A leading pharmacist has revealed three anti-depressant medications which leave patients struggling with ‘terrible’ withdrawal symptoms when they try to come off them, or miss a dose.
It is estimated seven million Britons take anti-depressants, with an estimated 89 million of the mood balancing tablets prescribed by NHS GPs in 2023/24.
It’s estimated that 85 per cent of the prescriptions were for three tablets which fall under the selective serotonin reuptake inhibitors (SSRIs) category, citalopram, sertraline, and fluoxetine, which is known as Prozac in the US.
SSRIs work by increasing the levels of the ‘happy’ hormone, serotonin, in the brain, which can combat feelings of gloominess and angst.
Anti-depressants are used to treat depression and other mental health conditions including anxiety, obsessive compulsive disorder (OCD) and post traumatic stress disorder (PTSD).
In a recent Instagram video posted to his 1.2 million followers Phil Cowely a US-based pharmacist known as @philsmypharmacist on the platform, explained why three anti-depressants in particular are renowned for terrible withdrawal symptoms.
These symptoms include stomach sickness and ‘brain zaps’, which is when users describe feeling random sparks of electricity or twitches inside their heads.
The first, he said is paroxetine—branded as Seroxat in the UK and Paxil in the US— is the strongest SSRI on the market.
Posting as @philsmypharmacist, he shared the three worst anti-depressants to come off of
He explained: ‘Paroxetine has a short half-life and it’s an SSRI so when you come off of it, it makes you sick to your stomach, you can get like brain zaps because as a short half-life you come off of it so fast everybody freaks out.’
The half-life of medications is the amount of time it takes for the drug’s active substance to lower by a half, and this can differ from person to person depending on factors like body weight.
‘Usually, you have to switch over to like fluoxetine or something like that to get off of it’, he added.
Other withdrawal symptoms of paroxetine include bad dreams, dizziness and paraesthesia—a feeling of tingling, numbness or ‘pins and needles’—according to the US Food and Drug Administration (FDA).
The second worst medication for withdrawal, he said is duloxetine—sold under the brand names of Cymbalta and Yentreve— which is a type of antidepressant known as a serotonin-noradrenaline reuptake inhibitor (SNRI).
This class of anti-depressant works by blocking the reabsorption of serotonin and norepinephrine—a neurotransmitter connected to our ‘fight or flight’ response’.
The drug works in a way which keeps them stable, levelling out mood.
Duloxetine works, he explained, by targeting the three hormones which the body needs not be depressed—serotonin, norepinephrine and dopamine, the hormone released by the body when we experience pleasure.
Millions of Britons are now prescribed anti-depressants by their GP
But when you stop taking it, the effects are felt rapidly as levels of all three neurotransmitters plunge.
He said: ‘You get this mixture of just terrible side effects which you come off of it. Not only are you going to get the SSRI stomach upset but you get the norepinephrine which really freaks out your brain.’
This is also accompanied with the effects of not getting the dopamine boost, which means, ‘not only do you have all these side effects, but now you don’t want to do anything’.
Other withdrawal side effects of duloxetine include dizziness, feeling sick, trouble sleeping, feeling agitated or anxious, headaches, shaking and numbness or tingling in the hands or feet.
The third medication is another SNRI called venlafaxine—branded as Vensir, Vencarm, Venlalix, Efexor, and Venlablue—which he warned is one he would never start taking because he wouldn’t be able to get off it.
‘It’s a norepinephrine uptake inhibitor along with serotonin, but it has the worst side effects coming off of it. The hardest thing is the half-life is so so so so short that when you come off of it you cannot taper properly.’
He warned the drug—which the NHS says can cause flu-like withdrawal symptoms like headaches, nausea, muscle pain, fatigue and restlessness—’probably takes three or six months to come off’.
After posting the video, social media users left comments in which they shared withdrawal symptoms they experienced after coming off of the medications.
In the comment section, one user wrote: ‘I’m a venlafaxine user, and luckily it’s done wonders for me. But I literally cannot miss one dose or my life comes crashing down.’
A second user wrote: ‘Venlafaxine!! Omg the worst side effects when trying to come off. I feel like I’ll be on these forever.’
Meanwhile a third user wrote: ‘Tried to come off of venlafaxine but it ruined my life so I went back on it and I haven’t tried to go off of it since.’
Another user said: ‘The zaps. Finally putting a name to the sensation was even such a relief, I thought I was losing it.
‘Doctors thought I was making it up. But man the withdrawal symptoms from venlafaxine were horrific.’
