Phases of SSRI Withdrawal

Clinically reviewed by Rachel Wise, ARNP

SSRIs aren’t addictive in the same way that alcohol and opioids are. But if a person has been using them for an extended period, and then abruptly stops, they may experience SSRI withdrawal symptoms.

Contact Time Wellness Centers today to learn more about our depression treatment in Tennessee.

What Are SSRIs?

Selective serotonin reuptake inhibitors (SSRIs) are a category of prescription medications that are most commonly used to treat depressive disorders.

Some of the most frequently prescribed SSRIs include:

• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
• Escitalopram (Lexapro)
• Fluvoxamine (Luvox)
• Citalopram (Celexa)

How SSRIs Work

As the full name of this drug category suggests, SSRIs work by preventing nerve cells from reabsorbing serotonin, a neurotransmitter that is involved in mood, appetite, sexual pleasure, memory, and an array of other functions.

Usually, once serotonin molecules have delivered their message from one nerve cell to a neighboring cell, the neurotransmitter is transported back to the originating cell so that it can be reabsorbed and stored for future use. SSRIs disrupt this process, which leads to a serotonin buildup within the synapses, or small gaps that separate cells throughout the central nervous system (CNS).

The accumulation of additional serotonin in the synapses has the effect of amplifying the message these molecules are carrying. For some people who have depression, this leads to an easing of symptoms and an improvement in mood.

History of SSRIs in the U.S.

As reported in a February 2015 article in the journal Experimental and Clinical Psychopharmacology:

• Researchers first began to uncover evidence of serotonin’s involvement in depression in the 1960s.
• The first published report on fluoxetine’s potential as an antidepressant appeared in 1974.
• Fluoxetine earned approval from the U.S. Food and Drug Administration in 1987.

When Prozac was released in the U.S. in the late 1980s, it represented a landmark development in the effort to treat depression with medication. The drug proved to be more effective than monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants, the meds that had previously been used to treat depression. Prozac also posed a lower risk of distressing side effects.

Today, Prozac, SSRIs, and similar medications that have been developed through the ensuing decades are first-line choices for treating depressive disorders and certain other conditions, usually in concert with therapy. 

MAOIs and tricyclics are still used, but typically only after other meds have proved to be ineffective.

Recommended: Common Mental Health Medications

Common SSRI Withdrawal Symptoms

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), developing withdrawal symptoms when you stop using a substance is one of the signs of addiction. 

As we noted at the outset of today’s post, SSRIs aren’t addictive in the same sense that alcohol and opioids are. They also don’t cause the severe withdrawal symptoms that those drugs are known for. But if you abruptly stop using an SSRI after having the drug in your system for a long time, you can expect to go through some physical or psychological discomfort. 

A May 2017 article in the Canadian Medical Association Journal reported that about 20% of people who take SSRIs or similar drugs may experience what the authors of that article call “antidepressant discontinuation syndrome.”

Common symptoms of SSRI withdrawal include:

• Dizziness or lightheadedness
• “Brain zaps,” which feel like brief electrical impulses in your head
• Headache
• Excessive perspiration
• Fatigue
• Nausea
• Insomnia
• Vivid nightmares
• Anxiety
• Agitation

Ending your SSRI use can also cause a return of the symptoms you were using the medication to treat. This underscores the importance of consulting with the physician who prescribed the med to you before making this change, which we’ll discuss more a bit later in today’s post.

Phases of SSRI Withdrawal

Your experience with SSRI withdrawal can be influenced by several personal factors, including:

• Which SSRI you had been taking it
• How long you’d been taking the medication
• Your daily dosage level
• Your overall health and metabolism
• If you taper your use or quit “cold turkey”

Generally speaking, though, SSRI withdrawal often occurs in two phases: acute and protracted.

Acute SSRI withdrawal

Acute withdrawal will usually begin within one to three days after you stop taking SSRIs, and may last from a few days to a few weeks.

During the acute phase of SSRI withdrawal, you’ll be most likely to experience headaches, fatigue, nausea, brain zaps, and many other upsetting physical symptoms. 

Acute withdrawal can also be characterized by mood swings, short-term memory problems, and difficulty concentrating and focusing.

Protracted SSRI withdrawal

For some people, SSRI withdrawal consists only of the acute phase. Once the early symptoms have peaked and dissipated – which usually happens within a few weeks – the process is complete.

Unfortunately, not everyone gets through SSRI withdrawal so quickly.

Protracted withdrawal was the focus of an April 2024 study the Journal of Affective Disorders Reports. That study, which involved a survey of 1,148 people who had stopped using antidepressants or were in the process of doing so, found that:

• 49.5% had symptoms that persisted for more than a year.
• 32.2% had symptoms that lasted for more than two years.
• 10.7% continued to have symptoms more than five years after ending their antidepressant use.

The most common extended withdrawal symptoms were anxiety and low mood. Other frequently reported long-term symptoms included vertigo, muscle cramps, vivid dreams, nausea, and heart palpitations.

How to Safely Stop Using SSRIs

The safest way to stop using SSRIs is to talk to your doctor about setting up a tapering schedule, which will allow your body to slowly adapt to diminishing levels of the drug in your system.

Following a doctor-approved tapering schedule can minimize your risk of developing particularly difficult withdrawal symptoms. Consulting with your doctor first can also help you to better understand what to expect throughout the process, including how to deal with the return of depressive symptoms or other mental health challenges.

Your doctor’s involvement can also be essential for determining the best course of action once you’ve completely ended your SSRI use. Depending on your needs and preferences, this may involve switching to a different medication, focusing more on psychotherapy, or taking a different approach.

Learn More About Depression Treatment in Tennessee

Time Wellness Tennessee is a premier source of residential and outpatient programming for adults who have been living with depression and other mental health concerns. 

Treatment options at our center in Chattanooga, TN, include a residential program, a partial hospitalization program (PHP), an intensive outpatient program (IOP), and an outpatient program. We also offer supportive housing for clients who need additional structure while receiving care at the PHP, IOP, or outpatient levels.

To learn more about how we can help you or a loved one, or to schedule a free assessment, please visit our Admissions page or call us today.