Mental Health Plartform.

Nutrition and supplements for antidepressant withdrawals

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Can I make my antidepressant withdrawal symptoms better with nutrition and supplements?

Planning your titration from antidepressants is important. There are core nutritional supports that include b-complex, amino acids, DHA and EPA, and other micronutrients that should be initiated 1 to 3 months prior to attempting titration. Experienced clinicians recommend titration occur slowly, between 4 months and 1 year, even with the additional nutritional and supplemental supports. In addition to increased nutritional support, many anecdotal reports exist of people finding withdrawals from antidepressants to be less severe while on a ketogenic diet.

Introduction

You do not need to be on a ketogenic diet to help with antidepressant withdrawals, but it sure helps. I am well aware that even people using a ketogenic diet will still get withdrawal symptoms from their medications. And that I have readers who are not on the ketogenic diet to treat their mental health but are struggling with withdrawal symptoms from antidepressants.

There is always the danger when titrating off antidepressants, that medication withdrawal looks and feels like psychiatric dysfunction. People will think the withdrawal effects they are experiencing are who they are and how they are capable of functioning. They will immediately go back on medication. 

“I feel awful, and my mood is so unstable! This must be what I am like when I am not taking my medication!”

Maybe. But more likely, it is that you are going through withdrawals. And you won’t know what your baseline mood and thinking are until you make it through the withdrawal from antidepressants. 

Don’t confuse your antidepressant withdrawal symptoms with who you are or how you function. It can take a long time to get off of antidepressants, with the last few milligrams the hardest to conquer.

Antidepressant Side Effects

As always, I am not your doctor. This blog is not medical advice. I am not advising you about whether or not to take or stay on your medications. That is between you and your prescriber.

That said, there are a lot of people trying to get off their antidepressants. And they started wanting to do so long before they ever encountered me or my blog.

Antidepressant side effects are numerous, unpleasant, and even a little scary. They include anxiety, weight gain, sedation, feeling emotionally flat, and reduced libido.

Side effects from antidepressants that are less talked about but well-documented in the research literature include psychosis, paranoia, violent thoughts and actions, suicidal ideation (thoughts), suicide, and behavioral disinhibition. 

Some antidepressants are harder to titrate down from and discontinue than others. Some are even described as “hellish” to get off of. If you are greatly suffering from antidepressant withdrawal, you are not alone. 

https://www.psychologytoday.com/us/blog/the-bipolar-lens/201312/lets-call-it-what-it-really-is-withdrawal

There are countless stories on Twitter, Reddit, FB, and various forums online of people suffering from antidepressant withdrawals. Many conclude it just cannot be done, even though they believe the medication is no longer providing them any benefit. 

Which means they continue to pay for a prescription for the rest of their life that they don’t feel they still need. They have to worry about times in their life when they may be without health insurance to help pay for the medication or go through terrible withdrawals. They may stay on medication with side effects that may affect the quality of their life for the duration of their lifetime. 

I find this to be ethically unacceptable for patients. 

Let’s begin by empowering you to know the difference between withdrawal reactions and discontinuation syndrome. 

(Spoiler Alert: There isn’t any)

Withdrawal Reactions vs. Discontinuation Syndrome

If you try to stop your antidepressants quickly, you will get a strong withdrawal reaction. It reminds people of benzodiazepine withdrawals. And people are not imagining that it is as difficult as going through benzodiazepine withdrawals; it’s actually been studied. 

Withdrawal reactions to selective serotonin reuptake inhibitors appear to be similar to those for benzodiazepines; referring to these reactions as part of a dependence syndrome in the case of benzodiazepines, but not selective serotonin reuptake inhibitors, does not seem rational.

Massabki, I., & Abi-Jaoude, E. (2021). Selective serotonin reuptake inhibitor ‘discontinuation syndrome’ or withdrawal. The British Journal of Psychiatry218(3), 168-171. https://doi.org/10.1111/j.1360-0443.2011.03686.x

Drug companies call that reaction a “Discontinuation Syndrome.” But there is really no difference.

Clinicians need to add SSRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs. The term’ discontinuation syndrome’ that is currently used minimizes the potential vulnerabilities induced by SSRI and should be replaced by ‘withdrawal syndrome.’

