Dr Mark Horowitz knows how hard it can be to come off antidepressants.
“When I got down to a very low dose – not even off the drugs – my entire world exploded,” the London-based doctor tells BBC Science Focus. “I had trouble sleeping and I would wake up in the mornings in a full-blown panic, like I was being chased by a wild animal, then that would go on for 10 or 11 hours of the day.”
He felt far worse – and had entirely different symptoms – compared to when he had been originally prescribed the Selective Serotonin Reuptake Inhibitor (SSRI) escitalopram, 12 years earlier at the age of 21.
Antidepressants are widely viewed as a huge success in the world of mental health treatment. Around a fifth of the population of the UK and the US use an antidepressant each year, and a 2025 study by King’s College London found 75 per cent of people who took SSRIs (the most common type of antidepressants, which include citalopram, fluoxetine, paroxetine and sertraline) thought they were helpful.
They’re often used long term: an investigation by BBC Panorama in 2023 found around two million people in England had been on antidepressants for more than five years (this figure is even higher now). And in the US, figures from the Center for Disease Control and Prevention suggest it’s at least 25 million.
Stopping the medication
But what happens when we feel like we don’t need them anymore?
According to the UK’s Royal College of Psychiatrists, symptoms of antidepressant withdrawal can include anxiety; low or rapidly changing moods; difficulty sleeping (including nightmares); an electric-shock feeling (‘zaps’) in the head and limbs; loss of coordination; suicidal thoughts; dizziness; and a feeling of inner restlessness (akathisia) – a symptom some of Dr Horowitz’s patients have described as feeling like “their nervous system on fire”. People pace the room and are flooded with a sense of terror.
Symptoms like these can be misinterpreted as a return of the original mental health problem says Dr Horowitz, now 43 and lead clinician at the Psychotropic prescribing Clinic at North East London NHS Foundation Trust, as well as a visiting lecturer in psychopharmacology at King’s College London.
Of course, many people have found antidepressants to be useful in treating severe depression or anxiety disorders. But even if they’ve worked well for someone, there are reasons they might not want to keep taking them.
“Some people experience side effects that they feel they can’t tolerate,” says Barbara Sahakian, professor of neuropsychology at the University of Cambridge.
“These range from sexual dysfunction and sleep disturbances to dizziness and gastrointestinal problems. Others feel their tablets are making them ‘emotionally blunted’,” she adds.
Some stop because they feel they’ve recovered fully from their mental health problem, says Prof Michael Hengartner, of Kalaidos University of Applied Sciences in Switzerland, whose research focuses on the effects and side effects of antidepressants, as well as their discontinuation.
“Staying on an SSRI for years after a single episode is not recommended by treatment guidelines.” Or women taking them “may want to become pregnant and do not want to risk adverse drug effects on their baby,” he adds.
But as Dr Horowitz found, coming off them can be difficult. And he’s not alone: the peer support websites Surviving Antidepressants and The Inner Compass have a combined one million hits a month from people seeking help.
Still, the research paints a confusing picture about how common and severe withdrawal is. In a large analysis of previous randomised controlled trials (RCTs), led by Imperial College London and King’s College London, and published in JAMA Psychiatry in July (2025), people who stopped antidepressants experienced an average of just one more symptom than the symptoms reported by those who stayed on their antidepressants or who had been taking a placebo.
A question of time
Experiencing just one more symptom isn’t enough to diagnose ‘discontinuation syndrome’ – that requires four symptoms, they say.
But critics claim the data analysed mostly came from trials in which people had taken antidepressants for only a short period.
“Analysing data from eight- or 12-week trials and concluding that antidepressant withdrawal is a minor issue is like studying dementia incidence in people aged under 40 and claiming that dementia is very rare and of no clinical relevance,” adds Prof Hengartner.
Dr Horowitz says: “In the UK, most people use the drugs for years, if not decades.” The problem is, there aren’t many long-term trials to analyse. The lack of longer-term RCTs is not because they’re hard to do, says Prof Hengartner, but because “the main sponsor of clinical research – the pharmaceutical industry – obviously has no interest in studying harms imposed by its products.
“Moreover, it seems that academic psychiatry, which strongly promotes widespread antidepressant use, is not honestly interested in the subject either.”
But he points to two longer-term ‘treatment interruption’ trials, which he says do provide strong evidence of withdrawal effects.
The first, published in Biological Psychiatry in 1998, found that 60 per cent of patients coming off the SSRI sertraline, and 66 per cent of those coming off the SSRI paroxetine (their medication was swapped for a placebo after an average of 11 months) experienced four or more withdrawal effects.
This met the criteria for what the researchers called ‘discontinuation syndrome’. “And the evidence from this trial is fully consistent with the findings from observational studies such as Horowitz et al 2025,” says Prof Hengartner.
That study, published in May 2025 in Psychiatry Research, found that 64 per cent of those who had taken antidepressants for two years or more reported moderate or severe withdrawal effects.
“We found a very clear relationship between how long you’ve been on the drugs and your risk of withdrawal,” says Dr Horowitz.
“After eight weeks, we found very low levels… once people were on the drugs for two years, we found extremely high levels of withdrawal.”
Relying on data from trials of short-term users was also why the original guidelines for stopping antidepressants, such as those issued by the National Institute for Health and Care Excellence in England and Wales (NICE), suggested withdrawal symptoms were usually “brief and mild”, he says. The NICE guidelines have now been updated.
Symptoms can continue for “months or even years”, Dr Horowitz says. But many clinicians think that, because the drugs leave the body within a few weeks, patients simply can’t have persistent withdrawal symptoms.
“It’s the time taken by the brain to re-adapt to there being less drug that explains how long withdrawal symptoms can last for, not how long it takes the drug to leave the body,” he adds.
Systematic change
“There are studies in humans that [suggest the] changes in the serotonin system can persist for up to four years after stopping antidepressant treatment.” The difference between what’s happening at a neurochemical level and what the brain expects seems to drive some of the worst withdrawal symptoms.
So, what other factors can make someone more likely to experience a difficult withdrawal?
One is the type of drug. While “all the other antidepressants have significant risks”, the SSRI paroxetine, and the serotonin-norepinephrine reuptake inhibitors (SNRIs) – venlafaxine and duloxetine are the SNRIs used in England – tend to be the worst, says Dr Horowitz.
Dose also plays “a little bit of a role: higher dose is higher risk to some degree,” as does your past experience coming off.
“If you’ve had trouble in the past, chances are you’ll have problems in the future,” he says. And the number of times a person stops and starts, the higher the chances, too.
So what do we know about how to withdraw from antidepressants as safely as possible?
Experts recommend tapering. Slowly. The UK’s Royal College of Psychiatrists’ website has examples of tapering plans, but stresses that patients must speak to their prescriber first before trying them. When tapering, “the last few milligrams are the hardest to get off,” warns Dr Horowitz, who has written the Maudsley Deprescribing Guidelines, which sets out for doctors exactly how to help patients withdraw from each specific antidepressant.
“It’s important to recognise how significant the disabilities from these conditions can be.”
We contacted the Royal College of Psychiatrists and the Association of the British Pharmaceutical Industry for comment on points discussed in this article, but neither body responded in time for publication.
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