Jamie Pearse was 14 when she started taking SSRIs, in the 1990s, as antidepressants were becoming a cultural fixture. She stayed on them for decades. When she decided to stop, she discovered it wasn’t as simple as she had been led to believe.
There was the insomnia — sometimes so severe that she struggled to care for her three children — and a disorienting dizziness.
“I would move my eyes, and my brain would track a couple of seconds behind,” Pearse, now 47, said. “I thought I was going crazy.”
For years, patients were told that coming off antidepressants was straightforward: taper over a couple of weeks, expect some discomfort, move on. But accounts like Pearse’s have become harder to ignore, with some patients describing intense and prolonged symptoms.
Guidance on how to transition remains sparse. In the absence of clear direction from the Food and Drug Administration or major medical groups, the process is often left to guesswork. Now, some are trying to change that.
For years, the issue lingered at the margins — on patient forums and in a handful of studies. It gained broader attention in early May, when Health Secretary Robert F. Kennedy Jr. announced an effort to study and support the “deprescribing” of psychiatric drugs. The Department of Health and Human Services said it will encourage other interventions such as therapy and lifestyle changes to treat mental health conditions, get experts to draft guidelines for going off psychiatric medications and develop materials on potential risks.
Selective serotonin reuptake inhibitors, or SSRIs, are among the pharmaceutical era’s defining success stories. They — and their close cousins, SNRIs, serotonin and norepinephrine reuptake inhibitors — work by making certain mood-related chemicals more available in the brain, helping millions of people regain stability.
Kennedy has long been skeptical of SSRIs, particularly their use in children, which has at times sparked controversy. Still, many scientists — including those who say the administration is overstating the potential harms of SSRIs or missing nuance — say the underlying concern is real.
Awais Aftab, a clinical associate professor of psychiatry at Case Western Reserve University, said “the gap in scientific knowledge has allowed a kind of polarized discourse” about the potential problems of SSRIs.
“Some people dismiss them, and others try to exaggerate them, turning them into a panic,” Aftab said. The truth, he added, probably lies somewhere in between.
The shift toward a more critical view of antidepressants is driven, in part, by how pervasive they are.
Antidepressants are among the most commonly prescribed medications in the United States. A study published this year in BMJ Mental Health found that 1 in 6 adults is taking one — roughly 45 million people.
Long-term use has become the norm. One large analysis put the median duration at about five years; a separate survey by the Centers for Disease Control and Prevention found that roughly a quarter of patients had been taking antidepressants for a decade or more.
Gerard Sanacora, a Yale professor of psychiatry who directs the university’s Depression Research Program, points to what researchers call “clinical inertia.” When patients appear stable at the three- or six-month mark, he said, doctors tend to almost automatically renew their prescriptions. Alternatives such as psychotherapy, meanwhile, can be more expensive and time-consuming.
The result, he said, is a system that keeps some patients on medication longer than necessary while bypassing others who never receive it at all.
“It’s really not so much an issue of overuse,” Sanacora said. “It’s an issue of appropriate and inappropriate use.”
A math problem
Since the first modern antidepressants were approved in 1987, far more attention has been paid to how patients begin treatment than to how they come off it.
Mark Horowitz, now a leading researcher on antidepressant withdrawal, was once one of those patients.
While Horowitz does not consider himself aligned with the Make America Healthy Again movement and has emphasized antidepressants that help when used appropriately, he joined an event on May 4 where Kennedy spoke about trying to take Americans off them.
Horowitz first went on SSRIs, as he put it, “as a demoralized medical student” in his early 20s. When he tried to stop a few years later, “my life kind of exploded,” he said. He would wake up in absolute terror and sometimes run until his feet bled.
Eventually, he went back on the medication, which brought relief. What stayed with him was something else: The symptoms he experienced while stopping were worse than those that had led him to start.
“I was trapped on the drug,” he said.
He turned to the research, which suggested that between 33 and 56 percent of patients experience some form of withdrawal, and more severe cases ranged from 3 to 25 percent. At the same time, he saw prominent psychiatrists downplay the issue, while industry officials described symptoms as typically “mild” and “brief,” calling it a “discontinuation syndrome.”
“Industry euphemisms,” he said.
Online, the picture looked different. Thousands of patients described similar experiences: “brain zaps” — a sudden electric jolt sensation — along with dizziness, anxiety, irritability and more. Some described lives upended.
Buried in those forums was a pattern. People who tapered more gradually — reducing doses in smaller and smaller increments — seemed to fare better.
