Withdrawal Symptoms or a Relapse of Depression?

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This post is from my archives. TRIGGER: Please communicate with your doctor if you are considering tapering off of an antidepressant. My depression did not involve psychosis or dangerous manias.

Four years ago a good friend of mine put her 10-year-old son on Prozac. He had always suffered from anxiety and anger outbursts, but at age nine, his behavior turned violent and his ruminations were keeping him up at night. She and her husband went to a variety of child psychologists, but the cognitive behavioral therapy wasn’t enough. Finally they got a referral to a psychiatrist who diagnosed the boy with Attention Deficit and Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), and generalized anxiety disorder (GAD), and prescribed both Methylphenidate (Ritalin) and Fluoxetine (Prozac).

His behavior was much better initially. However, the drugs presented other problems. The boy’s weight dropped and he stopped growing. A kid who was born with a healthy appetite and would try any food (chicken curry at age one), his parents couldn’t get him to eat anything. He went from being in the back row of his basketball photos (where the tall kids line up) to the front line (where the short kids kneel). And after six months, his old behavior returned.

The parents weaned him off the Ritalin and the boy’s appetite returned. They tried to get him to eliminate gluten and sugar as much as possible and have him load up on protein. They began giving him fish oil supplements, a multivitamin, and a probiotic. The diet changes had a substantial impact on his behavior.

A few months later they decided to try to taper him off the Prozac. He did fine initially. The parents thought they were home free. However, two months after he was off the Prozac, their son’s worrisome behavior returned—worse than ever. My friend thought that they should take him back to the psychiatrist, but her husband disagreed. He had researched the half-life of Prozac and other withdrawal stories, and told her that many people go through a delayed withdrawal two to three months after taking the last pill. Unfortunately, he said, they would have to tolerate the bad behavior for a few months until the synapses in his brain made the adjustments.

The husband was right. The boy had two and a half rough months, but he pulled through. Today he is eating, growing, and thriving—managing his anxiety some days better than others.

I remembered her story because I recently tapered off of one of my antidepressants. A month off, I was doing fine, when all of a sudden I was hit with some acute anxiety. I wondered, could it be a delayed withdrawal symptom? I brought this up to my fellow depression warriors on Group Beyond Blue, and ProjectBeyondBlue.com, and received confirmation: When you have tapered off an antidepressant, it is incredibly difficult to know whether you are relapsing into a depression or if you are merely experiencing withdrawal symptoms that will go away in a few weeks or months.

My friend Margarita Tartakovsy, M.S. interviewed Dr. Ross Baldessarini, professor of psychiatry and neuroscience at Harvard Medical School and director of the psychopharmacology program at McLean Hospital for an article on Psych Central distinguishing withdrawal symptoms from depression. He believes that when the depression re-emerges quickly, it’s easier to identify as withdrawal. If it happens weeks to months after discontinuation, then he thinks there is much more risk to it being relapse.

However, after weighing in with several of the members on both forums, I’m not so sure I agree with him.

For example, one woman went off her antidepressant in March and got really depressed and anxious in July. Her doctor said this is to be expected and is not unusual at all, that is a natural part of the brain’s readjusting process. According to her doctor, it takes a few months for the brain to realize something is missing and to start the readjusting. The whole process can last six months to a year.

That makes a lot of sense to me. There are so many organic changes going on in the gray matter of your brain when you stop taking an antidepressant. For people like me that have a significant response to a teaspoon of sugar or three bites of pumpkin pie, think about the mayhem that’s going on inside the limbic system of my brain, as it tries to reorganize all the synapses after it is no longer getting a hefty dose of a powerful psychotropic drug. Although I don’t believe most classifications of antidepressants to be addictive—unlike benzodiazepines–I do believe your brain becomes dependent on them, so that it needs to relearn how to ride the bike again without training wheels. Lots of skinned knees …

Of course, the withdrawal process is different for everyone. Much has to do with how long a person has been taking the medication and at what dose. Obviously, someone who was taking 60 milligrams of Prozac for 20 years might need to wean much more slowly and endure many more withdrawal symptoms (and for much longer) than a person who was taking 10 milligrams for a few months.

