Off the Pills?

As more Indians seek treatment for depression and anxiety, antidepressant use is steadily rising. While starting medication is often seen as a major milestone, mental health experts say stopping it requires just as much care. Tapering too quickly can trigger withdrawal symptoms, increase the risk of relapse and undo months of progress. Here's what psychiatrists want every patient to know before reducing or stopping antidepressants.

Feeling better doesn’t mean treatment is over

Many patients assume that once they feel emotionally stable, they can stop taking antidepressants. That’s one of the biggest mistakes, says Dr Virinchi Sharma, Consultant Psychiatrist, Apollo Hospitals.

“Antidepressants should never be stopped suddenly. The brain needs time to adapt to changing serotonin levels. Gradual tapering under psychiatric supervision makes the transition safer and reduces both withdrawal symptoms and the risk of relapse.”

When stopping feels worse than starting

Within days of abruptly stopping medication, some patients experience dizziness, nausea, headaches, insomnia, anxiety, irritability, fatigue and even “brain zaps”— brief electric shock-like sensations. These symptoms can be frightening but are usually temporary when tapering is done gradually under medical supervision.

Withdrawal or relapse? Knowing the difference matters

One of the biggest challenges is recognising whether symptoms signal withdrawal or the return of depression. Withdrawal symptoms usually appear soon after reducing medication and often include physical complaints. A relapse develops more gradually, with persistent sadness, hopelessness, loss of interest and worsening mood over several weeks. Recognising the difference early allows psychiatrists to adjust treatment before symptoms escalate.

There is no one-size-fits-all plan

Not everyone is ready to stop medication at the same time. “Patients whose depression or anxiety has remained stable for several months, who have completed treatment and have strong support systems may be considered for tapering. The decision is always individualised,” says Dr Sharma. “Factors such as the medication, dosage, treatment duration and previous episodes all influence how slowly doses should be reduced.”

Recovery isn’t just about reducing tablets

Medication is only one part of recovery. Dr Rajesh Ayyalasomayajula, Senior Consultant Psychiatrist, Medicover Hospitals, says therapy becomes especially valuable during tapering.

“Therapy prepares patients for emotional changes, teaches coping strategies, builds confidence and helps identify early warning signs of relapse.” Counselling also reduces the fear many people experience when lowering medication.

Lifestyle becomes your strongest medicine

Healthy habits play an even bigger role during tapering. Regular exercise, good sleep, nutritious meals, mindfulness, breathing exercises and stress management improve emotional resilience and reduce the intensity of temporary withdrawal symptoms. Maintaining social connections and following a structured daily routine also help patients navigate the transition more smoothly.

Families can make or break recovery

Recovery doesn’t happen in isolation. “When families understand depression and the tapering process, they're better able to offer reassurance rather than judgement,” says Dr Ayyalasomayajula.

Simple support, encouraging medical follow-ups, listening without criticism and recognising early warning signs, can significantly improve long-term outcomes.

Don’t let myths derail recovery

Many patients worry antidepressants are addictive or simply sleeping tablets. Experts disagree. “Antidepressants treat depression and anxiety by correcting chemical imbalances in the brain,” explains Dr Ayyalasomayajula. “They are not addictive, but they must be discontinued carefully.”

Withdrawal symptoms

· Dizziness

· Nausea

· Headache

· Fatigue

· Insomnia

· Anxiety

· Irritability

· Mood swings

· Electric shock-like sensations (“brain zaps”)

Who can consider tapering?

· Symptoms have remained stable for several months

· Treatment goals have been achieved

· You’re under regular psychiatric care

· You have good family or social support

· Your psychiatrist recommends it

Habits that help

· Exercise regularly

· Prioritise quality sleep

· Eat balanced meals

· Practise mindfulness

· Use breathing exercises

· Keep a daily routine

· Stay socially connected

· Continue therapy

Call your psychiatrist immediately if...

· Depression rapidly worsens

· Suicidal thoughts develop

· Anxiety becomes overwhelming

· Panic attacks increase

· Hallucinations occur

· Withdrawal symptoms become severe or persistent

· You’ve stopped medication on your own