Coming off an antidepressant, the right way

Discontinuation symptoms are real — and have a name

When an antidepressant is stopped or cut quickly, roughly a third of people get discontinuation symptoms. Clinicians remember them with the mnemonic FINISH: flu-like feelings, insomnia, nausea, imbalance (dizziness), sensory disturbances — the distinctive "brain zaps," brief electric-shock sensations — and hyperarousal or anxiety. They usually begin within two to four days and peak in the first week or two. This is a physical readjustment as the brain adapts to the medication leaving; it is not a sign of weakness, and it is not addiction.

Some medications are trickier than others

Risk tracks closely with how fast a drug leaves the body. The shorter-acting ones — paroxetine and venlafaxine in particular — are the most likely to cause discontinuation symptoms, sometimes within a day of a missed dose. Longer-acting ones like fluoxetine taper themselves to a degree, because the drug lingers and fades gradually, and tend to be far smoother. Some medications (such as vortioxetine) show little more than placebo. Your specific medication, and its half-life, shapes how a taper is planned.

Discontinuation is not the same as relapse

This distinction matters enormously, and it's the single best reason to come off with a prescriber rather than alone. Discontinuation symptoms appear within days, often include the physical "zaps," dizziness, and flu-like feeling, and — tellingly — ease within a day or two if the dose is restored. A true relapse of depression or anxiety builds over weeks and looks like the original illness returning, not a flu. Mistaking one for the other is common and costly: people either resign themselves to medication they no longer need, or abandon one that was genuinely holding them well.

How a taper actually works

Brief tapers of a week or two barely beat stopping cold turkey. Slow, individualized tapers do dramatically better: in one study, tapering paroxetine gradually over many months cut the rate of withdrawal from about 78% to 6%. The reductions often get smaller as the dose gets lower, because the effect of each milligram grows near the bottom. The largest recent analysis (a 2026 network meta-analysis of 76 trials) found that a slow taper paired with psychological support — CBT or mindfulness-based therapy — prevented relapse about as well as simply staying on the medication. The taper isn't a countdown; it's a monitored process that can be slowed or paused whenever your body needs more time.

When stopping is the right move — and when it isn't

Timing matters as much as technique. After a first episode of depression, guidelines generally suggest continuing the medication for at least 6 to 12 months after you feel well before tapering. After two or more episodes, or with a history of severe episodes, longer-term and sometimes indefinite treatment lowers the odds of recurrence — and that's a legitimate, evidence-based choice, not a failure. The decision to stop weighs how stable you've been, what's going on in your life, and your own goals.

The one rule

Don't stop on your own, and never stop abruptly. Foundry's role is to plan the taper with you, watch closely as the dose comes down, distinguish a discontinuation bump from a true relapse, and slow or pause if needed. Coming off a medication well is its own piece of careful care — not an afterthought.

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