Antidepressants are commonly prescribed medications used to treat depression and anxiety. They work by increasing the levels of certain neurotransmitters in the brain, such as serotonin, dopamine, and norepinephrine. While antidepressants can be very effective in treating mood disorders, many people end up stopping their medication, often prematurely. There are several key reasons why people may discontinue their antidepressant treatment.
One of the top reasons people stop taking antidepressants is bothersome side effects. All medications come with potential side effects, and antidepressants are no exception. Some common side effects of antidepressants include:
- Weight gain
- Sexual problems
- Dry mouth
While many side effects lessen over time as the body adjusts, some persist and can negatively impact quality of life. People may stop taking their antidepressant because the side effects are intolerable.
Lack of Effectiveness
Antidepressants don’t work for everyone. Up to two-thirds of people with depression don’t achieve remission with their initial antidepressant trial. It can take some trial and error to find the most effective medication and dosage. If someone doesn’t feel their antidepressant is improving their depressive symptoms after several weeks, they may prematurely discontinue it before giving it an adequate chance to work. Lack of perceived effectiveness is a common reason someone may stop taking their antidepressant.
Once a person starts feeling better, they may assume they no longer need their antidepressant and decide to stop taking it. Unfortunately, this leads to high rates of relapse. Quitting an antidepressant abruptly once symptoms improve increases risk of recurrence. It’s recommended to continue taking the medication for at least 6-12 months before considering tapering off gradually under a doctor’s supervision. Prematurely stopping medication due to feeling better too soon is not an uncommon occurrence.
Antidepressants can be expensive, especially newer ones that are under patent protection. Some people may struggle to pay for their medication each month and discontinue due to the cost burden. Access to affordable mental health services and medications is a barrier for many. Additionally, some may run into insurance coverage issues, restrictions, prior authorizations, or other administrative roadblocks that impede their ability to consistently obtain their prescribed antidepressant. Lack of access or affordability issues commonly lead to people abruptly stopping an antidepressant.
If a person becomes pregnant or wants to try conceiving while on an antidepressant, they will usually consult their doctor and strongly consider discontinuing use due to potential risks to the developing fetus. Most antidepressants have not been well-studied in pregnancy and risks are unclear. Many obstetricians and women are not comfortable continuing antidepressant use during pregnancy. Breastfeeding is another consideration, as very small amounts of antidepressants can pass into breastmilk. For those reasons, starting a family often leads women to prematurely stop taking their antidepressants.
Unfortunately, stigma remains around mental illness and use of psychiatric medications. Some people may feel embarrassed, ashamed, or weak for needing an antidepressant. They may hide their use from loved ones or discontinue their medication in an effort to feel “normal.” Additionally, many misconceptions persist about antidepressants being addictive or harmful. These stigmas can fuel motivation to stop taking antidepressants before medically advised.
Dissatisfaction with Providers
Lack of an established, trusting relationship with the prescribing doctor can lead some people to stop their antidepressant early. Poor provider communication, rushed appointments, and lack of education or follow up may result in patients feeling dissatisfied, unsupported, and more apt to discontinue against medical advice. Finding an empathetic provider who involves patients in shared decision making tends to promote medication adherence.
Lack of Support System
Having social support from loved ones facilitates staying on antidepressants as prescribed. However, some people keep their treatment private due to stigma or simply lack close confidants. Without a support system for encouragement and accountability, people may be more likely to prematurely stop their medication.
Forgetting to Take It
It can be easy to forget to take a daily medication. People can get busy, distracted, or interrupted and accidentally skip doses. Over time, missed doses here and there can turn into completely stopping the medication. Setting phone alerts, pairing it with a daily routine, using a pill organizer, and involving family in reminders can help minimize forgetting.
Feeling Better So Thinking You’re “Cured”
When antidepressants effectively relieve depressive symptoms, some people may assume they have been permanently “cured” and no longer require medication. In actuality, antidepressants are controlling symptoms rather than providing a cure. If the medication is stopped, high probability of relapse still exists. Unfortunately, people often learn this after discontinuing their antidepressant and having their mental health decline again.
