How to plan coming off your anxiety medication

"Can I come off these?" gets asked in my consulting room slightly apologetically, as though it were a big favour. It is not. Usually the answer is yes, eventually, though it depends on why you started and how things have gone. What decides how it goes is the plan underneath.

This is about antidepressants: the selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) used long term for anxiety. Two others differ. The National Institute for Health and Care Excellence (NICE) says benzodiazepines should not be offered for generalised anxiety disorder (GAD) except short term in a crisis. And pregabalin, which NICE does offer when SSRIs and SNRIs are not tolerated, is the one drug NICE says to reduce by a fixed amount each time rather than a proportion, so the staircase below is not yours.

The short version

• Do not stop suddenly, or without talking to your doctor.
• Timing matters as much as method. If the drug is working for GAD, NICE advises at least a year on it.
• Reductions should get smaller as the dose gets lower, not stay the same size all the way down.
• Withdrawal and returning anxiety feel similar, but how fast they arrive and respond tells them apart.

Start with when, not whether

NICE sets out the reasons worth discussing: the medicine is no longer helping, the problem it was prescribed for has resolved, the harms outweigh the benefits, or you want to stop. That last stands on its own. You do not have to build a case.

Timing is the part people skip. For GAD, NICE says that if the drug is effective you should keep taking it for at least a year, because relapse is likely. The NHS puts the general position at six months or more after symptoms improve. Those are floors, not ceilings. NICE also asks prescribers to weigh your circumstances: coming down through a house move or a bad quarter at work is harder.

Reducing the medicine is not the same as reducing the support. NICE says the underlying condition should still be managed during withdrawal if it needs managing. Talking therapy is one of them. It is also part of why we built brightloaf around 20 minute sessions rather than an hour you have to clear the diary for. More in anxiety medication vs therapy.

The taper is a staircase, and the steps get smaller

NICE is direct that these medicines should not be stopped abruptly except in exceptional medical circumstances, such as a serious side effect. Everything else is a taper, and the detail most people have not heard is that reductions should be proportionate to the dose you are on now, so the steps get smaller as it comes down. Not 10mg off every time. A percentage of where you are.

The Royal College of Psychiatrists, in guidance endorsed by the Royal College of GPs, works it through. Take 25% off 20mg and you are on 15mg. The next 25% is 3.75mg, not 5mg. That is proportional tapering. The College also sets out a slower version, hyperbolic tapering, because the effect on the brain does not fall away in a straight line. Some people need to reach 2% of their original dose.

In practice they suggest a 25% or 50% reduction, then two to four weeks' wait. If nothing distressing happens, repeat. If it does, go back to the last comfortable dose and use steps of 10%, or 5%. Anyone on the drug a long time, with a rough experience of coming off before, or on a higher-risk drug can start there.

Two things get missed. Do not do it by skipping days: in most cases that makes the level in your blood swing around and withdrawal likelier. Fluoxetine is the exception, because it stays in the body longer, but that is a conversation with your prescriber, not a change to make alone. And ask your pharmacist what your drug comes in: liquids and smaller tablet strengths are what make the small steps possible. That is the question I most wish people asked sooner.

The schedule is a starting point, not a contract. A step that turns out to be too big is information, not failure.

How rough is it, honestly

Estimates vary. The largest analysis so far, in The Lancet Psychiatry in 2024, pooled 79 studies and 21,002 people. Around 31% reported at least one symptom after stopping an antidepressant, but about 17% reported the same after stopping a placebo, so the authors put the share directly attributable to stopping at roughly 15%, one in six to seven. About 3% reported severe symptoms.

The Royal College of Psychiatrists gives a higher figure, between a third and a half, because it counts everyone who gets symptoms rather than isolating what stopping causes.

Practically, the NHS says symptoms usually begin within a few days and last a few weeks. Headaches, aching joints, nausea, dizziness, strange dreams, irritability and brief electric-shock sensations in the head, often called brain zaps, are the common ones. For a minority they are severe, start later and last months, likelier the longer you have taken the drug.

Telling withdrawal from anxiety coming back

This derails more tapers than anything else. NICE gives three markers pointing to withdrawal rather than relapse: symptoms arriving rapidly or early after a reduction, old symptoms that feel qualitatively different or more intense, and symptoms you have never had.

That last one does the most work. Brain zaps are the clearest example, because they are not something people recognise from their anxiety. Symptoms that overlap, dizziness included, will not separate the two. A fourth clue is speed: withdrawal settles within hours or days of going back a dose, whereas an antidepressant takes weeks to lift genuinely returning symptoms.

If it is not clear, ring your prescriber rather than pushing on to find out. And if it turns out to be the anxiety rather than withdrawal, that is information, not failure: NICE is clear that a reduction which has not worked can be paused and tried again later.

What to ask for at the appointment

Try to leave with four things: a written schedule with doses and dates; agreement on what happens if a step is hard; a review interval; and a name to contact in between. On the second, NICE says work out first whether the symptoms are withdrawal or the problem returning, and if they are new, the options are delaying the next reduction, making it smaller, or going back a dose. More on preparing for a GP appointment.

This is general information, not personal medical advice. Your drug, dose and history change the picture, so the plan has to be built with whoever prescribes for you.

One thing to take seriously. Feeling low, or having thoughts of suicide, is on the NHS list of withdrawal symptoms. If that happens while you are reducing, speak to your prescriber straight away rather than waiting for the review. If you are in danger or cannot keep yourself safe, call 999 or go to A&E. Samaritans is free on 116 123 at any hour, and there is NHS urgent mental health support too. brightloaf is not a crisis service.