For some, the withdrawal symptoms are very distinct from the symptoms that they were experiencing before. They might resemble that of the flu: headaches, dizziness, nausea, fatigue. In fact, Dr. Baldessari discusses “SSRI Discontinuation Syndrome” in his interview with Margarita that occurs in 20 percent of persons who withdrawal from antidepressants. A person may become agitated and angry more than depressed (if he or she was depressed before), or sad and lethargic more than anxious (if he or she was primarily anxious before). If a person is suddenly having crying spells after going off a medication that treated her anxiety and insomnia, chances are she is experiencing withdrawal symptoms rather than a relapse of her condition.

After reading dozens of articles on typical withdrawal times and corresponding with dozens of folks, it seems as though three months is the average recommended time (and this begins once you start having symptoms, which could be two months after you’ve weaned off your drug) to wait to see if the symptoms clear up.

Jim Kelly, a member of my forum and a mental health advocate and speaker living in Westchester, Illinois never agrees to a medication change without a transition plan.

“Changing medications, either starting or ending, cannot be fully assessed until two or three months in; that’s for me,” he says. “And I always request some transitional medication in small dose to ease side effects.”

He has learned to be patient with the ugly process.

‪”I’m undergoing a change right now, and two weeks in I feel terrible,” he explains. “It feels like withdrawal from the old, rather than anything to do with the new… yet. I wish the two or three months would go faster, but it is what it is.”

Ultimately, I think you know yourself better than anyone and can tease apart the difference between withdrawal or relapse more easily than you think you can. After comparing my symptoms this week to the symptoms of depression I’ve had for so much of my life (for this reason, it’s important to keep a mood journal!) and assessing other things going on in my life (different diet, changes in schedule, etc.), I could recognize it was my brain just readjusting to a different chemistry and that I’m on the right track.

Much like my friend’s son.

Join ProjectBeyondBlue.com, the new depression community.

Published originally on Sanity Break.

Photo credit: Thinkstock

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27 thoughts on “Withdrawal Symptoms or a Relapse of Depression?

  1. Great article.

    I’ve come to accept that for myself it takes between 4 and 6 months to be completely “free” from the side effects of being fully tapered off of a medication. Having this happen over the many years I’d been on medications, I finally started my tapering to coincide with the winter season since I wanted to feel more than halfway decent by springtime.

    I was off all daily medications for over a year and had to go back on an SSRI recently. I’m on a low dosage just to keep the death thoughts and dread at bay while I try to deal with what’s going on in my life currently that’s the underlying cause of them. I’m hoping that within a year or so I can taper off again. If not, I’m okay with that, but at least I’m (and my psychiatrist) are much better informed on how to do it with as little uncomfortableness as possible.

    In the meantime, Dr. Kelly Brogan, a holistic psychiatrist in NYC, has some really great information about how she has helped her patients taper off medication successfully with few withdrawal symptoms and negative side effects. For some patients, it’s taken a year or so, but everyone’s case is different.

    Blessings!

  2. In my case, I could not possibly wait months for my body to make adjustments. I reduced one drug, only because I wasn’t sure that it was causing a another disease.. That was in June. It is now October. I also finally stopping lithium in July. I had to stop the lithium due to chronic kidney disease I. had been on that for about 30 years! My kidney doctor said I was very lucky to have only moderate damage.

    I am a person of great faith. My relationship with God is the most important thing in my life. What happens to me when I relapse is that I lose my ability to hear and feel the Holy Spirit guiding me which induces great anxiety, both physically and mentally. Like Therese, I do everything I can to be well: exercise, meditation, prayer, cognitive behavior. I was ready for side effects during withdrawal and for several weeks, I kept up all my positive regimens and kept telling myself that everything was happening in order to strengthen me and that I just had to hang in there. When I had depression, anxiety and insomnia temporarily, I was able to use my tools. I was feeling I could adjust to and control my withdrawal. I should have paid more attention to my sleep problems. I just kept accepting them as just something that could be overcome if I just worked through them. Looking at my journal, I see that, in retrospect, these symptoms were becoming unmanageable. Suddenly, all the weeks of this struggle came to a head and I realized I had insomnia and that triggers overwhelming anxiety and depression and thus, triggered a relapse. I increased my lamictol back to the original dose today. . Fortunately, the new drug latuda has definitely helped and I’m feeling a little confident in resuming the lamictal. I know that Therese reads these comments and so I will direct these next thoughts directly to her. I am sure now of what I can do with all my tools and what medicine can do. I struggled for five years trying to get off a lifetime use of lithium. Finding just this year the right combination of meds has just been life changing. Reducing the lamictal at least ruled out that it was causing sjogrens syndrome. All my praying and positive thinking could no longer overcome the sleep deprivation which caused depression and anxiety.