Desire to Feel Normal/Like Yourself
Some people express they feel numbed emotionally or not like their normal selves when taking antidepressants long-term. They may stop taking their medication in hopes of feeling more clear-headed and like themselves again. However, this is usually an undesirable effect and other medications or dosages could potentially be explored instead of stopping completely.
Fear of Dependency
A common myth about antidepressants is that they are addictive or easy to become dependent on. This simply isn’t true – antidepressants are not addictive substances. However, some prescribers fail to properly educate patients about this. As a result, people may have underlying fears of dependency that motivate them to discontinue use. Accurate education about the difference between addiction vs. tolerance/withdrawal can help combat this misconception.
Pressure from Loved Ones
While social support aids adherence, social influence can also prompt premature discontinuation in some cases. If a person’s loved ones hold misconceptions or stigma towards antidepressants, they may pressure or encourage stopping medication right when symptoms improve. Lack of alignment with family on antidepressant use can jeopardize adherence.
Data on Antidepressant Discontinuation
Several studies have collected data on rates and reasons for antidepressant nonadherence. Here is a summary of survey statistics on this topic:
Overall Discontinuation Rates
|Sansone et al., 2012
|44% within 6 months of starting
|Kantor et al., 2017
|27% within 90 days of starting
|Bull et al., 2002
|31% within 90 days of starting
These studies demonstrate that around a third to nearly half of people discontinue their antidepressant within the first few months of treatment. Discontinuation rates appear highest very early on.
Most Common Reasons Reported
|Most Common Reasons
|Sansone et al., 2012
|Side effects (46%)
Felt better (32%)
|Bull et al., 2002
|Felt better (43%)
Side effects (32%)
|Kantor et al., 2017
|Felt better (61%)
Side effects (37%)
All three surveys found feeling better and side effects as the top two reasons for antidepressant discontinuation. Stigma, lack of effectiveness, and cost barriers were also cited.
Discontinuation Without Doctor Recommendation
|Discontinued without Provider Approval
|Kantor et al., 2017
|Sansone et al., 2012
These statistics indicate a large percentage stop their antidepressant prematurely without consulting their healthcare provider first. Many people take it upon themselves to discontinue when they see fit.
Risks of Stopping Antidepressants
What are the risks if someone stops taking an antidepressant too soon? There are several potential consequences:
- Relapse of depression – High risk of having depressive symptoms return, often more severely than before.
- Withdrawal symptoms – Headaches, nausea, dizziness, and flu-like feelings may occur as a side effect of stopping.
- Loss of progress – Improvements made in mood, functioning, and quality of life can be lost.
- Suicidal thoughts – Risk of self-harm may increase, especially if stopping suddenly without medical oversight.
- Difficulty restarting – May be harder to achieve a therapeutic response if the medication needs to be started again after stopping.
Based on these risks, it’s ideal to only taper antidepressants under a doctor’s supervision over an extended period of several weeks to months.
Strategies to Improve Adherence
How can people be supported in continuing to take their antidepressant medication as directed? Some strategies include:
- Ongoing education about needing to take medication continuously even when feeling better, rather than stopping immediately once symptoms improve.
- Routine follow-up appointments to monitor progress and support adherence.
- Teaching coping skills for managing side effects to increase tolerance.
- Utilizing pill organizers, phone reminders, alarms and other tools to prevent forgetting doses.
- Identifying affordability solutions such as pharmaceutical assistance programs or cheaper medication options.
- Cognitive-behavioral therapy or counseling to overcome stigma and build motivation.
- Encouragement and accountability from loved ones.
- Establishing a consistent daily routine for taking medication at the same time each day.
With proper education, support and routines, more people may be able to adhere to their prescribed antidepressant regimen long enough to achieve full therapeutic benefits.
Premature discontinuation of antidepressants is an extremely common issue. Up to half of people stop taking their antidepressant within the first few months of starting, often without consulting their doctor first. Key reasons for early discontinuation include side effects, feeling better, misconceptions, stigma, lack of access/affordability, pregnancy, and simple forgetfulness. This leads to high risks of relapse, loss of progress, and other negative consequences. Ongoing education, routine follow-up, use of reminders, cognitive-behavioral approaches, social support, and medication access solutions may improve adherence. With increased understanding of factors leading to early antidepressant discontinuation and application of targeted strategies, outcomes for many dealing with depression and anxiety could significantly improve.