Fava, G. A., Gatti, A., Belaise, C., Guidi, J., & Offidani, E. (2015). Withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation: a systematic review. Psychotherapy and psychosomatics84(2), 72-81. https://doi.org/10.1159/000370338 

Antidepressant withdrawals are the same as discontinuation syndrome—drug companies just like the title better for obvious reasons. 

But don’t get the idea that it is only SSRIs that cause withdrawals. TCAs and MAOIs can also cause really unpleasant side effects for people.  

Antidepressant Withdrawal Symptoms

Below are a list of antidepressant withdrawal symptoms found to be reported by people attempting to go down or discontinue use.

Generalflu-like symptoms, fatigues, weakness, tiredness, headache, tachycardia, dyspnea
Balancegait instability, ataxia, dizziness, light-headedness, vertigo
Sensoryparesthesias, electric shock sensations, myalgias, neuralgias, tennitis, altered taste, pruritus
Visualvisual changes, blurred vision
Neuromotortremor, myoclonus, ataxia, muscle rigidity, jerkiness, muscle aches, facial numbness
Vasomotorsweating, flushing, chills
Sleepinsomnia, vivid dreams, nightmares, hypersomnia, lethargy
Gastrointestinalnausea, vomiting, diarrhea, anorexia, abdominal pain
Affectiveanxiety, agitation, tension, panic, depression, intensification of suicidal ideation, irritability, impulsiveness, aggression, anger, bouts of crying, mood swings, derealization and depersonalization
Psychoticvisual and auditory hallucinations
Cognitiveconfusion, decrease concentration, amnesia
Sexualgenital hypersensitivity, premature ejaculation
Antidepressant withdrawal symptoms. Recreated from James Greenblatt, MD presentation found here: https://www.greatplainslaboratory.com/webinars/2016/5/10/nutritional-support-for-antidepressant-withdrawal

These symptoms can occur after just a few days or can last for weeks. And you can experience these symptoms in any combination. They can last for several months to years following the discontinuation of antidepressant medications. 

How do I use nutritional supports to manage antidepressant withdrawals?

The most important part of this article that I need you to know, is that you need to spend a good amount of time doing the nutritional supports first, BEFORE you begin to titrate down very SLOW. 

You should provide yourself these nutritional supports for a minimum of 1-3 months before you attempt titration. Once your nutritional supports are in place, experienced clinicians recommend titrating over 4 months to even over a year. 

What supplements do I need to minimize withdrawal symptoms from antidepressants?

The following core supplements are useful when trying to diminish withdrawal symptoms experienced when reducing or eliminating antidepressants. These supplements are best taken weeks or months prior to discontinuation attempts. If you are already experiencing difficult withdrawal symptoms, I will encourage you to talk to your prescriber about going back up to the next lowest dose that reduces withdrawal symptoms, and then begin these supplements for a few months and then try again. 

The below links are affiliate links (unless otherwise noted). Please do not feel obligated to use these links.

NAC (N-acetylecysteine) 

What is it and why should you take it? Its an amino acid variant that happens to be a powerful antioxidant and helps your liver detox pathways. It is used to assist with withdrawal from other substances and is well-established in the research literature for this purpose. 

How? Take (1) 600mg capsule with breakfast and dinner

Where can you find it? This supplement can be hard to find but can be ordered online through https://www.pureformulas.com (not an affiliate link) with free standard shipping. Brands that I like for clients include Pure Encapsulations, Thorne, and Integrative Therapeutics.

EPA/DHA

What is it and why you should consider taking it? You are going to need to build neuronal infrastructure as part of healing your brain and recovering from the withdrawals you are experiencing. EPA/DHA are healthy fats that your body uses to insulate nerves. You are going to burn through EPA/DHA rebuilding your brain. It also reduces inflammation improving the environment in which your brain is healing and making neurotransmitters. 

How do you take it? For either of the below brands, take 1 capsule at breakfast and dinner. This will put you at approximately 2g of fish oil a day. You may need more. Do not take if you are on blood thinners without talking to your doctor.

Where can you buy it?

