that antidepressants are “addictive” (Addiction), in large part because the withdrawal of antidepressants makes some of you think that if you go back on antidepressants, these adverse effects will go away, but then I will never be able to leave them. Antidepressants? Then they are not as addictive as caffeine and nicotine? In fact, it is understandable why this misconception has arisen, because addiction, to a certain extent, indicates an excessive dependence on a substance, and there is a significant psychological factor in addition to the biological one. But in fact, the pharmacological basis of antidepressants means that they are not so-called addictive (see my previous post on the difference between antidepressants and addiction for a related video). Which antidepressants are the least likely to “wear off”? Generally speaking, antidepressants that have a short residence time in the body and act on both the 5-HT and NE systems are relatively easy to discontinue, such as: Citalopram; Escitalopram; Paroxetine; Sertraline. Fluoxetine, which has a slower clearance rate in the body, is relatively less likely to produce adverse effects. However, please note that Fluoxetine is by no means a better choice than the above drugs. We are only discussing the withdrawal reactions resulting from abrupt discontinuation here, and the choice of drugs needs to take into account the indications, efficacy, individual differences, and the original adverse drug reactions. Please do not be confused and choose your medication according to your doctor’s recommendation. The older generation of antidepressants, such as tricyclics, can also cause withdrawal reactions. How do I stop taking the medication? While there is no guarantee that the likelihood of a discontinuation reaction will be reduced to zero, it is definitely wise to discuss with your doctor and follow medical advice to make the effects of a discontinuation reaction much less likely. Your doctor will generally adjust the dose to your specific situation and taper it over a period of several weeks to allow your brain time to adjust to the change. Never reduce or stop your dose on your own! In some cases, your doctor may prescribe another antidepressant or other medication (non-antidepressant) that can be taken for a short period of time to help reduce the withdrawal reaction. If you are switching from antidepressant A to another antidepressant B, your doctor will instruct you to start antidepressant B before you have completely stopped antidepressant A. Be especially careful: Most antidepressants interact with monoamine oxidase inhibitors (MAOIs), causing a “5-HT syndrome”-like Most antidepressants interact with MAOI’s and cause adverse effects similar to “5-HT syndrome” (e.g., hyperthermia, tonicity, myoclonus, mental instability, etc.) and their combination should be strictly prohibited. If an MAOI has to be used as soon as possible, it should be started at least 7-14 days after stopping the antidepressant (e.g. escitalopram should be stopped for more than 14 days). You do not need to fully understand or be familiar with the above, as long as you remember that “antidepressants should not be discontinued on their own”, then the purpose of this article will be achieved. As always: follow your doctor’s instructions. I wish you all a healthy and happy day!