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By the way, doctor: How do I quit my antidepressant?

By the way, doctor

How do I quit my antidepressant?

Q. My physician prescribed Celexa for me three years ago when I was upset over a family problem. I'm feeling better, and my situation has changed. I'd like to get off the medication. How do I do that?

A. It's ultimately up to you whether to discontinue the medication, but before you make a final decision, talk to your clinician, unless you already have. For example, if you've had several episodes of depression — rather than just the one you mention here — the medication could help prevent a future episode.

If you do decide to quit, you should reduce the dose of Celexa, or any other serotonin reuptake inhibitor (SSRI), gradually. The aim is to avoid discontinuation syndrome, a set of symptoms that isn't dangerous but may be disconcerting. It's sometimes described as resembling the flu, and sometimes as a "brain shimmer." One common symptom is dizziness or vertigo. Others include headache, muscle aches, and sensations like electric shocks in the arms, legs, or other parts of the body. The discontinuation syndrome can last for several weeks, and it's more likely to occur with shorter-acting drugs, like Paxil (paroxetine) and Effexor (venlafaxine). Celexa (citalopram) remains in the bloodstream longer, but it still can cause symptoms. Prozac (fluoxetine) rarely causes any discontinuation problems because it disappears from the bloodstream so slowly, often over a period of several months.

The last few steps are usually the hardest for people who experience discontinuation syndrome (not everyone does), so if you're in a hurry, you can start out a little faster. There's no perfect prescription for reducing the dose, but here's one I've used:

If you're taking 40 milligrams (mg) of Celexa every day, you can decrease the dose to 30 mg/day; or you can take 20 mg and 40 mg on alternate days. Try either of these schedules for about a week. Then, if you're feeling fine, go down to 20 mg/day for one to two weeks. If you continue to feel okay, alternate 20 mg/day with 10 mg/day for about two weeks. Finally, take 10 mg/day for two weeks, followed by 10 mg every other day for one week, then stop altogether. This is a very conservative schedule. Many people can discontinue their medication faster without problems.

If at any point you begin to have symptoms, you can always return to the higher dose — or simply wait longer before reducing the dose further. People taking the shorter-acting medications (who are more likely to have discontinuation symptoms) can try switching to a very low dose of Prozac for a short time toward the end of the process.

— Margaret Ross, M.D. Harvard Women's Health Watch Advisory Board member in psychiatry

Last updated:	September 05, 2008