Life Extension- Mega EPA/DHA

B-Complex

What is it and why should you take it? Stress depletes the body of B vitamins. Withdrawals are stressful. You are probably B deficient which is part of why you may have ended up on antidepressants in the first place. B vitamins should have been your first line of treatment. Psychiatric medication use also depletes B vitamins as does hormonal birth control. You might need special B vitamins if you have trouble absorbing them due to genetics. This blend is already modified to be the easiest to assimilate.

How? 1 capsule with breakfast and dinner; do NOT take on an empty stomach as it will cause nausea

Where can you get it? Below are affiliate links that you can use to purchase. I have included my favorite brands for clients that I know use good, bioavailable forms in high enough doses.

Inositol

What is it and why do you want it? Myo-Inositol is a carbolytic sugar that used to be called Vitamin B8. It serves an important role in cell membrane formation and supporting neurotransmitter function. It also just happens to be great for anxiety and it is going to help quiet the symptoms of anxiety that you may get as you got through antidepressant withdrawals.

How do you take it? 1/2 tsp with breakfast and dinner. It tastes slightly sweet. Put it in your coffee in the morning if you want or in some tea. Or just pop it in your mouth with some water. It’s not particularly yucky. You can work up to a much higher dose if you feel it is helpful. Many of my clients will take up to 3g (3,000 mg) total a day for specific reasons. Taking too much too soon can cause stomach upset. It also comes in capsules for better convenience.

Where can you get it? Lots of places, but also at the affiliate links below:

Pure Encapsulations – Inositol Powder

Magnesium glycinate

What is it and why do you need it? Magnesium is a mineral that is either required or helpful in about 800 different processes your body needs to carry out. And you are depleted in it. Even if you know enough to supplement it in your diet, you are still likely insufficient because your psychiatric medications depleted your levels even further. Stress also depletes your magnesium. And going through withdrawals is very stressful. It also helps you useother vitamins like Vitamin D and Bs better. Trust me, it’s just a win win sort of supplement.

How is it taken? 1 capsule at breakfast and 2 at dinner

Where can you find it? You can find it online here. I prefer the glycinate form because it’s better utilized by the body. Stay away from Magnesium Oxide and watch out for Magnesium Citrate because it can cause cramping and loose stools.

Pure Encapsulations Magnesium Glycinate (Swanson Vitamins)

Lithium (orotate)

What is it and why should you consider taking it? First of all, don’t freak out. This is not prescription lithium. This is lithium orotate and it is in very small amounts. If you already take prescription Lithium, it would be ok to skip this and check with your doctor. Why? Because you already have really high levels from your prescription and your doctor is working hard to monitor your levels. So don’t mess with them. But if you are not already taking prescription lithium, you will likely benefit greatly from this mineral. It is particularly good for depression and suicidal ideation. And can be very helpful with substance abuse cravings. It also has a lot of neuroprotective qualities that are very helpful to a brain struggling to rewire itself and maintain cognitive function.

How do you take it? 1mg with dinner or before bed, work up to 5mg dose, going up 1mg per week. Some people take small doses during the day. But it enhances sleep so I like to recommend it before bed.

Once you have worked up to a 5mg dose, you may find this formulation more convenient. It’s also less expensive but still high quality.

Swanson Ultra Lithium Orotate, 5mg

Amino Acids

What are they and why do you absolutely need them? A lot of people with mental health issues have serious gut issues. If you are taking anything for acid reflux or gerd, you probably do not have adequate stomach acid to break your protein down into amino acids. This is a huge problem. We have to fix the root digestive problem and get you off those medications. But in the meantime, you need amino acids in order to make important neurotransmitters. This is one of those supplements you probably should have been given before the doctor told you to go on an antidepressant. Amino acids are building blocks for a nervous system under reapir. Which is you if you are working to discontinue your antidepressant medication.

How do you take them? 1 scoop at breakfast and 1 at dinner if using Amino Replete (with food, note this formula has B6 in it and will make you nausous if you take on an empty stomach). If using Hardy’s Naturals use 4 capsules, 2x per day, without food if you want to improve absorption. But don’t over think it. Just get it into your body. Do not use Branch Chain Amino Acid (BCAAs) formulas because they are not complete and can throw your neurotransmitter balance off.

