Antidepressant Withdrawal: A Scandal the FDA and MDs Have Mostly Ignored

When most people hear the word “withdrawal” they think of drug abuse. Alcoholics who stop drinking suddenly can experience delirium tremens or the DTs. Going “cold turkey” after injecting heroin for weeks or months can cause a range of horrible symptoms. Antidepressant medications are prescribed for a number of conditions including depression, anxiety, obsessive compulsive disorder, fibromyalgia, nerve pain, arthritis, hot flashes and PTSD. People who suddenly stop taking such drugs can experience severe side effects that they were not warned about. The FDA has sanitized the problem of antidepressant withdrawal. The agency calls this condition “discontinuation syndrome.”

Abandoned by Medicine and the FDA:

Antidepressants are among the most commonly prescribed drugs in America. At last count, nearly 50 million Americans are taking medications such as sertraline, escitalopram, trazodone, amitriptyline, bupropion, fluoxetine, duloxetine, citalopram, venlafaxine and paroxetine.

One of the most controversial issues involving antidepressants involves what most people would call withdrawal. The first alert that patients could experience unpleasant symptoms upon stopping antidepressants was published in the Canadian Psychiatric Association Journal (Jan. 1959).

These Canadian physicians were reporting on an early medication called imipramine, referred to as a tricyclic antidepressant (TCA).

They describe withdrawal phenomena:

“One well-defined withdrawal reaction was noted in our series; another was reported to us in a personal communication and is noted here. Chief symptoms were nausea, vomiting, dizziness, chills, and great anxiety. Possibly more reactions of this type would have been seen if abrupt withdrawal of the drug had been more frequent.”

As far as we can tell, neither the FDA nor medical societies seemed very concerned about antidepressant withdrawal symptoms. Although there were early warning signals like this one, we believe that most healthcare professionals ignored this problem for decades.

Downplaying Antidepressant Withdrawal to This Day:

A recent analysis of 50 studies found that stopping such medications could result in dizziness, nausea, vertigo and nervousness more often than stopping placebo (JAMA Psychiatry, July 9, 2025). The authors conclude, however, that many reports of withdrawal symptoms from antidepressants have been overemphasized. They suggest that most of the time such problems may not be clinically important.

The authors describe the current thinking regarding “antidepressant withdrawal syndrome:”

“While most international depression guidelines acknowledge and support tapering of antidepressants when discontinuing them, there remains variability in specific guidance on duration and types of withdrawal symptoms among antidepressants.

“In the UK, guidelines from the National Institute for Health and Care Excellence state that for some people, antidepressant discontinuation symptoms can be mild and transient, but in other cases, symptoms can be more severe and last longer. The American Psychiatric Association guidelines state that antidepressant discontinuation symptoms usually resolve within 1 to 2 weeks without treatment.

“There is also lack of consensus and clarity on the evidence relating to incidence and duration of antidepressant discontinuation symptoms.”

The conclusions of this meta-analysis:

“In conclusion, data from RCTs [randomized controlled trials] suggest that on average, those who discontinue antidepressants experience 1 more discontinuation symptom compared to placebo or continuation of antidepressants, which is below the threshold for clinically important discontinuation syndrome. Mood change was not seen in antidepressant discontinuation. While acknowledging that discontinuation symptoms exist, results of this systematic review and meta-analysis suggest that the rates are lower than those reported in prior reviews. The need for prolonged tapering regimens is open to question, with concerns previously noted, in addition to possible nocebo effects.”

In other words, these authors conclude that antidepressant withdrawal is not that big a deal and could be mostly psychological in nature (the “nocebo” effect). We beg to disagree! Many of our readers would also disagree. What follows is just a few of the thousands of comments we have received over the decades.

Real World Antidepressant Withdrawal Symptoms:

One reader decided to:

“…Quit Effexor (venlafaxine) cold turkey. I have been off the drug five days and have been experiencing stomach cramps, nausea, indigestion, gas, emotional dives and brain zaps. These make driving a car scary because turning your head results in extreme dizziness.”