    So, my main question, if all this is withdrawal symptoms, how could a person accept going without sleep for months, waiting for their body to adjust? In my case, I could not wait for that. It would’ve turned into a long lasting relapse.I’m hoping that it will only take a short time for the latuda and lamictal to work together. I found that I had relapses with lamictal alone. All this trial and error… I think this relapse is temporary and that the symptoms are not as severe.

    The bottom line is, I knew I’d have discomfort for awhile going through withdrawal. There was no way on God’s green earth that I could continue not sleeping and function. Being a patient person, I went too long thinking I was just dealing with withdrawal. If you find the right medication combo, it may be a big mistake to change it.

    I’m glad that so many of you are able to withdraw from medications. But some, like me, cannot do so without what could be devastating consequences. I’m not sure how well I’m expressing myself since I am going through a relapse which I KNOW now is not just withdrawal. I am using all my tools to try to help this process along. I don’t know how you guys experience this, but every relapse makes you feel like you’re back to square one and that all the progress you’ve made working on yourself is gone. The rational says it’s still there but the FEAR that you will never move forward through this dreadful illness is terrifying when you are in it.

    I’m not saying that withdrawing isn’t a great thing for many and I would love to just use all the tools I’ve acquired to control my illness and not take medication at all. I am 63 and after having childhood depression, was diagnosed and treated for bipolar for about 40 years. All these years I have shrived to do whatever I could in order to keep the illness in check to the best of my ability. I cannot do this without a certain amount of medication. I know that all my tools only work if I have the right amount of medication. They must work hand in hand. I am not very strong right now but I think I may have circumvented a complete meltdown by returning to my original lamictal dose (of course, only under medical supervision) today.

    I’m sure my thoughts are a little rambling but I truly wanted to communicate this in hope that others may be able to give me their thoughts and experiences on this”withdrawal or relapse” topic to reassure me that I have not “failed” by not sticking it out with the withdrawal. And also, in hopes that others might recognize sooner than I did that I was headed for a relapse after a few months after withdrawal.

    I keep trying to proofread this to make it better but my focus isn’t great so I’m sorry if any of this sounds disjointed. I really needed to express these thoughts with those who know how horrible it is to have this baffling illness.

    1. Shelley, I so totally don’t think you have failed in any way whatsoever. In fact, I think you are strong and courageous to realize what you need to do to help yourself. That is great.

      There can be such a stigma being on medication that it can seem like we are weak and flawed if we need it. I recently went through it with some people close to me. One of them in particular was very disappointed that I had to go back on medication. I was initially quite hurt but then regrouped myself – something I may not have done had I not been a member of this wonderful site. I then told that person that I am caring for myself in the best way possible so I can have a decent life experience. They backed off. Although, I don’t think they understood since they don’t have the same need for medication, I felt empowered.

      I am glad that I have been able to come off medications at times, but I am also glad that I have had the strength to go back on them.

      A relative of mine has never been able to come off her medication even when she tried under close supervision, as well as trying other remedies. We spoke about it and besides the weight gain, it was the stigma. When we spoke further about it, she realized how much better she did on the medication and resumed her treatment with her doctor’s supervision. She is doing much better. That’s what’s so important.

      For myself, besides the stigma issue initially, yet even before going on medication initially years ago, I never liked taking medication. Heck, even some vitamins and herbals were too strong for me at the lowest dosages. Then add in the negative side effects of some of the medications, so I was not thrilled. Yet, on the other hand, I am so grateful that there is something that I can take when and as I need it all under the supervision of a great doctor.

      I am currently of the mind to remain “fluid” to all of this. In other words, as I told my doctor, if I have to stay on medication for the rest of my life, so be it.