Where can you find them?

Hardy’s Naturals Balanced Free-Form Amino Acid (Not an affiliate link, but you can get 15% off using the discount code: MentalHealthKeto).

What is a minium supplement plan to help reduce withdrawals from antidepressants?

If all of the above supplements just feel like too much for you to handle right now, I have also successfully helped people with withdrawal symptoms using just two supplements. The amino acids and a broad spectrum micronutrient from Hardy Nutritionals. You can find a link to the amino acid supplement above (under Amino Acids) and a link to the broad spectrum micronutrient here. Again, not an affiliate link, but you can get 15% off using the discount code: MentalHealthKeto

Conclusion

If you have tried unsuccessfully in the past to titrate down from or discontinue your antidepressants, do not lose hope. You may have been missing the important piece of nutrient support to help your process.

If you have sufficient nutritional support, as you go through your antidepressant withdrawals, you will have an easier time reducing and/or eliminating your antidepressant medication (hopefully). 

Your brain will also get the support needed to heal, and you will have a better chance of figuring out how well your brain actually truly works or is capable of working.

Will all these nutritional supports fix your brain so you don’t have to be on antidepressants? Maybe. There are a lot of other factors that probably need to be fixed. 

  • Your diet
  • Your digestive health 
  • Eliminating factors causing neuroinflammation

All of these play a role. You really do deserve a full functional and nutritional psychiatry sort of workup, with all the support that that includes. But you can definitely start here! You can definitely start by giving your brain what it needs to help it adjust to antidepressant withdrawals.

I help people explore medication-free options for their mental health using research and evidence-based nutritional and functional psychiatry so that people can get their lives back without side effects or dependence on big pharma. You can learn more about me or contact me for a consultation.

If you want to be alerted to different learning and coaching opportunities around ketogenic diets, mental health, supplements, and psychotherapy, you can sign up for these announcements here.

Because you have the right to know all of the ways that you can feel better.


References

Fava, G. A., Gatti, A., Belaise, C., Guidi, J., & Offidani, E. (2015). Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review. Psychotherapy and Psychosomatics, 84(2), 72–81. https://doi.org/10.1159/000370338

Harvey, B. H., Brink, C. B., Seedat, S., & Stein, D. J. (2002). Defining the neuromolecular action of myo-inositol: Application to obsessive–compulsive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 26(1), 21–32. https://doi.org/10.1016/S0278-5846(01)00244-5

Let’s Call It What It Really Is: Withdrawal | Psychology Today. (n.d.). Retrieved February 20, 2022, from https://www.psychologytoday.com/us/blog/the-bipolar-lens/201312/lets-call-it-what-it-really-is-withdrawal

New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal—Abstract—Psychotherapy and Psychosomatics 2015, Vol. 84, No. 2—Karger Publishers. (n.d.). Retrieved February 20, 2022, from https://www.karger.com/Article/Abstract/371865

Nielsen, M., Hansen, E. H., & Gøtzsche, P. C. (2012). What is the difference between dependence and withdrawal reactions? A comparison of benzodiazepines and selective serotonin re-uptake inhibitors. Addiction, 107(5), 900–908. https://doi.org/10.1111/j.1360-0443.2011.03686.x

Nutritional Support for Antidepressant Withdrawal. (n.d.). Great Plains Laboratory. Retrieved February 20, 2022, from https://www.greatplainslaboratory.com/webinars/2016/5/10/nutritional-support-for-antidepressant-withdrawal

Supplements for Happiness & Health: Lithium Webinar | PR. (n.d.). Psychiatry Redefined. Retrieved February 20, 2022, from https://www.psychiatryredefined.org/lithium-supplement-for-happiness-and-health-webinar/

Tomko, R. L., Jones, J. L., Gilmore, A. K., Brady, K. T., Back, S. E., & Gray, K. M. (2018). N-acetylcysteine: A potential treatment for substance use disorders. Current Psychiatry, 17(6), 30.

von Schacky, C. (2021). Importance of EPA and DHA Blood Levels in Brain Structure and Function. Nutrients, 13(4), 1074. https://doi.org/10.3390/nu13041074

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