A registered nurse describes her own experience.

“The symptoms I suffered were: vertigo, nausea, diarrhea and subsequent constipation, anorexia, profuse perspiring often followed by feeling extreme chills, shooting pains in my head with any movement of my head (including blinking my eyes), muscle cramps, mood swings (irritability to weepy), palpitations, unsteadiness, insomnia, abdominal pains and fatigue.”

Another reader described her experience after taking Cymbalta (duloxetine) for six years to treat neuropathy and fibromyalgia. A job loss meant she could no longer afford it.

“It took three weeks to come down from 120 mg to nothing. I’ve had brain zaps and violent outbursts resulting in hitting, screaming, throwing things and terrorizing the dogs. I’ve hit myself until there were bruises and destroyed things I loved. And I can barely remember it.

“My husband has hidden our guns and my medications because of the suicidal threats I’ve made over and over. I can’t sleep, my neuropathy is back with a vengeance and the pain from the fibro is worse than ever. The way I see it, the drug is like Hotel California: ‘You can check out any time you like, but you can never leave!’”

Waking Up to Antidepressant Withdrawal Symptoms:

The mainstream media have discovered that stopping antidepressants can lead to disastrous symptoms. An article in the New York Times carried the headline, “Many People Taking Antidepressants Discover They Cannot Quit” (April 7, 2018).

A patient who had been on sertraline (Zoloft) described symptoms of antidepressant withdrawal: dizziness, confusion and fatigue. They persisted far longer than most health professionals would imagine.

According to the NYT account:

“It took nine months to wean herself from the drug, Zoloft [sertraline], by taking increasingly smaller doses.

“‘I couldn’t finish my college degree,’ she said. ‘Only now am I feeling well enough to try to re-enter society and go back to work.’”

Medical Researchers Reporting “Discontinuation Symptoms”

An article in Lancet Psychiatry, July, 2024, reported on something the FDA calls “discontinuation syndrome:”

“Antidepressant discontinuation symptoms are becoming an increasingly important part of clinical practice, but the incidence of antidepressant discontinuation symptoms has not been quantified.”

Do you find that somewhat disquieting? Antidepressants have been on the market for about 70 years. And yet here are psychiatrists admitting that health professionals have not “quantified” the incidence of this problem. The authors reviewed 79 studies of people discontinuing their antidepressants. Of these, 44 were randomized controlled trials, allowing for comparison between placebo and antidepressant.

The findings:

“Considering non-specific effects, as evidenced in placebo groups, the incidence of antidepressant discontinuation symptoms is approximately 15%, affecting one in six to seven patients who discontinue their medication.”

“Our study yielded four main results. First, across all studies and antidepressants, we found that approximately every third patient discontinuing antidepressants will have antidepressant discontinuation symptoms of any kind…”

We cannot verify those stats, though we suspect the likelihood of antidepressant withdrawal symptoms may be even higher. The authors of the Lancet Psychiatry article list these symptoms:

• Dizziness
• Headache
• Insomnia
• Nausea
• Irritability

The 1959 study from Canada reported: “nausea, vomiting, dizziness, chills, and great anxiety.”

The 2024 study in Lancet Psychiatry suggest that the medicines that were most frequently associated with discontinuation problems included desvenlafaxine, venlafaxine, imipramine and escitalopram. The most severe symptoms were linked to imipramine, paroxetine, desvenlafaxine and venlafaxine. That does not mean, however, that people taking other antidepressants are home free. As you will read shortly, people can experience severe symptoms after stopping duloxetine or some other SSRI or SNRI antidepressant.

The authors discuss tapering the dose of antidepressant medication to reduce the likelihood of developing withdrawal symptoms. The trouble is that there are no clear instructions on how to do that! Each clinician is on her own when it comes to developing a dose reduction plan. Neither drug companies nor the FDA seem inclined to provide much guidance.

Antidepressant Withdrawal an Old Story:

Readers of this column have been reporting the same kind of problem for decades.

