What to know about fluoxetine withdrawal

Share on Pinterest

Fluoxetine is a medication that belongs to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

SSRIs work by increasing the amount of serotonin available to the brain. Serotonin is a neurotransmitter that promotes positive feelings and stabilizes mood.

The Food and Drug Administration (FDA) has approved the use of fluoxetine in adults for the treatment of:

• major depressive disorder (MDD)
• obsessive-compulsive disorder
• bipolar depression
• panic disorder
• premenstrual dysphoric disorder
• bulimia nervosa
• treatment-resistant depression, when people take it alongside other medications

The FDA has also approved it for the treatment of MDD in children aged 8 years and older.

It can take several weeks after beginning fluoxetine for the symptoms of these conditions to improve.

Fluoxetine is a prescription drug that comes in the form of a capsule, tablet, or solution. In the United States, it is available as a generic drug or under the brand name Prozac.

Fluoxetine withdrawal symptoms may occur when a person stops taking the medication. These symptoms may develop because of the rapid changes in the brain’s serotonin levels following antidepressant cessation.

A 2019 review of existing research reports that 56% of people experience withdrawal effects when stopping various antidepressants. About 46% of these individuals report “severe” symptoms.

One of the studies in the review found that out of 95 people who abruptly stopped taking fluoxetine, 67% experienced withdrawal symptoms. Doctors do not recommend stopping antidepressant use abruptly because it may lead to more severe symptoms.

Other research suggests that fluoxetine may be “particularly unproblematic” when people stop taking it because of its especially long half-life of 96–144 hours, which equates to 4–6 days.

A drug’s half-life refers to the time it takes for the amount of the medication’s active substance to reduce by half in the body. Antidepressants with a long half-life tend to cause fewer withdrawal symptoms than those with a shorter half-life.

Fluoxetine and other SSRIs may cause the following withdrawal symptoms when a person stops using them:

• a feeling of detachment
• a loss of balance or coordination
• a sensation that resembles an electric shock in the head, which people may describe as “brain zaps”
• anxiety
• depression
• diarrhea
• difficulty concentrating
• dizziness or vertigo
• fatigue
• flu-like symptoms, such as chills or body aches
• involuntary movements
• mood changes
• nausea and vomiting
• ringing in the ears, or tinnitus
• sensory disturbances, such as smelling odors that are not actually there
• sleep issues, including vivid dreams and nightmares
• stomach cramps
• suicidal thoughts

Withdrawal vs. a return of depressive symptoms

Some of the mood-related symptoms that experts associate with fluoxetine withdrawal may resemble the symptoms of depression or another mental health condition.

Experiencing these symptoms does not necessarily mean that someone is having a recurrence of depression.

To help distinguish between withdrawal symptoms and a return of depressive symptoms, it is important to consider when the symptoms first occurred and how they developed.

Discontinuation symptoms appear within a few days or weeks of stopping antidepressants, whereas returning depressive symptoms develop after some weeks and tend to come on gradually.

Discontinuation symptoms will improve as the body adjusts, but returning depressive symptoms will persist or worsen as time passes.

The severity and duration of fluoxetine withdrawal can vary.

Doctors and professional organizations often say that antidepressant withdrawal symptoms are self-limiting and typically resolve within a couple of weeks.

However, a 2019 review of existing research indicates that this may not always be the case.

Sometimes, symptoms can persist for several weeks or months. In a small number of cases, people may experience withdrawal symptoms for more than a year.

One of the studies in the review found that 40% of people who abruptly stopped taking fluoxetine still experienced symptoms 6 weeks after discontinuation.

The researchers did not follow up with the participants after this time, so it is impossible to say how long these effects lasted.

Most people, however, will likely feel better within a few weeks.

Several treatments and self-care practices may help those who wish to stop taking fluoxetine to do so safely and in a way that minimizes discomfort.

