Coming off psychiatric drugs

Explains issues faced when coming off medication, how to approach it, techniques for gradual reduction, possible withdrawal symptoms and how to tell the difference between withdrawal and relapse.

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What are the withdrawal effects of different types of drugs?

As all psychiatric drugs change brain and body chemistry, they may all cause withdrawal symptoms, especially if you have been taking them for a long time. You will not necessarily get any withdrawal symptoms when coming off, but many people do. The symptoms differ to some extent between drug types.

Information on the withdrawal effects of different types of drugs is given on the relevant pages:

Information about the withdrawal effects of individual drugs is on the information page for each drug, found in the relevant A-Z.

How can I tell whether I have withdrawal symptoms or my mental health problem is coming back?

If you have symptoms related to drug withdrawal, they:

usually happen very soon after you start to come off (this is related to half-life – in a drug with a long half-life, withdrawal effects will be delayed by as much as two weeks)
are often different from anything you have had before
go as soon as you re-start the drug
will eventually subside without treatment if you don’t re-start the drug.

If you have symptoms related to your mental health problem coming back, they:

are delayed, and are not related to the half-life of the drug
are the same as the symptoms you had before – when you first started the drug
get better slowly if you re-start the drug
continue indefinitely without other treatment.

Switching drugs to help withdrawal

If you are taking a drug with a short half-life and having problems with withdrawal symptoms, it may be possible for you to switch to a related drug with a long half-life, which should be easier to come off. You will need the help of a doctor to switch drugs because your prescription will need to be changed.

Tranquillisers and sleeping pills

The benzodiazepine tranquilliser with the longest half-life is diazepam (Valium). If you are coming off one with a short half-life (such as temazepam) you could switch to diazepam.

Some people also use diazepam to help come off the ‘z’ sleeping pills, which act in a very similar way to benzodiazepines.

Equivalent doses for benzodiazepines and z sleeping pills

Change to 5mg of diazepam (Valium) from:

chlordiazepoxide 15mg
loprazolam 0.5-1.0mg
lorazepam 500mcg (0.5mg)
lormetazepam 0.5-1.0mg
nitrazepam 5mg
oxazepam 15mg
temazepam 10mg
zaleplon 10mg
zolpidem 10mg
zopiclone 7.5mg

Antidepressants

The SSRI antidepressant with the longest half-life is fluoxetine (Prozac). It may be helpful to switch from a drug with a short half-life (such as paroxetine) to fluoxetine and slowly withdraw from that. As fluoxetine takes a little while to build up in your system, some specialists suggest starting it while you lower the dose of the other drug, taking both drugs together for a week or two.

Equivalent doses for SSRI antidepressants and venlafaxine

Change to 20mg fluoxetine liquid from:

citalopram 20mg
escitalopram 10mg
fluvoxamine 50mg
paroxetine 20mg
sertraline 50mg
venlafaxine 75mg

When coming off antidepressants, an alternative to fluoxetine is to switch to clomipramine 100mg/day.

Antipsychotics

Drug switching techniques may be used with antipsychotics but you would need advice from a psychiatric pharmacist or psychiatrist on which drug to switch to.

Half-lives of all psychiatric drugs are given in the comparison tables for each drug type, as well as the information page for each drug.

Lithium and other mood stabilisers

You would need advice from an experienced psychiatrist or psychiatric pharmacist on whether this technique would work for mood stabilisers, and which drugs might be suitable to switch to.

It's possible that you might be advised to switch to antipsychotic medication.