      Again, you haven’t failed. You are strong.

      Blessings always!

      1. Thanks so much for your support. I wish I had had more responses to my comment but I guess no one was interested or else didn’t want to discuss relapses. What do you think?

        1. Hi, Shelley.

          You’re welcome.

          As to your question, I don’t know the answer.

          I do know for myself though, having had relapses throughout my life that initially they were extremely embarrassing for me. I had not only felt so flawed, but, cursed. I know that might sound strange, but I’ll try to explain.

          At the times of some of my relapses, I couldn’t understand at the time why God would allow it after everything I had done (mission-type work). Then I thought maybe I offended God. Then there were the years in between of experimenting with different medication combinations. After years of this, I didn’t even recognize myself. At that point in time, I was hospitalized. It was surreal at the time, but I began to slowly find my own self again.

          After that time period, when I did eventually come off medication and had a relapse, even after trying vigorously other holistic approaches, my butt was right back in my doctor’s office. I was no longer thinking I was cursed. I’d realized that my body, for whatever reason, be it overly sensitive or perhaps a chemical imbalance or perhaps a mini breakdown and resulting stress, or maybe even something in my diet however healthy or not, whatever it was behind the relapse ultimately didn’t matter at that time. I needed to “protect my life” from myself and get help. I’m actually going through this again right now having recently gone back on an SSRI.

          It’s been a couple of months and I just feel like now that I am slowly coming out of the mire of my relapse. It’s not easy and it’s still not great dealing with the stigma of going back on the medication – especially when you get some health care “professionals” who may be like, “Oh, you’re back on such-and-such.” Or comments from people who don’t understand our situation and are like, “Oh, but you seemed to be doing so well on the (natural supplements/holistic treatment names here).” Ugh! “Yeah, well I was.” Then I’d sometimes get so ticked off and blurt out, “Well, I guess I’m just a flippin nut. But at least I’m cute.” That shut them up. Some laughed, but got my drift. Some apologized.

          Gosh, sorry I was so long-winded about that. I just wanted to share my own personal experience with you because I have known for myself that relapsing has been a really tough thing. I’m getting better dealing with it, but I am by no means out of the woods. I may never fully be. But with this website, Bipolar First Bipolar Together’s website and Toni Bernhard’s site, I’m feeling a little stronger.

          Blessings to you and all!

          1. Oh, I should add that when I finally found the best psychiatrist for me and we learned how my body worked, we were able to figure out the difference between withdrawal symptoms and relapses. That definitely wasn’t fun, but I did get to know my body better – which is a good thing. :)

          2. Hi DM,

            I am very glad to get your input and would like to reply, but I need a few days to, hopefully, feel more focused. I find your responses on point and informative. So I will definitely reply as soon as I can.

            Blessings to you also,
            Shelley

            I

    2. Shelley, I’m thankful that you brought up the issue of it not always being safe to wait through the withdrawal period. I know that even one night of particularly bad trouble sleeping really scares me.

      I also appreciate what you said about not being able to hear God when your depression gets bad. I get so frustrated when people say that hard times bring us closer to God. I’m not sure what part of depression messing up my brain and distorting my thinking lends itself to feeling closer to God.

      I haven’t remained well enough long enough to try getting off my meds. I did try to get off one – the psychiatrist said it would taper off naturally, so i could quit cold turkey. I think i lasted two days before getting back on. (Which would suggest withdrawal effects, but i didn’t think it was worth it.) Other than that, I’ve just switched from medication combination to medication combination. The one time i reached something close enough to well, i told the dr (and he agreed with me) that i didn’t want to mess with my medications for a year since it had taken a few years to find this combination. I went one year without seeing my psychiatrist, and by the end of the year knew that the combination was no longer working well enough. So basically, I’m still trying to get the depression to adequately respond to medication long term. I’m pretty sure you wouldn’t call me a failure for being on medication. And i certainly wouldn’t call you a failure for taking medication despite the stigma.

      By the way, have you ever had well-meaning friends who are not medical professionals ask you if you felt better off medication? Or ask if you had considered getting off your medications? I know they mean well, but i find it frustrating.

