Coming Off Antidepressants: How to Know Whether You’re Ready to Taper Off

If you’re one of the millions of Americans taking antidepressants, then you know how helpful—even lifesaving—these medications can be. But you might’ve also wondered at some point, Do I still need to take these if I’m feeling good? Or maybe you’re just curious about what the game plan is for coming off your antidepressants, but you don’t know how to raise it with your doctor.

Either way, it’s a valid question that’s worth discussing—and probably doesn’t come up enough. “There are times where physicians won’t bring it up, and there are other times that maybe patients are nervous to,” Dustin Z. DeYoung, MD a psychiatrist at UCLA Health, tells SELF. “But I think that it definitely is an important conversation to have.” The question of whether you’re ready to come off your antidepressants is incredibly nuanced and individual; it can only be answered through open conversations with your prescribing doctor. “It really is a shared decision between you and your physician,” Dr. DeYoung says. On that note, having a doc you trust and feel comfortable talking to is key here, whether that’s your primary care physician or a psychiatrist.

That said, we asked psychiatrists for some general guidance that can help you think through this topic. Here’s how they weigh the decision, some of the signs they look for when determining whether somebody might be ready to come off their medication, and when (and how) to start the conversation.

Signs that you might be ready to come off of your antidepressants

Most psychiatrists will approach the question of whether someone should come off or stay on their antidepressants by weighing the risks and benefits, Steven Siegel, MD, PhD, chief mental health and wellness officer with Keck Medicine of USC and chair of the department of psychiatry and the behavioral sciences with the Keck School of Medicine of USC, tells SELF. The main calculation they’re trying to make is the likelihood that you’ll continue to do well in the absence of medication, Dr. Siegel says.

Unfortunately, there’s no magic formula or simple checklist they can use to predict that. “We don’t have the definitive science to decide who should stay on and who shouldn’t,” Dr. DeYoung says. “It’s very variable based on the individual.” It’s also personal: Some people are just more willing to take a chance and see how they do sans medication, Dr. Siegel says, while others might prefer the security of continuing treatment. Plus different doctors take different approaches, so there aren’t hard-and-fast rules.

That said, most doctors generally look for certain indicators that someone has a higher likelihood of doing well after tapering off their meds. (FYI: Tapering, or slowly reducing the dose over time until you’re down to nothing, is essential to avoid withdrawal symptoms.) Here are some solid signs your doctor may factor into their recommendation.

1. You’ve been depression-free for at least six months to 18 months, depending on your depression history.

How many months of recovery from depression you should have under your belt before even considering weaning off isn’t clear-cut. The studies are a little all over the place, Dr. DeYoung says, and docs have different takes. But the gist is that your risk of relapse or recurrence—symptoms returning or worsening when you stop medication—goes down the longer you’ve been stable.

You’re technically considered to be in full remission when you haven’t met the diagnostic criteria for major depression laid out in the DSM (the diagnoses reference book for psychiatric disorders) for at least two months. But in practice, Dr. DeYoung says, everyone’s symptoms are unique to them—and therefore, so is what their recovery looks like. To gauge whether you’ve been in remission or not, think about if the specific symptoms that drove you to seek treatment have resolved, Dr. DeYoung says. Say you came to your doctor with sleep problems, a loss of interest in your usual hobbies, and feelings of hopelessness. If you’re now sleeping well, hanging out with friends and enjoying activities, and not feeling hopeless, that indicates your depression is in remission. On the other hand, if your symptoms have only kinda gone away, or a couple are still hanging around, you’re not completely in remission.

Several guidelines say that for somebody’s first episode of depression, four to nine months of remission is long enough to consider weaning off medication. But in practice, many doctors look for at least six if not 12 months of full recovery before stopping “maintenance” antidepressants, Dr. DeYoung says. Other doctors prefer to see an even longer stable period. Dr. Siegel points to research showing people who taper off after six or nine months of maintenance are “very likely to relapse.” That data suggests most people should stay on antidepressants after their depression goes into remission for at least 12 months and ideally 18 months.

2. You don’t have a history of multiple, severe depressive episodes.

Having multiple recurrences of depression—meaning, distinct periods when you’ve experienced daily depression for at least two weeks—suggests your biology or personality is more prone to it, Dr. Siegel says. For every past depressive episode, the likelihood of having another one goes up. So in general, the more severe or debilitating past bouts of depression have been, the riskier it is to go off medication, Dr. Siegel explains. If you have a longer and/or more severe history of depression, the goal is typically to wait for a longer period of remission before considering tapering.