In August, 1995, we heard from one person:

“I’m having trouble with rather severe withdrawal effects caused by abrupt discontinuation of paroxetine [Paxil] nearly two months ago. I took 20 mg daily for about two years for depression. When I felt less depressed and realized my inability to have orgasms was a side effect of the drug, I asked my shrink about discontinuation. He said to stop cold, so I did.

“Two days later, I saw sparkling zig-zag colored lights and had tunnel vision. Diarrhea, shakiness, horrible insomnia, wildly brittle emotions, and overwhelming crankiness set in. I was completely unable to concentrate or to do normal mental tasks, such as subtracting one four-digit number from another. I kept saying there was something wrong inside my head! I fell down, ran into things, and got covered with bruises. I was nauseated.

“I called the psychiatrist, who told me to take more Paxil. Instead, I asked him to do a literature search about withdrawal from Paxil, so he would know more about the drug he was prescribing. Two days later I received a letter from him, firing me as a patient.

“I am still emotionally volatile, really mad at the shrink and wondering if my depression is back. Was this doctor out of line, or was I?”

Our 1995 People’s Pharmacy Response:

In our answer, we pointed to a growing recognition that sudden discontinuation of antidepressants like paroxetine (Paxil) can sometimes cause withdrawal symptoms. The manufacturer told us that dizziness, sensory disturbances, nausea, agitation and anxiety had all been reported.

We were disappointed that the psychiatrist wasn’t more understanding and sympathetic about the symptoms this person was experiencing. We weren’t that surprised, however. In the mid 1990s, there still wasn’t widespread realization that stopping drugs like sertraline or paroxetine could lead to long-lasting and severe adverse reactions.

The Official Paxil (Paroxetine) Prescribing Information:

In our 1994 edition of the Physicians’ Desk Reference (PDR), the only mention we could locate about Paxil withdrawal was this:

Physical and Psychological Dependence

“Paxil has not been systematically studied in animals or humans for its potential for abuse, tolerance, or physical dependence.”

Another SSRI-type antidepressant, sertraline (Zoloft) had equally reassuring prescribing information in 1994:

Physical and Psychological Dependence

“ZOLOFT has not been systematically studied in animals or humans for its potential for abuse, tolerance, or physical dependence. However, premarketing clinical experience with ZOLOFT did not reveal any tendency for a withdrawal syndrome or any drug-seeking behavior.”

It’s hardly any wonder that physicians did not think there was such a thing as antidepressant discontinuation symptoms. The official prescribing information for paroxetine and sertraline was reassuring. The FDA did not require studies and drug companies did not feel motivated to investigate this issue. See no evil, hear no evil, speak no evil.

Antidepressant Withdrawal Is Now “Discontinuation Syndrome”:

Fast-forward to 2025. There is much more awareness about antidepressant withdrawal symptoms. The FDA has given this kind of reaction a scientific name: “discontinuation syndrome.” It may seem less scary than antidepressant withdrawal.

Today, the official prescribing information for Zoloft (sertraline) is quite different from the 1994 PDR:

Discontinuation Syndrome

“Adverse reactions after discontinuation of serotonergic antidepressants, particularly after abrupt discontinuation, include: nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesia, such as electric shock sensations), tremor, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible.”

The FDA requires this for generic Zoloft (sertraline):

After a long list of antidepressant withdrawal symptoms comes:

“During marketing of sertraline and other SSRIs and SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs…While these events are generally self-limiting, there have been reports of serious discontinuation symptoms.

“Patients should be monitored for these symptoms when discontinuing treatment with sertraline. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate.”

The current prescribing information for paroxetine (Paxil) is quite similar and differs dramatically from the official line of the mid 1990s.

What Does “Gradual Reduction” in Dose Mean?

Neither the FDA nor the drug companies that make antidepressant medications spell out in detail what they mean by gradual reduction in dose. For some physicians that could be interpreted as a week or two. Others may understand “gradual” as covering several weeks. For still others, that could translate as one to two months. And a minority might define “gradual” as six months to a year.