      1. Abigail,
        It’s only been a week that I relapsed and it feels like forever. I know that Therese has severe treatment resistant depression. But she also has a family, a job, etc. I have been unable to work for about 20 years. When I went on disability, I told myself that I had worth even if I didn’t work and that I would do everything to be as healthy as possible. I I have also been unable to cultivate a more active life because I had just enough energy to exercise, go to church and very limited friends since I had to stay home alot not to be over stressed. I’m thinking that I just don’t have whatever it is to tolerate my illness. What’s happening now is that I feel “frozen”,(deer in headlights). The worst is that my childhood trauma completely overwhelms me and I act as if I can’t do anything or that anything I do is meaningless. I was a severely anxious and fearful child, starting at 8. I knew something was dreadfully wrong with me and suffered silently. It wasn’t a time like now that there was information on depression/bipolar. I was a great student and had many friends then, but when I went home alone I was terrified. All my life the theme has been stuck in my childhood trauma. I was doing very well for about 6 months this time, longer than usual. My way of dealing with my withdrawal was to tell myself that my higher self is my true self and that God would continue to strengthen me in order to stay well and finally move forward. That my true spiritual self is stronger than my mind and my body so that I could withstand the withdrawal symptoms, and then the fear and anxiety would lessen as my spirit grew. Well, that really did work for almost 4 months. I was so sure that my medication reduction was OK and that I was finally on the right track after about 50 years of battling, first depression, then bipolar.

        My sleep problems have almost always precipitated a meltdown. This time, my confidence was high because when I started to have depressive or anxiety symptoms I was quickly able to stop them. I did get a little nervous about my increasing sleep problems but I thought I could manage that, too. It was the first time in my life I was having such success with my own efforts.

        I recall my trigger vividly. I had depressive dreams one night that went on and on. It wasn’t just the small ones where I could spend alot of time when I woke up getting myself back to my spiritual self. This time, when I woke up, I told myself that I am not in that mindset anymore and that this couldn’t affect me. I was exhausted and still thinking I was doing OK. When I got up the next day, I knew that the depression and anxiety was no longer controllable and had a big crash…

        I don’t have much faith in increasing the meds back to where they were. It seems like when I crash, it takes about a month to stop that frozen childhood trauma. I don’t know how much of it is a sudden remission, medicine or regaining my spirit. I do have a boyfriend and, as we all experience, he doesn’t understand but is very supportive. But I’m so childlike and helpless and negative and constantly telling him how awful I feel and that it is my chemistry that makes me unable to sleep and pull out of this relapse. I have totally relied on my “true self” to guide me and this estrangement from God is the worst part of my symptoms. If I could just shut up about it and somehow function somewhat as an adult and stop stressing out my boyfriend and myself. I do not have family support and he is my main source of support. Not good to have all your eggs in one basket but it is what it is. He is the one person who has seen me through these episodes in the last few years and says that he would never leave me but that may not be true in the long run. I certainly wouldn’t blame him.

        One thing that confuses me now is, was I wrong about relying on my higher self to guide me as my main tool? I do not have an active social life or other friends and activities and maybe that’s why I can’t hang on to myself when I crash. Maybe if I’d had a different kind of life I would know how to cope better. My exercise and my faith, meditation, cognitive behavior. These things have been a full time job for me. How can I add things on to my life if I can barely function for periods of time?

        I am having a hard time expressing myself with all these symptoms so please understand if my writing is somewhat disjointed. I am very stressed out from writing all this although it is great to get feedback as I feel so alone and so ill. I am so proud of the person I’ve become when I am stable. Then it all disappears into the hell until the episode ends and I once again feel so hopeful .I would like to keep up a dialogue with you or others. I don’t know if that is done in posts like these.

        I also want to mention that DM was very supportive and I didn’t reply but I just happened to see this comment today and felt I should write right away. I hope that some of my words have helped someone.

        I think I’ve said enough for now and thank you again for giving me an opportunity to vent. I can’t keep proof reading this anymore for more clarity….

        1. Hello, Shelley.

          I just saw your post now. Got sick with food poisoning and slowly recovering.

