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GUIDELINES FOR WITHDRAWAL
OF ANTIDEPRESSANT DRUGS
Professor C Heather Ashton DM, FRCP,
January 2001

School of Neurosciences
Division of Psychiatry
The Royal Victoria Infirmary
Queen Victoria Road
Newcastle upon Tyne NE1 4LP

See also:
SSRIs, Drug Withdrawal and Abuse: Problem or Treatment?
C. Heather Ashton and Allan H. Young, 1999.
Antidepressant News · Antidepressant Links
The Ashton Manual · Professor Ashton's Main Page

These guidelines are intended for long-term benzodiazepine users who are also taking an antidepressant and wish to withdraw from both drugs.

The guidelines are not intended for people who have been prescribed an antidepressant by a psychiatrist or GP for a major depressive disorder. Such patients may need to continue taking an antidepressant for several months to avoid a recurrence of depression. They should consult their doctor before deciding to withdraw. If the doctor agrees, the withdrawal can then be conducted as outlined in these guidelines.

General principles for long-term benzodiazepine users who are also taking antidepressants and wish to withdraw from both drugs

Complete the benzodiazepine withdrawal before starting to taper your antidepressants.

Allow at least 4 weeks after stopping your benzodiazepines before starting on antidepressant withdrawal.

Consult your doctor before starting to withdraw the antidepressant and agree on a tapering schedule.

Antidepressant withdrawal must be gradual to avoid withdrawal effects.

Make each dose reduction as small as possible, e.g. by halving the tablets or using a liquid preparation.

If smaller doses are not available, reduce by taking a tablet every other day, then every third day, etc.

Allow 1-2 weeks between each dosage reduction.

If withdrawal symptoms are severe increase the dosage slightly (e.g. to the dose at your last reduction). When symptoms have settled, resume withdrawal at a slower rate.

With slow tapering, as outlined above, withdrawal symptoms from antidepressants are usually absent, or if they occur, are mild and short-lived.

ANTIDEPRESSANTS

DOSAGE STRENGTHS AND FORMULATIONS*
Professor C Heather Ashton

TRICYCLICS

Amitriptyline (Tryptizol, Elavil) tabs 10, 25, 50mg; liquid 25mg/5ml

Amoxapine (Asendis) tabs 25, 50, 100mg

Clomipramine (Anafranil) caps 10, 25, 50mg; syrup 25mg/5ml

Dothiepin (Prothiaden) tabs 25, 75mg

Doxepin (Sinequan) caps 10, 25, 50, 75mg

Imipramine (Tofranil) tabs 10, 25mg; syrup 25mg/5ml

Lofepramine (Gamanil) tabs 70mg; liquid 70mg/5ml

Nortriptyline (Aventyl, Allegron, Pamelor) tabs 10, 25mg

Protriptyline (Concordin, Vivactil) tabs 5, 10mg

Trimipramine (Surmontil) tabs 10, 25mg

RELATED ANTIDEPRESSANTS

Maprotiline (Ludiomil) tabs 10, 25, 50, 75mg

Mianserin (Bolvidon, Norval) tabs 10, 30mg

Trazodone (Molipaxin, Desyrel) caps 50, 100mg; tabs 150mg; liquid 50mg/5ml

Viloxazine (Vivalan) tabs 50mg

MAOIS (monoamine oxidase inhibitors)

Phenelzine (Nardil) tabs 15mg

Moclobemide (Mannerix) tabs 150mg

SSRIs (selective serotonin reuptake inhibitors)

Citalopram (Cipramil, Celexa) tabs 10, 20, 40mg

Fluoxetine (Prozac, Sarafem) caps 20, 60mg; liquid 20mg/ 5ml

Fluvoxamine (Faverin, Luvox) tabs (s) 50, 100mg

Paroxetine (Seroxat, Paxil) tabs (s) 20, 30mg; liquid 10mg/5ml

Sertraline (Lustral, Zoloft) tabs 50, 100mg

Escitalopram (Cipralex, Lexapro) tabs 5, 10(s), 20mg(s)

OTHERS

Mirtazapine (Zispin, Remeron) tabs (s) 30mg

Nefazodone (Dutonin, Serzone) tabs (s) 100, 200mg

Reboxetine (Edronax, Vestra) tabs (s) 4mg

Venlafaxine (Efexor, Effexor) tabs 37.5, 75mg

* tabs: tablets; (s) scored; caps: capsules; 5ml = 1 teaspoon.

ANTIDEPRESSANT WITHDRAWAL EFFECTS
Professor C Heather Ashton

PSYCHOLOGICAL SYMPTOMS:
agitation, crying spells, irritability,
overactivity, aggression, depersonalisation,
memory problems, confusion, lowered mood.

PHYSICAL SYMPTOMS:

GASTROINTESTINAL:
abdominal pain, diarrhoea, anxiety,
nausea, vomiting.

INFLUENZA-LIKE:
fatigue, headache, muscle pain,
weakness, sweating, chills,
palpitations.

SLEEP DISTURBANCE:
insomnia, vivid dreams, nightmares.

SENSORY DISTURBANCES:
dizziness, light-headedness, vertigo,
pins and needles, electric shock sensations.

MOTOR DISORDERS:
tremor, loss of balance, muscle stiffness,
abnormal movements.

See also:
SSRIs, Drug Withdrawal and Abuse: Problem or Treatment?
C. Heather Ashton and Allan H. Young, 1999.
Antidepressant News · Antidepressant Links

The Ashton Manual · Professor Ashton's Main Page

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