Stopping an antidepressant is often far more difficult than starting one. Yet for millions of patients, this challenge goes unaddressed — or worse, misidentified. A recent special report published in Psychiatric News (Shapiro & Cohrs, 2025) sheds important light on this issue, and the findings have meaningful implications for anyone navigating antidepressant withdrawal while managing Depression, including patients who may be considering or already receiving TMS.
What Is Antidepressant Withdrawal?
Formally recognized in the DSM-5-TR as antidepressant discontinuation syndrome, withdrawal occurs when antidepressants are stopped abruptly or too quickly. What was once considered mild and short-lived is now understood to be a significant clinical concern.
Symptoms typically appear within 24 to 48 hours of stopping treatment and can include:
- Anxiety and mood instability
- Dizziness and flu-like symptoms
- Insomnia
- Sensory disturbances, including the distinctive “brain zaps” — electric shock-like sensations in the head
According to the Psychiatric News report, systematic reviews estimate that between 33% and 56% of patients who discontinue antidepressants will experience withdrawal symptoms. These are not rare or trivial experiences.
Why Withdrawal Is So Often Missed
One of the most consequential problems with navigating antidepressant withdrawal is that it frequently gets mistaken for a return of Depression itself. This misidentification matters — it can lead to unnecessary reinstatement of medication or a diagnosis of relapse when, in fact, the patient is responding to the withdrawal process.
The Psychiatric News report emphasizes that certain features can help distinguish withdrawal from true relapse. Withdrawal symptoms tend to emerge rapidly after dose reduction and often include physical and neurological sensations — like dizziness, brain zaps, and tingling — that are not typical of a depressive episode. True relapse, by contrast, tends to develop more gradually.
Who Is Most at Risk When Navigating Antidepressant Withdrawal?
Not all antidepressants carry the same withdrawal risk. The report identifies several key risk factors:
- Medication type: Serotonin reuptake inhibitors (SSRIs and SNRIs) carry the highest risk. Paroxetine (Paxil) is considered the highest-risk SSRI, largely due to its short elimination half-life. Venlafaxine, desvenlafaxine, and duloxetine are also considered high risk.
- Duration of treatment: Risk increases significantly with longer-term use, particularly beyond six months — and even more so beyond two years.
- Higher doses: Especially relevant for SNRIs, where withdrawal risk appears to be dose-dependent.
- Prior withdrawal sensitivity: Patients who have struggled to taper before are more likely to do so again.
Why Standard Tapering Often Isn’t Enough
The Psychiatric News report explains something that surprises many patients and clinicians: gradually tapering from a full therapeutic dose to the lowest available dose is often still not gradual enough for navigating antidepressant withdrawal well.
This comes down to the pharmacology of how these medications work. Most SSRIs and SNRIs occupy roughly 80% of the brain’s serotonin transporters even at their minimum therapeutic dose. So what looks like a significant dose reduction on paper translates to a comparatively small change in brain activity — until the very last step, when stopping entirely causes a sudden and steep drop.
What the research supports instead is a hyperbolic taper: one that incorporates very small, subtherapeutic doses, sometimes as low as 5% to 10% of the minimum therapeutic dose. In practice, this may require liquid formulations or compounded medications, and it can take six to twelve months or longer to complete safely. The case study in the Psychiatric News report illustrates this clearly: a patient who had been on sertraline for 12 years required a carefully structured multi-month taper using liquid formulations before she could discontinue successfully without withdrawal symptoms.
A Gap in Clinical Guidance
Despite the scale of the problem — roughly one in eight adults in the United States currently takes an antidepressant, with a median treatment duration of five years — formal guidance on how to safely discontinue these medications remains limited. The Psychiatric News authors note that current FDA and APA guidelines offer only general recommendations, and some medications lack dosage options that would even allow a gradual taper.
Patients frequently turn to online support communities to fill this gap, which speaks to how underserved this population has been.
What This Means for TMS Patients
Many patients who come to Mid City TMS have a long history with antidepressants. They may have tried multiple medications, experienced difficult side effects, or found that medications stopped working over time. In this context, navigating antidepressant withdrawal is not an abstract concern — it’s often part of their direct experience.
TMS offers a meaningful advantage here: it is not a systemic treatment, meaning there is no withdrawal syndrome associated with completing a course of TMS. For patients who are navigating medication changes, TMS can support Depression treatment without adding to the medication burden. It can also be used concurrently with antidepressants when appropriate.
At Mid City TMS, Dr. Bruno works closely with each patient to understand their full treatment history and coordinate care with their other providers. If you are struggling with navigating antidepressant withdrawal, or if ongoing medication side effects have made it difficult to manage your Depression, we are happy to consult with you about whether TMS or Spravato may be an appropriate option.
A Note for Patients Navigating Antidepressant Withdrawal
If stopping or reducing an antidepressant has felt unexpectedly difficult, you are not alone. The research is clear that this is a common experience, and it does not reflect a failure on your part. It reflects the pharmacology of the medication and, often, a need for a more individualized and gradual approach.
If you have questions about your options, contact us today.
Sources
- Shapiro, Bryan, M.D., M.P.H., and Daniel Cohrs, M.D. “Antidepressant Withdrawal.” Psychiatric News. vol 60,9 (2025). https://doi.org/10.1176/appi.pn.2025.09.9
- Gabriel, Matthew, and Verinder Sharma. “Antidepressant discontinuation syndrome.” CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne vol. 189,21 (2017): E747. doi:10.1503/cmaj.160991
- Shelton, Richard C.. “Steps Following Attainment of Remission: Discontinuation of Antidepressant Therapy.” Primary care companion to the Journal of clinical psychiatry vol. 3,4 (2001): 168-174. doi:10.4088/pcc.v03n0404