These options include:

• Discussing discontinuation with a doctor: It is important to discuss stopping antidepressants with a doctor before making any changes. Suddenly stopping a medication increases the risk of severe symptoms.
• Tapering slowly: Usually, doctors advise that people reduce their dosage slowly, typically over 4 weeks or longer — particularly if they are taking higher dosages or have been taking the medication for an extended period.
• Managing withdrawal symptoms with other medications: A doctor may sometimes prescribe treatments for nausea, flu-like symptoms, sleep problems, or other withdrawal effects.
• Visiting a doctor for regular follow-ups: Undergoing regular checkups during the withdrawal process can help the person manage their symptoms and allow the doctor to monitor for a recurrence of depression.
• Attending psychotherapy: Trying psychotherapies such as cognitive behavioral therapy or mindfulness-based cognitive therapy may help a person discontinue antidepressants without experiencing a return of symptoms.
• Making healthy lifestyle choices: Getting regular exercise, eating a nutritious diet, practicing stress relief techniques, and getting adequate rest and sleep can help a person manage the symptoms of depression and some of the effects of discontinuing antidepressants.

A person who is pregnant or thinks that they might be should speak with a doctor to determine whether fluoxetine is right for them. Research on animals has shown that the drug can have adverse effects on the fetus. There have not been enough studies on humans to be certain how the drug might affect a developing baby.

People should take the drug during pregnancy only when the potential benefit justifies the possible risk to the fetus.

For some people, fluoxetine and other SSRIs are important treatments that they must continue during their pregnancy to prevent the return of depressive symptoms. The National Alliance on Mental Illness advises that people who become pregnant while taking this drug should inform a doctor.

Withdrawal symptoms in pregnant people are likely to be the same as those in the general population, and the management techniques are also likely to be similar.

A person should contact a doctor if they:

• are experiencing unwanted side effects from antidepressant use and wish to discuss other options
• wish to stop taking fluoxetine in a safe manner and under medical supervision
• experience withdrawal symptoms after stopping fluoxetine

People should call a doctor if the side effects are severe but call 911 if they feel life threatening.

Long-term use of fluoxetine is safe if a person takes it as the prescribing doctor directs.

However, it may also cause side effects with long-term use. These side effects may include sexual dysfunction, nausea, a loss of appetite, and sleep issues. These issues may cause some people to want to stop treatment with fluoxetine.

Other people may wish to stop using it because they feel better or become pregnant.

Stopping antidepressants following long-term use may increase the risk of having withdrawal symptoms.

Some research indicates that all antidepressants can cause withdrawal symptoms if a person takes them for longer than 6 weeks — particularly if they stop or rapidly reduce their dosage.

Those who have been taking fluoxetine in the long term should work with a doctor to find treatments and strategies to minimize the potential withdrawal effects. It is also important to monitor for a return of depressive symptoms.

Some FAQs about fluoxetine withdrawal may include:

How long do fluoxetine withdrawal symptoms last?

The severity and duration of fluoxetine withdrawal can vary. In many cases, withdrawal symptoms should resolve within 2 weeks. However, in some cases, symptoms may last for several weeks or months, or even longer than a year.

What helps with SSRI withdrawals?

Tips to help with withdrawal symptoms can include slowly tapering off the drug under medical supervision, maintaining emotional health, such as lowering stress levels and trying relaxation techniques, and looking after physical help, such as getting sufficient sleep, following a healthful dietary pattern, and exercising regularly.

How long does antidepressant withdrawal last?

The duration of withdrawal symptoms from other antidepressants can also vary greatly. However, in general, people will experience symptoms within a couple days of drug cessation, which may last for up to 2 weeks. In some cases though, symptoms can persist for more than a year.

What is the hardest antidepressant to come off of?

The withdrawal effects of different antidepressants can vary among people. However, withdrawal symptoms are more common in antidepressants with a shorter half life. This means drugs that stay in the body for a shorter period of time. This includes antidepressants such as paroxetine, sertraline, escitalopram, and citalopram.

Stopping fluoxetine can cause several withdrawal symptoms, including flu-like symptoms, digestive issues, sleep problems, and mood changes.

However, several strategies and treatments can reduce or prevent such discontinuation symptoms.

People should work with a doctor to come up with a plan that best meets their needs.