No matter how hard we search, we cannot find guidelines from the FDA or medical societies for clinicians or patients! We suspect that many health professionals have very little idea what their patients go through when they try to stop antidepressant medications. Just listing symptoms such as brain zaps, dizzy spells, nausea, headaches, sweating, anxiety, fatigue, insomnia and digestive problems does not do antidepressant withdrawal justice.

More Stories from Readers:

You will find over 1,900 reader comments associated with this article:

Duloxetine (Cymbalta) Side Effects & Withdrawal

If you would prefer to just read just a few more case reports, here are some:

Carl in Brisbee, Arizona, is going through hell:

“I was prescribed Cymbalta [duloxetine] and Provigil [modafinil] for PTSD (post-traumatic stress disorder) and narcolepsy.

“In the fall of 2017 my insurance company suddenly decided to not pay for my prescriptions. This lasted for 5 1/2 months. My Provigil alone is $4,500.00 a month! I could not afford to buy anything for 3 1/2 months.

“I had no idea about the side effects of stopping CYMBALTA suddenly! I was going crazy! I was suicidal. It was the most horrible I have ever felt in my life!

“It has been nearly seven months since the onset of withdrawal symptoms. I have been in bed for 3 3/4 months. Just a few steps make me exhausted. I am dizzy. I cannot walk a straight line. I bounce off the walls and hit the sides of doorways. It is as if I have very little control over my upright body.

“I know it is from the suddenly stopping Cymbalta! I took this drug for more than a decade. I just got used to it. I kept taking it for years, until insurance refused to pay in Sept. 2017. My life has been a wreck ever since. It still is going on. I am in a living hell and am unable to find a solution!”

Diane in Texas reduced her dose very gradually:

“I took Cymbalta for years and got off of it a few years ago. It was very difficult. I ended up opening the capsules and counting beads. I made very gradual adjustments and it took months to get off it. I felt withdrawal symptoms from the slightest decrease.”

Cindy in Seattle, Washington, offers an insider’s perspective:

“I worked in psych for 30 years (inpatient units), and one of the main reasons for an admission was to ‘wean’ the patient off SSRI’s. The withdrawal symptoms were that horrible and dangerous.”

Dagny offers an interesting taper tip:

“Antidepressants can quit working and result in withdrawal symptoms that are the same as they would be if the person quit the drug cold turkey. You might want to ask your doctor about switching to a different SSRI and see if that helps.

“I’ve gone through antidepressant withdrawal cold turkey. It was three and a half years of misery. The discomfort slowly decreased over that time period.

“If you want to get off antidepressants, your doctor may be able to prescribe a liquid version. As you get close to reducing the dose in smaller increments this will make it easier to titrate the dose. You can taper very gradually during the last months. That is when it begins to get most difficult. A compounding pharmacy can make up the prescription for you.

“It will no doubt be more expensive than an ordinary prescription, but it would be well worth it. I wish I had known about this when I was suffering. Whatever you do, don’t just stop the drug. After a month or so of going off cold turkey, going back on the drug to stop withdrawal symptoms may not work. Take it slow and easy.”

How to Stop Duloxetine (Cymbalta) from “Hopeful” in Indiana:

Patients who have been through the hell of antidepressant withdrawal often try to help their fellow sufferers. Here is an article we wrote about a year ago with some thoughtful suggestions from “Hopeful” in Indiana. Remember to always check with a health professional about any withdrawal strategy:

How to Stop Duloxetine (Cymbalta) Without Withdrawal Symptoms

Why Is It So Hard to Stop Antidepressants?

To our surprise, there has not been much research devoted to this crucial question. We now know that antidepressants affect a number of important neurochemicals: serotonin, norepinephrine and dopamine for starters. It is likely that other systems are also impacted, including GABA and “neurotrophic factors” (Frontiers in Pharmacology, April 16, 2013).

When drug-induced modifications occur within the body, there are frequently cellular adaptations. Receptor sites on neurons change. This is the way the body attempts to deal with changes in neurochemistry. Because neuroscientists have not devoted a lot of research to this issue, we do not yet have a good explanation for the underlying causes of discontinuation syndrome.

