Depression or anxiety: staying on treatment once you feel better

Why it is best not to stop an antidepressant or anti anxiety medicine when you feel better, how long treatment usually lasts and how to come off it properly.

If you take an antidepressant or an anti anxiety medicine and you already feel better, the advice is not to stop it on your own. Improvement usually means the treatment is working, and when and how to stop is decided with your doctor to avoid relapse and withdrawal symptoms.

It is one of the most common doubts among people being treated for depression or anxiety. Here we explain why it is worth continuing, how long treatment usually lasts and how to come off properly when the time comes.

Why keep going with treatment if you already feel better?

Because feeling better does not mean the underlying problem has been resolved. The NHS explains that antidepressants are normally continued for at least 6 months after you feel better, and MedlinePlus warns that stopping too soon can make depression come back or get worse.

It is a very human situation: when you are sleeping well again, have energy and enjoy things, the tablet seems unnecessary. But those extra months help consolidate your recovery. We develop the same idea, applied to other treatments, in can I stop a medicine if I feel well?

How long does it take to work and how long does treatment last?

Antidepressants take weeks to reach their full effect and treatment usually lasts months. Anti anxiety medicines from the benzodiazepine group, by contrast, are intended for short periods.

These are general guidelines: your doctor may recommend a different length depending on your history, for example if you have had previous episodes. At the start of treatment it is usual to have more frequent reviews to see how it suits you.

What happens if you stop suddenly?

Stopping an antidepressant abruptly can cause withdrawal symptoms and increases the risk of relapse. With benzodiazepines, the summary of product characteristics warns that abrupt discontinuation may be accompanied by withdrawal symptoms and a rebound effect, which is why gradual dose reduction is recommended.

According to the NHS, antidepressant withdrawal symptoms can include:

• Dizziness, nausea, sweating and palpitations.
• Headache and muscle aches.
• Sleep problems, irritability, low mood or confusion.
• Sensations like small electric shocks in the head.

They usually start within a few days and last a few weeks, although for some people they are more intense or longer lasting. That is why coming off is done with your doctor, reducing the dose gradually over weeks or months and adjusting the pace if symptoms appear.

How do you stay consistent and when should you ask for help?

Keeping up treatment is easier if you build it into your routine and talk openly with your doctor about how it suits you. Many people give up because of side effects that can be dealt with.

• Link the dose to a fixed daily habit, such as breakfast or brushing your teeth.
• If a side effect bothers you, mention it: the dose, the timing or the medicine can often be adjusted.
• Avoid alcohol or ask first, because it can interfere with these medicines and with your mood. More information in alcohol and medication: what you should know.
• When you think you are ready to stop, book an appointment to plan it rather than stopping on your own.

Ask for help straight away if you have thoughts of harming yourself, if your symptoms get worse or if you notice sudden changes in mood or behaviour. The Spanish Ministry of Health's 024 line is confidential and available 24 hours a day for people with suicidal thoughts and those close to them; if there is immediate danger, call 112.

A practical example: Elena, 49, and the temptation to stop

Let us take the case of Elena, 49, a teacher who started an antidepressant after a very difficult year. Four months later she is sleeping well, wants to go out again and thinks she no longer needs the tablet.

• Instead of stopping, Elena books an appointment with her GP and tells him how she feels.
• Her GP explains that it is best to continue for a few more months to consolidate the improvement, and they set a review date.
• When the time comes, they agree a gradual reduction plan and Elena notes any symptoms she feels.
• For a week she feels a little dizzy, mentions it and they adjust the pace of the reduction.

Elena made the decision to stop her treatment, but she did it with a plan and with support, which is what reduces the risk of relapse.

How can IMA Health help you?

If you take other medicines as well as your treatment for depression or anxiety, having everything prepared avoids missed doses and doubts, including during a gradual reduction. At IMA Health we coordinate with a specialised pharmacy that prepares your medication by day and time of each dose as your doctor directs, we deliver it to your home and we provide personalised follow-up of every change.

Sources

• Spanish Ministry of Health: 024, suicide prevention helpline (in Spanish)
• CIMA (AEMPS): summary of product characteristics for Diazepam Prodes (duration of treatment and withdrawal) (in Spanish)
• MedlinePlus: Antidepressants (in Spanish)
• NHS: Antidepressants, overview

This article is for information only and does not replace advice from your doctor or pharmacist.