Emotional distress when stopping antidepressants appears to be due to withdrawal, not relapse

When people reduce or stop taking their antidepressants, they often experience a surge of negative emotions like anxiety and low mood. A new study published in Psychotherapy and psychosomatics suggests that these sudden emotional changes are usually a sign of a physical withdrawal reaction to the drug, rather than a return of the person’s underlying mental health problem. Research provides evidence that tracking physical symptoms such as dizziness as well as emotional changes can help doctors accurately identify withdrawal.

Antidepressants are medications widely prescribed to treat conditions such as depression and anxiety disorders. Patients often take these medications continuously for months or years, during which time the body adapts to their presence. When a person decides to stop taking the medication, they usually engage in a taper, a process of gradually reducing the dose over several weeks or months.

During this time, it is common for individuals to experience a range of acute symptoms. Some of them are physical, such as dizziness, nausea, muscle cramps, and “brain zaps,” which are sudden electric shock-like sensations in the head. These physical reactions are widely recognized as direct signs of drug withdrawal, a state in which the body responds to the absence or reduced level of a medication to which it has become accustomed.

However, the decrease is also frequently accompanied by emotional or affective symptoms. These may include depressed mood, irritability, anxiety and sudden outbursts of anger. Because these emotional symptoms are nearly identical to the core features of depression and anxiety disorders, doctors face a major diagnostic challenge. When a patient feels anxious or depressed after reducing their medication dose, it can be difficult to tell whether they are experiencing a temporary withdrawal effect or a relapse, which is the return of the original mental health problem.

Making the right distinction has major implications for patient care. If emotional symptoms indicate a relapse, medical guidelines generally suggest that the patient should return to treatment to control their condition. But if the symptoms are a reaction to withdrawal, a better approach is to reduce the dose in smaller, slower steps to give the body more time to adapt.

The scientific community has debated the frequency of withdrawal and how it should be classified. For example, a systematic review covered by PsyPost in 2024 argued that antidepressant withdrawal is relatively rare, affecting only about one in three people stopping their treatment, with serious effects being rare. In contrast, other research covered by PsyPost in 2025 indicates that post-acute withdrawal symptoms can be severe and persist for months or even years.

The research team, led by Michael P. Hengartner, professor of clinical psychology and research group leader at Kalaidos University of Applied Sciences, launched the current study to help address this problem. They sought to determine whether emotional symptoms that appear shortly after a dose reduction follow the typical periodic pattern of withdrawal or the more gradual, persistent pattern of relapse.

“Various lines of evidence strongly suggest that rapid onset of depressive or anxiety symptoms after stopping antidepressants or during tapering are manifestations of withdrawal reactions,” Hengartner, who also authored the book. Evidence-based antidepressant prescribing: overmedicalization, flawed research, and conflicts of interesttold PsyPost. “Yet these problems are commonly interpreted and recorded as signs of mental illness relapse, leading to inadequate treatment decisions and overestimation of the benefits of antidepressant maintenance treatment. »

To explore this, researchers conducted a prospective longitudinal cohort study involving 32 adult primary care patients in Switzerland. Participants had been taking antidepressants for an average of 42 months and were in a stable state of remission, meaning their initial symptoms of depression or anxiety were no longer active. All participants planned to stop their treatment. The research team assessed participants immediately before they began tapering their treatment and followed them at two, four, six, eight, 16 and 26 weeks.

At each measurement point, participants completed standardized questionnaires to track their mental and physical state over the previous two weeks. Researchers used the Patient Health Questionnaire-9 to measure depression symptoms and the Generalized Anxiety Disorder Scale-7 to measure anxiety symptoms. To capture withdrawal effects, they used an adapted version of the Discontinuation Signs and Symptoms Scale. From this scale, the team calculated two separate scores: one for emotional withdrawal symptoms like nervousness and mood swings, and another for discriminatory physical symptoms like incoordination, ringing in the ears and brain zaps.

The researchers found a consistent pattern linking patients’ emotional states to their medication doses. Over the 26-week observation period, whenever participants’ depression and anxiety scores increased, their emotional and physical withdrawal symptom scores also tended to increase.

When participants reduced their antidepressant dose, they experienced an acute increase in symptoms of depression, anxiety, and emotional withdrawal. During intervals where the dose remained stable and was not reduced further, the intensity of anxiety and emotional withdrawal symptoms gradually decreased. This wave-like pattern, where symptoms increase immediately after a dose reduction and then subside as the dose stabilizes, is characteristic of a pharmacological withdrawal reaction. Relapses of a mental health disorder tend to develop more gradually and generally do not wax and wane in rapid response to dose adjustments from week to week.

To test the nature of these emotional symptoms, the researchers analyzed what happened when they statistically explained physical withdrawal symptoms. They reasoned that if a patient’s sudden depression was actually a relapse, it should have no direct connection to physical signs of withdrawal like dizziness or nausea.

The researchers found that accounting for changes in physical withdrawal symptoms significantly weakened the statistical link between dose reductions and spikes in anxiety and emotional withdrawal symptoms. In the case of depression scores, the association with dose reductions disappeared entirely when physical symptoms were taken into account. This indicates that the physical and emotional symptoms were part of the same underlying withdrawal process.

“The rapid onset of depressive and anxiety symptoms and their reduction within weeks after sequential dose reductions and stabilizations reflect the typical pattern of repeated withdrawal reactions, particularly when these emotional problems are accompanied by discriminatory physical withdrawal symptoms such as dizziness, incoordination, visual or auditory sensory changes, muscle cramps or nausea,” Hengartner said. “In such cases, patients are advised to taper their antidepressant treatment more slowly and in smaller steps to alleviate withdrawal effects. »

The magnitude of the dose reduction also played a role in the severity of symptoms. Researchers ranked dose adjustments relative to the minimum therapeutic dose of each drug. They found that small dose reductions, defined as reducing the dose by no more than 25 percent of the minimum therapeutic amount, largely prevented acute spikes in depression and emotional withdrawal symptoms compared to larger reductions.

“The magnitude of the effects is variable, because it depends on the drug taken, the duration of use, the tapering stages and the individual propensity for pharmacological withdrawal effects,” explained Hengartner. “Some people will barely feel the effects of withdrawal, some will have milder and tolerable symptoms, while still others will suffer severe and disabling symptoms. For the latter group, the effects have strong clinical relevance and important practical consequences.”

“We already knew from previous research that there is significant interindividual variability in the propensity to experience clinically significant withdrawal reactions, but we were still surprised to find that in some cases even people who had been taking a drug for a long time at considerable risk of withdrawal could discontinue treatment relatively quickly without problem, while others experienced substantial withdrawal effects,” he said. “Much of this heterogeneity of effects remains unexplained. »

As with any research, there are a few things to keep in mind about this study. The sample size of 32 participants was relatively small. This has limited researchers’ ability to conduct more detailed analyses, such as comparing the specific withdrawal effects of different types of antidepressant medications or examining how duration of medication use affects withdrawal severity.

“This was a naturalistic study, meaning people declined at their own rate,” Hengartner noted. “Also, because this was not a randomized, controlled study, we cannot draw firm causal conclusions. Our results show a trend that indicates withdrawal effects, but it is not definitive proof.”

The study also relied entirely on self-reported questionnaires to measure symptoms, with no independent clinical assessments to confirm the severity of depression, anxiety or withdrawal signs. Additionally, the intervals between measurements became longer during the later stages of the study, such as the eight-week interval between week 8 and week 16. Since withdrawal symptoms can sometimes appear, peak, and disappear quickly, or sometimes have a delayed onset, these extended intervals might have missed some daily fluctuations in how…