Page 21 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

• fluoxetine's prolonged duration of action means that it can sometimes be safely

stopped in the following way:

－ in people taking 20 mg fluoxetine a day, a period of alternate day dosing can

provide a suitable dose reduction

－ in people taking higher doses (40 mg to 60 mg fluoxetine a day), use a gradual

withdrawal schedule.

－ allow 1 to 2 weeks to evaluate the effects of dose reduction before considering

further dose reductions. [2022] [2022]

1.4.20 If a person has withdrawal symptoms when they stop taking antidepressant

medication or reduce their dose, reassure them that they are not having a
relapse of their depression. Explain that:

• these symptoms are common

• relapse does not usually happen as soon as you stop taking an antidepressant
medication or lower the dose

• even if they start taking an antidepressant medication again or increase their dose, the
withdrawal symptoms may take a few days to disappear. [2022] [2022]

1.4.21 If a person has mild withdrawal symptoms when they stop taking antidepressant
medication:

• monitor their symptoms

• reassure them that such symptoms are common and usually time-limited

• advise them to contact the person who prescribed their medication (for example, their
primary healthcare or mental health professional) if the symptoms do not improve, or

if they get worse. [2022] [2022]

1.4.22 If a person has more severe withdrawal symptoms, consider restarting the

original antidepressant medication at the previous dose, and then attempt dose
reduction at a slower rate with smaller decrements after symptoms have
resolved. [2022] [2022]

1.4.23 For further advice on stopping antidepressants, see also the NICE guideline on
safe prescribing.

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