How long do SSRI withdrawal symptoms last?

 

This is one of the most common, and hardest to answer, questions about SSRI withdrawal.  Withdrawal from psychiatric medications is still officially a mystery.  According to the manufacturers, SSRI do not cause severe withdrawal.  Instead, symptoms from “discontinuation syndrome” are mild to moderate and last one to three weeks.  This is in direct contrast to some patients that experience prolonged, severe, symptoms.  The disparity between experience and official information causes a lot of confusion for patients.  When we break a bone or pull a muscle, there are long established timelines for recovery.  Individual recoveries can vary in time and intensity.  Overall, most patients follow the timeline and recover close to the time expected.

The lack of information about SSRI may be part of the reason why it is so hard to predict how long withdrawal symptoms will last.  Most studies of SSRI are limited to 8-12 weeks and do not address cessation of the drug.  Manufacturers study their drugs in this manner to gain regulatory approval for sale, not so much to study the effects of the drugs.  Studies of the effects and withdrawal would be more of an academic pursuit and wouldn’t contribute to the commercial application of the medications.  Fewer people would begin prescriptions for SSRI if they knew that there was a chance that they would become dependent on the drug and have to go through an extended withdrawal period when they decide to stop taking it.

From the symptom perspective, it’s very hard to say which patients will experience withdrawal.  Some patients do follow the accepted tapering schedule and are able to stop taking the medication with minimal symptoms, despite taking the drug for a long time.  Other patients experience extended symptoms after taking the drug for a short period.  The underlying predictors of which patients are sensitive to SSRI and which ones aren’t are not well understood.  Without enough knowledge to predict which patients will experience withdrawal, it is even harder to predict how long those symptoms will last.  It becomes a very personal, individual, struggle for each patient.  That being said, there are some ways to gauge progress and predict how long an individual will experience withdrawal.

When a patient first experiences withdrawal symptoms, they can be quite frightening.  Since the mind creates reality in real time, withdrawal can seem like it will become permanent and debilitating.  That is the reality that withdrawal creates, though, not reality as an impartial observer would see it.  We live in a relative state of mind, though, so that’s all we see.  If we could step back from withdrawal symptoms, we would realize that this is a temporary crisis and not a permanent state of mind.  Withdrawal forces the mind to act more on instinct than it normally would.  In normal thought, the intellect regulates instinctual responses, moderating them to match social situations and our own moral beliefs.  Withdrawal disconnects the intellect from its normal regulatory function.  Instead of moderating behavior, anger, fear, and anxiety are allowed to come to the conscious mind.  As an example, take a trip to a supermarket and pay attention to your reactions.  When another shopper blocks an aisle or cuts you off at an intersection, anger is a possible reaction.  Normally, that anger is easily suppressed and you let the incident go without any reaction.  Withdrawal removes that moderating behavior and allows anger to become the acceptable response.  For a person not experiencing withdrawal, it takes a great deal of introspection to even detect the anger that arises from the incident.  It’s almost automatic to suppress the anger because reacting to such a trivial interaction is socially inappropriate.

Reasserting the intellect during withdrawal is the best way to control symptoms and mitigate the power they have.  Being mindful of how you would normally react to a situation and forcing yourself to follow that course of action can help.  It’s easier said than done.  Because of the mental relativism that withdrawal causes, it can be very hard to separate yourself from the immediate symptoms you’re experiencing.  Mindfulness is the process of stepping back from a situation and evaluating the emotions that you are feeling, and then changing your behavior based on what you think rather than your immediate emotions.  Essentially, it’s replacing the automatic moderating behavior that’s suppressed in withdrawal with conscious effort.  It can slow down the flow a conversation quite a bit second guessing every thought, but it’s better than acting out in a way that you might regret later.  It’s not necessary to think your way through every interaction forever, just until the automatic moderating function reestablishes itself.

Taking a longer view of withdrawal can help as well.  It’s very hard to envision how you will feel in two months when you’re living with symptoms minute by minute.  SSRI withdrawal happens in waves and windows.  Those are the names that veterans give to the cycle of withdrawal symptoms.  Waves are periods of time when symptoms are more severe.  Windows are periods when symptoms are not as bad.  As withdrawal progresses, waves come and go.  In the long term, the waves become shorter and milder, while the windows become better and longer.  Eventually, you enter a “window” that doesn’t end.  Mindfulness allows you to see that waves are not permanent and not put too much hope in the permanency of windows.  It sounds fatalistic to acknowledge that windows do not represent a cure, but it’s more realistic.  It’s a delicate balance between hope and pragmatism.  Being aware of how you are feeling during a window is just as important as being aware of your feelings during a wave.  Just as you need to consciously moderate your feelings in a wave, you have to bank the good parts of a window to use when you enter the next wave.  It’s an intrinsic exercise that you can’t really start to practice until you have the experience of a couple cycles behind you.  In the beginning, it’s very hard to see the larger picture because all there is is the immediate symptoms.  Some faith that symptoms will get better is required.  Faith is one of the first things to be shaken in withdrawal.  Family and friends don’t understand, doctors don’t believe it’s withdrawal.  You can’t “suck it up”, either, it doesn’t work like that.  All that can shake anyone’s certainty.  The wave/window pattern is part of withdrawal, though.  Just as you will enter waves during withdrawal, they will also end at some point.

As time goes by and you become accustomed to the cycle of waves and windows, the question becomes less about how long will withdrawal last.  Mindfulness becomes a habit, something that is almost second nature.  It’s something that you can apply to your life after withdrawal.  Most people started taking an SSRI to treat an existing condition.  The decision to stop taking an SSRI usually comes after the drug has lost efficacy or the side effects outweigh the benefits.  That requires some way of dealing with the symptoms of the condition after withdrawal is over.  It’s hard to see the mindfulness that withdrawal forces on you as a benefit of that trauma, but it does give you a good way to handle an existing condition.  In the long term, the goal becomes less about getting off the drug as fast as possible, and more about getting off the drug with as much quality of life as possible.  In a way, a good way, the coping tools you develop during withdrawal will serve you for the rest of your life.  The adage that alcoholics use to describe recovery is apt for people suffering from SSRI withdrawal. “One day at a time” is the best way to approach recovery.