          I’m so sorry to hear that you are going through this darkness right now. Please know, though, that your writing doesn’t seem disjointed to me. In fact, it’s very expressive and understandable. You seem very much in touch with what is going on inside of you.

          I wish I had the answers to your questions, but being a fellow depressed person, I’m lucky if I have even just a few answers for myself.

          It sometimes feels so difficult to move forward when you feel enveloped by the darkness of depression, bipolar, anxiety and such. It can be a very lonely place to be. But I personally hope and pray that what you are doing by reaching out and getting the help you need right now will bring about at least some relief.

          I personally think it’s great that you are in touch with your higher self. I learned about that last year from a hypnotherapist I went to for almost a year. I don’t want to sound preachy, but simply want to share what this hypnotherapist did with me. She found I lacked greatly in self-compassion. In fact, I down right hated myself, especially as a result of comparing my past me to the present me or to others. In working with her, using dialoging with my higher self, she tried to teach me self-compassion. I’m not perfect at it as I’m not even 2 years old with it, LOL, but when I start disliking or hating on myself due to my mental state of being, I try to practice self-compassion mainly by reading posts and books on it and then time for quiet reflection (if I’ve managed to calm myself down).

          Right now, perhaps this all sounds a bit too much. No worries. Just take good care of yourself.

          If you don’t mind my mentioning it, if you’re not on it already, Project Beyond Blue is a great way to connect with others on this journey we’re on. It’s more private too.

          Know that you are in my prayers.

          Blessings always!

          1. Shelly, So sorry to hear about your struggles. Keeping you in my thoughts and prayers. But the conversation here makes me really happy–people sharing and reaching out. Thanks, DM and Abigail.

          2. Therese, I wanted to answer your comment first but it ended up with a reply to DM. I appreciate your kind words and am glad that you encourage my interactions with DM and Abigail. I thought of you often today as I recalled your article on the highly sensitive person and how well meaning we can be and yet say the wrong thing too often. I really blew it when I just tried to make casual conversation to a woman who already has alot of issues to begin with. She berated me in front of everyone in my apartment community center. And I am so raw and fragile. Recalling your article really helped me because your responses were so similar to mine: we are well meaning people who are inordinately bothered by experiences like these.
            .

          3. Hi DM,
            I do belong to Project Beyond Blue and looked at the membership list for you. I did not see it. I would like to correspond with you and Abigail but I do not know how to make the request. Maybe you could help me with this. I will wait to hear from you about this before I write more. I am very happy that you have followed up with me, DM!

        2. Hi Shelley,
          I’ll second what DM said about Project Beyond Blue. I believe if you join that, you can find me in there as Abigail L.

          One of the things about mental illness is that even if you had the best childhood ever, it can still paralyse you as an adult. And taking care of yourself is a very worthy full time job, even if it doesn’t pay in dollars and cents. I’m sorry you’re struggling so much, and i hope this time your illness surprises you by going away extra fast.

          1. Abigail,
            Thanks so much for telling me how I can find you on the site. I will write you there. My comment about depression in children was only made because it is so intrinsic to my illness. I know that adults can suffer just as much without having depression as children…

          2. Abigail, that’s so true. Taking care of oneself with mental illness is a very worthy job. I know I try my hardest to make it like an adventure. Not to minimize it, but to keep myself from going down that slippery slope.

          3. Okay, I am really technologically challenged lately, LOL.

            Shelley, my reply to you which should have been here is down below…I think. :)

  3. Hi, again, Shelley.

    No worries or pressure regarding replying. Just glad to be able to share here and maybe be of some help. I’m sometimes not able to reply myself, but I was glad to be able to have had the time to do so this past week, as well as my wits about me, LOL.

    Blessings to you and to all here too!

    1. Oops…sorry my reply didn’t follow directly beneath your latest comment, Shelley. I’m using a different device to reply and didn’t see where the reply button was. :)

  4. Hello.

    Therese, glad to be of help if I can. I know I’ve received some really great support when I’ve been close to checking out. Bless you, again, for your work.

    Shelley, sure, I’m on the site, but with a twist to my name to protect my identity online for a few reasons which I can further explain on the site there. Would you be okay with telling me how you are listed so I can find you on PBB? If not, I totally understand and we can figure something out.

    Blessings!

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