Coming off antidepressants can be a significant decision. For some people, medication has been an important part of getting through depression, anxiety, trauma-related distress or a difficult period in life. Others may reach a point where they wonder whether they still need it, feel concerned about side effects, or want to understand their options.

Deprescribing antidepressants is not simply a matter of stopping tablets. It is a process that is best approached thoughtfully, with support from a GP, psychiatrist or prescribing clinician, and with attention to the psychological and social factors that affect wellbeing.

Why people think about stopping antidepressants

People consider reducing or stopping antidepressant medication for many reasons. Some have been well for a sustained period and want to see how they manage without medication. Others experience side effects such as emotional blunting, sleep changes, sexual difficulties, weight changes or digestive symptoms. Some feel unsure about being on medication long term, even if it has helped.

These are all valid concerns to discuss. At the same time, antidepressants can be protective for some people, particularly where depression or anxiety has been severe, recurrent or associated with significant risk. The question is not whether medication is good or bad, but what is appropriate for this person, at this point in their life.

Withdrawal symptoms are not the same as relapse

One of the difficulties in coming off antidepressants is that withdrawal symptoms can resemble a return of anxiety or depression. People may notice dizziness, irritability, low mood, tearfulness, sleep disturbance, flu-like sensations, vivid dreams or unusual bodily sensations. These experiences can be unsettling, especially if they are unexpected.

Relapse is also possible, particularly if the original difficulties remain unresolved or current stresses are high. Distinguishing withdrawal from relapse can be clinically complex. Timing, symptom pattern, previous history and the pace of dose reduction all matter. This is one reason gradual tapering and regular review are usually preferable to stopping suddenly.

The role of psychotherapy and counselling

Psychotherapy or counselling can be useful before, during and after medication changes. Therapy does not replace medical advice, but it can help people understand the emotional patterns, relationships, stressors and life experiences that may have contributed to their distress.

For some, antidepressants reduce symptoms enough to make therapy possible. For others, therapy provides a place to strengthen coping, process grief or trauma, address self-criticism, improve boundaries, or build a more sustainable way of responding to stress. If medication is being reduced, therapy may also help a person notice early warning signs and develop a plan for support if symptoms return.

Taking a careful, collaborative approach

A careful approach to deprescribing usually includes a clear reason for change, a realistic timeframe, and a plan for what to do if symptoms become difficult. It can be helpful to consider sleep, alcohol and other drug use, physical health, work pressure, relationships and available support. Life transitions, bereavement, burnout and unresolved trauma can all affect how manageable the process feels.

Coming off antidepressants is not a test of strength or willpower. Nor is remaining on medication a failure. Good mental health care involves making informed decisions, reviewing them over time, and adjusting support as circumstances change.

If you are thinking about changing antidepressant medication, it is worth starting with a conversation with your prescriber. Psychotherapy or counselling may also provide a supportive space to think through what is happening beneath the symptoms, and what might help you stay well over the longer term.

For more information about Robert St Clinic’s range of treatments and practitioners, call us on 09 973 5950, email us via info@robertstclinic.co.nz or leave a message via the website.