For someone on their second episode of depression, many doctors will probably want to wait at least two years or so, Dr. DeYoung says; for Dr. Siegel, it’s around three years. For someone who’s had three episodes, some guidelines recommend staying on maintenance antidepressants for at least two years, Dr. DeYoung says—if not for the foreseeable future, according to Dr. Siegel. (You might also need additional treatments, like cognitive behavioral therapy or brain stimulation therapy, he adds.) This certainly isn’t to say that having a more extensive history of depression means you can’t or shouldn’t try to taper off your meds at some point, Dr. DeYoung notes. But it is an important factor for you and your doctor to consider.

3. You’re in therapy (and plan to continue).

Therapy can help you process trauma, shift patterns, learn coping skills, and even improve your odds of getting off medication successfully. It isn’t a replacement for medication (just like medication isn’t a replacement for therapy). But “it can potentially help you get off antidepressants a little bit easier,” Dr. DeYoung says. Research has found that people who engage in evidence-based therapy (like CBT) throughout treatment, remission, and tapering are less likely to relapse into depression than people who don’t, Dr. Siegel says.

Plus, your therapist can help you sort through your feelings about coming off meds or not—and give you their take on how much progress they think you’ve made. “Their opinion matters,” Dr. Siegel says. Which is why it’s so important to find a therapist who is fully credentialed and well-trained in using evidence-based techniques. (If you need help finding a great therapist, we’ve got some tips for you here.)

4. You have a strong support system.

Social bonds are crucial for mental health. So while we don’t have studies on this, it stands to reason that having healthy relationships generally puts you in a better position to transition off medication, Dr. DeYoung says.

When you’re still considering whether you’re ready to come off, sometimes getting the perspective of someone who knows you really well and who you deeply trust—like a partner, roomie-bestie, or family member—can be helpful, Dr. DeYoung says. How they think you’ve been doing isn’t going to be a deciding factor, he notes, since your experience of your mental health is most important. But it’s sometimes hard to see yourself 1srcsrc% clearly.

Then, if and when you do taper off, it’s nice to be able to lean on someone during any bumps in the process (like discontinuation symptoms), as well as have them look out for you. In the event you start to relapse, “you may or may not be the first person to notice a change,” Dr. Siegel explains. He usually asks patients, “Would you be willing to let someone in your life know that you’ll be discontinuing your medication and give them permission to let you know if they see something concerning?” This isn’t necessarily standard practice, he notes. But Dr. DeYoung agrees that “having support or another set of eyes can be helpful.”

5. Your self-care is pretty solid.

Good lifestyle habits and self-care (like regular exercise, a good sleep routine, a healthy diet, time with friends, and activities you enjoy) can create a strong foundation that puts you in a better spot for tapering. “It can help continue the benefits that you may have achieved with that antidepressant,” Dr. DeYoung explains.

We don’t have studies showing that people who engage in greater self-care lower their risk of relapse. (And certainly, people successfully discontinue their antidepressants without paying special attention to this stuff, Dr. DeYoung notes.) That said, we do know these things generally support mental health, Dr. Siegel says. Dr. DeYoung’s philosophy: “Let’s do everything we can to raise the chances of you being successful getting off the medication and staying off the medication.”

How to bring up a potential medication change with your doctor

You might be wondering if your doctor should be the one to bring up tapering first. The fact is, some physicians will regularly reevaluate whether a patient should continue their meds or not while others will take a more conservative approach, Dr. DeYoung says. So some psychiatrists and primary care doctors may—as long as you’re doing well and not having side effects—keep renewing your prescription without revisiting the conversation, Dr. DeYoung explains.

If the question is on your mind, don’t hesitate to start the discussion yourself, Dr. Siegel says. He suggests saying something like, “I’ve been on these medications and doing well for a while. I’m not sure I still need to be on them. What do you think? How will we know when it’s time for me to come off?”

Whether your doctor thinks you’re ready or not, the conversation will be clarifying. You’ll get the expert recommendations and information you need to help you make the right decision, Dr. DeYoung says. And you’ll leave your appointment with a solid plan (or at least a next step) to start tapering—or the confidence that you’re staying on your meds for really good reasons right now.