We suspect that withdrawal symptoms occur as the body tries to reestablish homeostasis. Some people are super sensitive to this challenge. It may take them months or years to achieve balance. Others may overcome the challenge over several weeks.

The Antidepressant Withdrawal Scandal:

For decades we have heard from patients that the day they tried to stop antidepressants, their world tilted. Brain zaps are a common complaint, but one that the researchers often seem to ignore. We suspect that there is no official medical term for this symptom. Then there is the dizziness and the nausea that are more recognized symptoms.

When patients turn to their healthcare professionals, the FDA or drug companies for guidance, they may get little more than vague reassurances that such symptoms will disappear within a few days or weeks. Worse, many patients’ complaints may be met with dismissal or silence.

We are glad to learn that some in the medical profession and the media are starting to wake up to the seriousness of antidepressant withdrawal. This is not the depression returning. That has sometimes been used as an explanation for why people suffer symptoms after stopping an antidepressant. It is much easier to blame the patient than the drug.

People report the discontinuation syndrome even if they were taking the medication for reasons other than depression. Remember, doctors prescribe antidepressant drugs for a long laundry list of conditions, including hot flashes, fibromyalgia, nerve pain and osteoarthritis. Doctors cannot claim that the depression is returning if patients were not depressed to start with.

Jan was taking duloxetine for the pain of fibromyalgia:

“I was on Cymbalta for over 10 years for fibromyalgia. I just didn’t feel good on the medication. I asked myself, why I am I taking it? My symptoms were actually worse.

“I decided I need to get off this drug. At my annual checkup my doctor said fine, but let me give you 30 mg for a month (I was on 60 mg.) Then you should be fine.

“NO. I am on my 3rd day and as everyone else has said on this website, I am going a bit crazy. I threw up the first day. I had the brain zaps, crying and the shakes to name a few! I have been drinking tons of water and trying to eat lots of fruits and veggies. I took a long Epsom Salt bath with peppermint oil to try and soothe my pain.

“Thank you so much for sharing the idea of opening the capsule and removing the small white balls and weaning that way…who knew?”

We have received countless similar stories from readers of our newspaper column, newsletter and this website. What almost everyone complains about is a lack of reliable information about how to taper off such drugs so that these symptoms can be avoided. Neither the FDA nor the pharmaceutical industry has provided any meaningful details about how to discontinue such drugs safely.

One man described his strategy to get off duloxetine. Because this medication comes in capsules filled with tiny beads, he removed one additional bead a week to reduce his dose incrementally. It took him many months, but he was finally able to stop the drug entirely without suffering.

Occasionally, patients may need to stay on antidepressant medication for many years. Others may need to be on such drugs indefinitely. But for those who wish to get off their medicine, there are no good guidelines for gradual tapering. It is past time for the FDA to require research on safe strategies to help patients get off antidepressant medications.

People’s Pharmacy Perspective:

You may be interested in our podcast “Are We Medicating Normal Emotions?” in which we speak with a psychiatrist about the withdrawal phenomenon. And our Show 1389: Getting Off the Medication Treadmill may also be helpful.

Our eGuide to Dealing with Depression shares some other strategies for slowly tapering off antidepressant drugs. It provides links to the Ashton Manual that offers detailed instructions from Dr. Heather Ashton. She was a British physician and psychopharmacologist who taught clinical psychopharmacology at the University of Newcastle upon Tyne.

Dr. Ashton discovered that benzodiazepines such as diazepam (Valium), chlordiazepoxide (Librium) and temazepam (Restoril) could lead to dependence. Stopping suddenly might cause severe withdrawal symptoms. She came up with a slow taper that people use to this day. She also developed a plan to phase out antidepressants gradually. You can find our eGuide to Dealing with Depression under the Health eGuides tab.

Share Your Own Antidepressant Withdrawal Story:

If you needed to stop an antidepressant medication for any reason, please share your experience in the comment section below. If you think this article is important, please pass it on to family and friends. Just scroll to the top of the page and click on the icons for email and/or social media.

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