Antidepressants can cause side effects for longer than you think.

Student Brenda Schulz, 25, from Vitória, Espírito Santo, underwent a long treatment regimen with antidepressants. It lasted three years in total. As her therapy progressed, with psychiatric monitoring, she reached a point where she felt she had reached a certain level of stability. Then, during one of her appointments, she stated that she wanted to stop taking the medication. What she didn't imagine was that the withdrawal process (or "weaning," as it's commonly called) would take so long and require so much effort.

Brenda isn't alone. A study from University College London (UCL), published this year in the scientific journal Psychiatry Research , showed that stopping antidepressants can lead to lasting side effects, especially for those who take them for a long time.

British researchers analyzed reports of 310 people's attempts to discontinue antidepressants. Of the total, 79% reported experiencing at least one withdrawal symptom during the discontinuation process. More than half of the participants who had used antidepressants for two years or more reported having failed when trying to discontinue. Only 21% reported the same experience among those who had used the drugs for a shorter period—a significant drop.

According to the study, prolonged use and the choice of more potent medications are associated with the perception of more symptoms of what is known as withdrawal syndrome, which can arise when stopping antidepressants. These symptoms can be physical, such as dizziness, headaches, sensations of "electric shocks" or "lightning bolts" in the head, sweating, and chills; or emotional, such as irritability, depressed mood, and anxiety, among others. The syndrome can also cause sleep disturbances and gastrointestinal issues, such as vomiting and diarrhea.

In a press release, UCL scientists reinforced the importance of further research into more effective tapering protocols and emphasized that prescriptions should be carefully considered. "This is one reason not to use antidepressants for longer than necessary, as it can make it harder to stop using them later," said psychiatrist Mark Horowitz, lead author of the study.

How long can antidepressants be used?

There is no reliable data to support the prescription of antidepressants for more than six months, according to psychiatrist Sivan Mauer, a professor at the Mackenzie Evangelical College of Paraná (FEMPAR). "This type of medication is not harmless, meaning it is not free of side effects. Despite this, it is common to see patients in our office who have been taking it for 15, 20 years," he reports. He reinforces the study's conclusion, confirming that antidepressant withdrawal syndrome is, in fact, more common in patients who have been taking the medication for longer.

Brenda, who used antidepressants for three years, is an example of this. She began psychological counseling between childhood and adolescence, due to losses and family conflicts. "I became emotionally worse after entering university, due to self-harm," says Brenda, who is studying Production Engineering. When the psychiatrist prescribed the antidepressant, there was no time limit. "Everything would depend on my progress with therapy and medication. First, we tried one, which didn't help. So, we switched to another, with a higher dose," she explains.

When she felt ready to begin withdrawal, the student spoke with her psychiatrist, who reduced her dosage. Then, the symptoms of the syndrome came back in full force. "In the first few weeks, I experienced sleep disturbances, frequent headaches, and some tremors and irritability," she recalls. "Even before starting withdrawal, on the days I forgot to take the medication, I experienced all these symptoms, but more intensely, including feelings of shock and nausea," she adds.

The type of antidepressant, however, also influences withdrawal. "Some cause more withdrawal symptoms than others," explains psychiatrist Henrique Bottura, president of the Instituto de Psiquiatria Paulista (IPP). "Those we call 'dual'—those that act on two neurotransmitters, primarily serotonin and norepinephrine—have a slightly more difficult withdrawal profile," he emphasizes.

One of the challenges for psychiatrists monitoring discontinuation is identifying the source of the complaints. When withdrawal symptoms are diagnosed as relapse, the person may return to the medication and take it longer than necessary.

" Not every patient who stops taking an antidepressant will experience a new depressive episode. Typically, what happens immediately after starting to stop taking it, in a stable patient, is due to withdrawal," warns Professor Mauer. However, continuing to take the prescription for a prolonged period, as the British study attests, can make discontinuation even more difficult. Some people experience episodes of depression or anxiety more frequently than they did when they first started taking it, as the brain's sensitivity to the medication tends to decrease over time.

One step at a time

The key to successfully navigating withdrawal, even in the face of all the difficulties, is understanding the stages and reasons for the process. According to Mauer, this is one of the main obstacles. "The patient needs to understand that there is no longer a need for antidepressant use. Even if they are sad, in some cases, which should be individually evaluated by a psychiatrist, the antidepressant itself may be worsening these symptoms," he explains. As mentioned above, the brain adjusts to the medication, and episodes recur more frequently. Hence the need for timely withdrawal.

The professor also emphasizes the importance of providing honest guidance, noting that, during the process, the individual may experience difficult times and require support. "The family must also understand this in order to provide appropriate support," the professor states. "It's a step toward more lasting improvement," he adds.

Suspension, however, should not be done suddenly or abruptly. This reduces the risk of instability and confusion of symptoms with those of a relapse, which could lead to a return to the medication. The specialist notes that each person should receive individual guidance. "There's no set formula. The important thing is to do this in a planned manner, always in consultation with the doctor," suggests Bottura, from IPP.

In general, the doctor gradually reduces the medication dosage, often by dividing it up in a compounding pharmacy. Switching and alternating with other medications can also be effective measures.

In addition to all this, it's important to consider other factors in the patient's routine. For Brenda, lifestyle changes were key to successfully withdrawing from antidepressants. "I really got into weight training and, later, running, and this gave me the space and energy to spend quality time with friends and family, which also helped me a lot," the student explains. "When we're in this situation, social isolation is common, but being around people you love makes all the difference," she says.

Today, it's been two years since she stopped taking antidepressants. Understanding everything that led her to this point and getting to know herself were essential steps. "I feel lighter, more aware of my triggers, and better able to understand the signals my mind and body give me. I'm more patient with myself," she adds. Everything indicates that patience is indeed key here.