Horowitz began to investigate. Reanalyzing brain-imaging data from earlier studies, he found a biological explanation: SSRIs block serotonin transporters in the brain, but the relationship between dose and effect is not linear. Even small doses can block most of these transporters, meaning that the most significant changes occur at the lowest doses — the point at which many patients struggle the most.
He describes it as descending a hill that’s progressively steeper. Reductions at higher doses produce modest changes; at lower doses, the drop becomes sharper.
The model led him to advocate for “hyperbolic tapering” — progressively smaller reductions as doses decrease.
His findings also aligned with differences between drugs. Medications with short half-lives, such as Effexor (venlafaxine), which clears the body in three to seven hours, appeared to produce more severe withdrawal symptoms. Prozac (fluoxetine), with a half-life of four to six days, tapers itself more gradually.
His work, published in Lancet Psychiatry in 2019, helped drive updated U.K. guidelines in 2022 recommending hyperbolic tapering.
Some psychiatrists caution against overcorrecting. They worry that the growing focus on withdrawal could discourage appropriate use of antidepressants or lead patients to attribute symptoms during tapering to withdrawal when they may reflect a return of the underlying illness.
Drug labels, written by manufacturers and approved by the FDA, typically advise tapering gradually rather than stopping abruptly and monitoring for symptoms, but offer little specific guidance.
Mike Ybarra, chief medical officer at PhRMA, the lobbying group for the drug industry, said in a statement that the safety and efficacy of FDA-approved SSRIs have been studied extensively for decades across diverse patient populations.
“Like any prescription medication, the benefits and risks of SSRIs should be discussed with a health care provider to help patients make informed treatment decisions,” Ybarra said.
Detox
While tapering antidepressants slowly is straightforward in theory, in practice, it can be anything but. Many medications are available only in fixed doses; liquid formulations exist for just some SSRIs. Even when patients are told to taper, the instructions can be difficult to interpret.
James Murrough, director of the Depression and Anxiety Center for Discovery at Mount Sinai, said predicting how long tapering will take — five weeks or up to a year — is difficult.
“Patients will say, ‘Doc, how long to get off?’” he said. “I tell them we have to run the experiment, and they look at me funny, but every patient is different.”
Michael Bosco, 36, a manager at an aircraft company in Plymouth, Connecticut, has been taking antidepressants since he was 8 years old. After being diagnosed with ADHD and struggling with insomnia on stimulants, he was switched to SSRIs, starting with Paxil (paroxetine).
He has tried to stop twice. The first time, in high school, he spent a few years in a protracted withdrawal phase, with chills, gastrointestinal problems and mood instability. He eventually went back on medication — this time Zoloft (sertraline).
For five to six years, he felt stable. Then came persistent fatigue and a loss of motivation. Tests found nothing physically wrong. After learning fatigue could be a side effect of SSRIs, he decided to stop again.
Under his doctor’s advice, he tried to taper in eight weeks.
“I felt like I was being chased and had impending thoughts of doom and gloom,” he said, describing the experience as feeling like he was in a horror movie “24-7.”
So he went back on the medication once again.
Later, he found Horowitz’s start-up, Outro Health, and paid out of pocket to try again — this time tapering more slowly. Over six months, he has reduced his dose by 10 percent every four weeks — with minimal symptoms.
He compares the process to detox, though clinicians caution the analogy is imperfect. Alcohol withdrawal typically unfolds over three to seven days and can escalate into a potentially fatal condition if untreated. Antidepressant withdrawal is generally not considered life-threatening, but it can last much longer and, for some, be deeply disruptive.
“I don’t think people understand you don’t have a life if you do it the wrong way,” he said.
Pearse took a different approach by tapering on her own.
Despite being active in school — serving on the student council and being a cheerleader — she struggled with depression and anorexia.
Her first attempt to stop came during her third pregnancy, after FDA warnings about using Paxil during pregnancy. She stopped abruptly and felt so unwell — “like my head was underwater” — that she resumed the medication after giving birth.
Two years later, with more research emerging and side effects such as loss of libido becoming clearer, she decided to try again. She reduced her dose slightly, waited weeks — sometimes longer — for symptoms to settle, then reduced again.
The process took 18 months.
“I was always convinced that for me to stay even I needed to be on the medication,” she said. “So I never considered coming off until I realized I had been on them for over 20 years.”
Rachel Roubein contributed to this report.
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