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Discontinuation Syndrome

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There are upwards of 20,000 medications currently approved by the FDA, and all of them are capable of producing unwanted symptoms; unfortunately, undesirable and even dangerous symptoms frequently worsen after the medication has been discontinued. 10 This guide to the issues caused by discontinuing certain medications (discontinuation syndrome) will provide critical information about the types of drugs that can cause discontinuation syndrome, the unique symptoms that frequently arise after quitting each drug, what actually causes discontinuation syndrome, and information that can help you determine whether you’re at risk. Perhaps even more importantly, we will help you understand just why it is so important to discontinue medications safely with a supervised tapering process.

Discontinuation syndrome typically occurs when an individual stops taking psychiatric medications like antidepressants, antipsychotics, or benzodiazepines and triggers unpleasant symptoms that not many people may be aware of. Symptoms can last a few weeks, but discontinuation syndrome often comes with lingering effects that may linger over the next year or more. 1

If you are ready to cease taking your psychiatric medication, you should seek professional help, even if you have only been taking it briefly. Learn more about discontinuation syndrome, what causes it, and how to prevent it.

Discontinuation Syndrome

Medications That Can Cause Discontinuation Syndrome

The type of psychiatric drug you are taking significantly affects your risk of discontinuation syndrome. This risk is associated with how long the medication lasts in your body, which is linked to the medication’s half-life. 

A half-life of a medication is the time it takes for the amount of a drug in your body to reduce by half. If a drug has a short half-life, it is processed quickly and needs to be taken more frequently. If it has a long half-life, it stays in the body for a longer period and requires less frequent dosing. Drugs with shorter half-lives are more likely to cause discontinuation syndrome.

Antidepressants

Antidepressants are used to treat depression, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and some eating disorders.

Antidepressants are among the most common psychotropic drugs that can cause discontinuation syndrome, especially if they have short half-lives. 2

Antidepressants known to cause discontinuation syndrome are:

  • Selective serotonin reuptake inhibitors (SSRIs): 
    • Paroxetine (Paxil
    • Sertraline (Zoloft)
    • Fluvoxamine (Luvox)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs):
    • Venlafaxine (Effexor)
    • Duloxetine (Cymbalta)
  • Tricyclic antidepressants (TCAs):
    • Amitriptyline (Elavil)
    • Imipramine (Tofranil)
  • Atypical antidepressants:
    • Bupropion (Wellbutrin)
    • Mirtazapine (Remeron)

Symptoms

Stopping antidepressants suddenly can cause a wide range of unpleasant symptoms, such as:

  • Flu-like symptoms such as fatigue, headache, muscle aches, or excessive sweating
  • Sleep disturbances like insomnia, vivid dreams, or nightmares
  • Digestive issues
  • Lightheadedness, vertigo, or balance problems
  • Tingling, numbness, or electric shock sensations or “brain zaps” throughout your body
  • Mood changes, including anxiety, irritability, agitation, or depression
  • Headaches

Benzodiazepine

Benzodiazepines are central nervous system depressants, meaning they slow down the connective messages between the brain and the body. They are commonly used to treat anxiety disorders, insomnia, seizures, and muscle spasms and are typically only used in the short term. 

Benzodiazepines known to cause discontinuation syndrome are:

  • Alprazolam (Xanax)
  • Lorazepam (Ativan)
  • Clonazepam (Klonopin)
  • Diazepam (Valium)

Symptoms

Abruptly stopping benzodiazepines can come with symptoms such as: 3

  • Anxiety and panic attacks
  • Insomnia 
  • Irritability and restlessness
  • Muscle aches and tension
  • Excessive sweating or tremors
  • Digestive issues
  • Lightheadedness, vertigo, or balance problems
  • Headaches
In severe cases, a person may experience seizures, hallucinations, and delirium. 

Antipsychotics

Antipsychotics are used to treat conditions such as schizophrenia, bipolar disorder, severe depression with psychotic features, delirium, and dementia. 4

Antipsychotics known to cause discontinuation syndrome are: 

  • Atypical antipsychotics:
    • Olanzapine (Zyprexa)
    • Risperidone (Risperdal)
    • Quetiapine (Seroquel)
  • Typical antipsychotics: 
    • Haloperidol (Haldol)

Symptoms

Common symptoms of stopping antipsychotics abruptly include: 

  • Nausea, vomiting, and diarrhea
  • Headaches and dizziness
  • Sweating, tremors, and muscle aches
  • Insomnia or excessive sleeping
  • Irritability, anxiety, agitation, or depression
  • The return of psychotic symptoms

What Causes Discontinuation Syndrome?

