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'What I Wish I Knew About Switching Antidepressants'
The Rollercoaster Of Switching Medications
When my family doc suggested switching to a different SSRI, I figured it was no big deal; after all, it was the same class of drugs, affecting the same neurotransmitter, right? I worked out a taper plan with my pharmacists, and began the process of switching my medications.
But those sh*t feelings? They started as soon as I stopped taking the old med and started the new one. A quick Google of phrases like “switching antidepressants and feel like crap” turned up the same result over and over again: serotonin discontinuation syndrome (SDS).
Turns out SDS is incredibly common and can cause a mish-mash of symptoms to make you miserable: flu-like dizziness, nausea, fatigue, chills, headaches, insomnia, nightmares, and “brain zaps”—mini electric shock-like sensations in the brain, says Everett. For people totally coming off the meds (rather than switching), they can mirror depression, leading women to wonder if they’re having a relapse, she says.
Experts don’t fully understand why SDS occurs, but they suspect the majority of it is due to the immediate adjustment of the amount of serotonin in the brain, says Everett. That adjustment happens more gradually with some drugs than others, depending on the medication’s half-life, or the amount of time a drug stays in your system after you stop taking it.
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And it’s something that the 12 percent of Americans (more women than men), who take antidepressants need to be more aware of. Because, among people who switch or stop taking an SSRI, “it’s pretty universal, and it’s a very real thing,” says Everett. The authors of one recent report in the journal Psychotherapy and Psychosomaticstakes it one step further. After reviewing dozens of studies and case reports on SDS, they concluded that “clinicians need to add SSRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs.”
What I Wish I Knew
I definitely wish my GP—who I generally adore—had warned me about SDS in advance. I get that family docs can’t be the masters of All Things Medical. But as Everett points out, the majority of antidepressants are prescribed by non-psychiatrists. And while “GPs tend to get comfortable with one medication, psychiatrists are more familiar with the personalities of different medications,” says Everett. That’s why, while she notes that some GPs are “great” at advising patients on antidepressant use, she recommends that if possible, patients should see a psychiatrist if they're thinking about changing or coming off the meds.
If you and your doctor have determined that it’s the right time to come off the meds altogether (you should never stop cold turkey or without your doc’s okay), she should formulate a tapering plan to gradually reduce the dose of the meds to allow your body to adapt to its absence in baby steps. If you’re switching meds, she may have you gradually increase the dose of the new drug at the same time, a process called cross-tapering, says Everett.
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The rules for tapering depend on which drugs you’re stopping and starting, the dose, and how long you’ve been on an SSRI, says Everett, but it can take three to six months, she says. “We need to be really gentle with the brain.” And while I'd worked out a taper plan, I now realize it may have been too fast. (Kick back with these color therapy bath botanicals, available at the Women's Health Boutique!)
If you start to feel the symptoms of SDS during this process, call your doc ASAP. She may need to slow the rate of the taper to allow your brain more time to adjust.
My SDS lasted about two weeks (a typical amount of time, Everett told me). And now, a few months later, I’m happy with my new prescription.
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