The precise cause of discontinuation syndrome is unknown, much like the exact mechanism of antidepressants and other psychiatric drugs is unknown. Drug advertisements and marketers promoted the idea that psychiatric medications could create neurotransmitter chemicals, like serotonin and norepinephrine. They claimed that these drugs could improve mood, prevent depression and treat other disorders.

It is critical to recognize that this chemical imbalance theory has never been proven. In fact, research data questions the theory. Multiple data reviews and meta-analyses regarding serotonin and serotonin metabolites showed no correlation between reduced serotonin and depression. While a few others showed only a very weak association between those with deep family history of depression and slightly reduced serotonin levels, subsequent data showed no association. What’s more, research has since suggested that antidepressants may themselves lead to lower serotonin concentrations. 8

About Neuroplasticity

Neuroplasticity is a word used to describe the brain’s capacity to not only form new connections between neurons (synapses) to relay messages, but to reorganize existing ones. Instead of boosting neurotransmitter levels to exert changes in mood and behavior, it is thought that psychiatric medications cause a cascade of physiological and chemical changes in the brain that “rewire” the brain itself. Studies show that these changes remain long-term. 9

Unfortunately, these changes are not only poorly understood and only marginally acknowledged by drug manufacturers, but they may not be positive changes for the individual. Since they remain on a long-term basis, discontinuing a medication does not mean an individual will revert back to their previous state. An extended period of time is typically necessary to allow the brain to reorganize its synapses and rebuild healthy neurotransmitters that are ableto function without the medication. For this reason, recovering from the effects caused by psychiatric medications and discontinuation syndrome is often a long journey.

Risk Factors For Experiencing Discontinuation Syndrome

Abruptly stopping the use of a psychiatric medication is the leading contributor to discontinuation syndrome. Research shows there are also some additional risk factors that increase the likelihood of experiencing discontinuation syndrome, listed below. 5

Duration of Medication Use

If someone has been taking a medication for a long time, they’re more likely to experience withdrawal symptoms when they stop. That is because their body has gotten used to having the drug in their system, and it takes time for the body to adjust when the medication is gradually reduced or stopped. Over the years a person may take the drug, it can change the way the brain works; when it is no longer there, the brain has to learn how to function again without it. 

Dosage Amount

Taking a higher dose of a medication can make symptoms more likely and intense. When you’re on a higher dose, your body becomes more dependent on the drug to feel balanced. So, when you start to reduce or stop the medication, it can be harder for your body to adjust. This is why it is important to taper off the drug gradually. 

Type of Medication

As mentioned, drugs with shorter half-lives are more likely to cause discontinuation syndrome because they leave the body more quickly. When a medication has a short half-life, it means that it does not stay in your body for long, so the effects wear off faster. This rapid change can make it harder for your body to adjust when you stop taking the drug. For example, medications like paroxetine and duloxetine are known for having shorter half-lives.

Previous Experiences

If you have previously experienced discontinuation syndrome symptoms, you are more likely to experience it again, especially if you are tapering off similar medications. Once your body has been through a withdrawal process, it can be more sensitive to future changes in medication. For example, people who have already experienced withdrawals from benzodiazepine medications are not only more likely to experience them again, but may experience more severe symptoms. 16

Individual Sensitivity

Some people are naturally more sensitive to medication changes than others due to their unique physiology, metabolism, or psychological makeup. Every person’s body has differences in how they metabolize medication, their brain chemistry, and their emotional resilience. Research demonstrates that people experience a range of withdrawal symptoms at varying intensities across a number of substances. 17

Underlying Mental Health Conditions

If you have severe underlying mental health conditions that your medication was used to treat, ceasing your medication can lead to a return of symptoms. This so-called “rebound effect” occurs because your brain becomes dependent on the drug to maintain stability. Taking it away abruptly can lead to a return or even a worsening of your mental health symptoms. 18

Lack of Medical Supervision

Attempting to taper off medication without professional guidance can increase the risk of symptoms. Without medical support, you might end up reducing the medication too quickly or not at the right pace for your body, leading to a rough withdrawal process. A tapering expert can tailor your tapering schedule to fit your specific needs by evaluating your medication history, current health status, and how your body responds to changes. 

Use of Multiple Medications

Taking other medications concurrently can complicate the withdrawal process and increase the risk of discontinuation syndrome. When you’re on multiple drugs, they can interact in ways that might affect how your body handles the medication when trying to stop. This often leads to more intense and unpredictable symptoms. In the case of polypharmacy, the order in which multiple drugs are tapered must be carefully considered for greatest success. 11

High Stress Levels

Stressful situations like changes in personal relationships, job loss, or other major life events can increase anxiety and emotional strain, which can amplify the physical and psychological symptoms of discontinuation symptoms. 

The Importance of Tapering Off Medications

Tapering off medications is the safest way to gradually reduce and eliminate psychotropic medications in the system. Tapering helps prevent discontinuation syndrome, and tapering off slowly gives the body time to adjust to the decreasing levels of the medication in your system. 

For many people taking psychotropic medications, tapering off helps reduce the risk of relapse for those using the medications to manage their mental health conditions such as depression, anxiety, bipolar disorder, or schizophrenia. When these medications are stopped abruptly, they can cause a rebound effect that brings back symptoms at a more intense level than they were before. In fact, the chances of discontinuation syndrome being misdiagnosed as either relapse or a newly emerging mental illness are high. 1,12

In abrupt cessation, the return of symptoms can create an enormous risk. However, research shows that individuals who taper away from medication have lower instances of misdiagnoses,  clinical relapse and fewer recurrences of the symptoms that caused them to take medication in the first place. 6

Discontinuation Syndrome FAQs

If you have concerns about discontinuation syndrome, it is essential that you seek professional help as soon as possible. In the meantime, learn more about safe medication discontinuation with these common FAQs.

How Can I Prevent Discontinuation Symptoms?
The best way to lower the discomfort of discontinuation symptoms is to taper off your medication gradually. A medical professional will create a personalized tapering plan based on the type of drug you are taking, your dosage, and your overall health. Regular check-ins will help monitor your progress and adjust the tapering schedule if needed.
Is Discontinuation Syndrome Dangerous?
Abruptly stopping some drugs, including heavy alcohol use, can be deadly. Discontinuation syndrome can be very uncomfortable due to the common symptoms of dizziness, headaches, or mood swings. In some cases, if left untreated, people may experience severe symptoms such as hallucinations, aggression towards others, self-harm, tremors, extreme anxiety, agitation, suicidal thoughts, and more. 13
What Is a “Brain Zap,” and Why Does It Occur During Antidepressant Discontinuation?
A “brain zap” is a sudden, brief sensation that feels like an electric shock to the brain. This is a common but not completely understood symptom of antidepressant discontinuation syndrome. Gradual tapering can mitigate the effect. 14
What Is the Difference Between Withdrawal and Discontinuation Syndrome?
In the context of psychotropic medications, many clinicians denote little significant difference between withdrawal and discontinuation syndrome. Both of these terms refer to the symptoms that can occur when a person stops taking their medications. Discontinuation syndrome is the more modern term for withdrawal and is more often used in a clinical or medical setting. 19
How Common Is Antidepressant Discontinuation Syndrome?
According to research, up to 61% of people stopping medications will develop discontinuation syndrome. Symptoms will emerge within hours to days after cessation. These symptoms can last for weeks, months, and years if left untreated. 7,13,15
How Do You Treat Discontinuation Syndrome?
At the Alternative to Meds Center, we offer a specialized approach to treating discontinuation syndrome. Rather than addressing discontinuation syndrome with still other medications, we utilize holistic methods to address the root causes of a patient’s mental health issues. 

We offer a structured and supportive environment for those who are seeking to reduce or eliminate their dependencies on psychiatric medications. Our personalized inpatient medication tapering program includes personalized tapering plans with on-site medical staff to monitor patients throughout the process. In addition to medical care, our program emphasizes holistic approaches that include nutrition, exercise, stress management, and psychotherapy to support a person’s overall well-being. 

Get Help with Discontinuing Your Medications

At Alternative to Meds Center, we provide the most effective treatments to help alleviate discontinuation syndrome symptoms and enable you to find freedom from medications and their side effects.

If you are concerned about experiencing these effects associated with getting off your medication, contact us today to learn more about our holistic approach to treatment.

Alternative to Meds Center in Sedona

References:

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  8. Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry. 2023 Aug;28(8):3243-3256. doi: 10.1038/s41380-022-01661-0. Epub 2022 Jul 20. PMID: 35854107; PMCID: PMC10618090. [Cited 2024, Sept 30]
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Medical Disclaimer:
Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.

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