Antidepressants and

Psychedelics
INTERACTION RISKS AND TAPERING GUIDE

Benjamin Malcolm, PharmD, MPH, BCPP

SPIRITPHARMACIST | SPIRITPHARMACIST.COM
 Antidepressants and Psychedelics:
Interaction Risks and Tapering Guide

Ben Malcolm, PharmD, MPH, BCPP

Spiritpharmacist.com

This guide is intended to be used for information and educational purposes only. It is not designed to
make medical decisions. Consult with a qualified provider when considering or planning to use
psychedelics or taper psychiatric medications.

Table of Contents
I. Antidepressant & Psychedelic Drug Interactions and Discontinuation Times……….3
II. At a Glance: Antidepressant & Psychedelic Drug Interaction Chart…………………….13
III. Safely and Successfully Stopping Antidepressants………………………………………………16
IV. Antidepressant Taper Planning and Monitoring Support Kit……………………………….22
1. Course of Therapy and Taper Readiness Quiz………………………………………….23
2. Pre-Taper Reflection and Support Planner………………………………………………31
3. Daily Antidepressant Withdrawal and Mood Tracker………………………………36
4. Monthly Taper Dashboard………………………………………………………………………68

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Dedications and Acknowledgements
This guide is dedicated to all the persons working hard to better themselves as well as helping
others to. Patients, therapists, doctors, healers, coaches, alternative practitioners, shamans, and
countless others alike, we are all here to walk each other home. We learn, grow, and heal
together.
An immense level of gratitude and appreciation is owed to all the researchers and scientists who
have dedicated their time, efforts, and careers to elucidating the information presented in this
guide, it would not have been possible to write any of it without their efforts.
To indigenous persons, the true wisdom keepers and stewards of ecologic diversity, community,
and preservation of sacred traditions, rituals, songs, and psychedelics sacraments in the world
today.
Lastly this guide is dedicated to my family, teachers, and mentors. My parents who provided a
stable and nurturing environment that met my needs and allowed me to flourish. To my wife
and daughter for their support and love as I continue to evolve and push the limits of myself to
further a path of psychedelic healing within myself and for others. And to all the brilliant
mentors and teachers who provided the opportunities, guidance, training, and confidence to be
who I want to be.

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 Section I. Drug Interaction & Discontinuation Times

The Cat’s Out of the Bag (Again)

You’ve seen the headlines in the New York Times, read a few books or articles on psychedelic healing, or
through the grapevine you’ve become savvy to the therapeutic potential of psychedelics to help with
mental illnesses [1-4]. You’ve considered trying them and perhaps even began searching for a
psychedelic retreat center or facilitator of psychedelic experiences.

But there’s a lingering issue, what to do with your antidepressant?

After browsing through a few Reddit threads and Facebook forums about how to manage the
antidepressant you’ve come across confusing and conflicting information. You’re earnestly looking for
information and get emotionally charged or even false responses like “Pharma poison and psychedelics
always harm” or “It’s a myth that ayahuasca can cause serious drug interaction” or “Try asking a doctor
instead of the internet!”. You may have serious and valid reservations about discussing psychedelics
with your prescriber as you know that if psychedelic drug use gets documented in your medical record,
you may be treated differently by medical teams or shamed by your prescriber due to the stigma around
psychedelic use. People that have combined psychedelics and antidepressants are saying that it didn’t
really work for them, while people that haven’t are saying that you’ll die of serotonin syndrome (aka
serotonin toxicity) if you do. Even when you think you’ve got it straight, some say to stop for a few days,
others say to stop for four to six months prior to using a psychedelic.

So who is right?

It’s true that most psychedelics and most antidepressants don’t mix well, although why they don’t mix
well and how dangerous it is depends on the antidepressant(s) in question and the psychedelic drug
planned for use.

A Note on Tapering, Discontinuation, and Antidepressant Free Periods

Before we get into the concerns and answering some of the questions surrounding antidepressant and
psychedelic use, it is recommended to perform a thorough and thoughtful reflection on whether it’s
truly a good time to try psychedelics and/or discontinue your antidepressant. Part IV of this guide
includes a taper planning and monitoring support kit that is a useful tool for this.

If you are undergoing or are anticipating major life changes or are weathering a particularly rough patch
at the moment, it may not be the right time. If you’re in a crisis, it’s almost certainly not the right time. If
you’ve experienced extreme symptoms or suicidality in the past, please don’t make a hasty decision as
changing doses of antidepressants and the associated discontinuation syndrome has been linked to
suicidality [5]. If you do ultimately decide that discontinuation and psychedelic use is part of your
treatment path, then plan time to taper slowly as faster tapers or abrupt discontinuation lead to more

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severe discontinuation syndromes. For detailed information on how to stop antidepressants safely and
successfully, see section III of this guide.

It’s recommended to have your prescriber on board and in agreement for a plan to taper. They can help
with prescribing any step-down doses you may need and provide additional support to help you through
the process. Tapering and discontinuation of antidepressants can lead to either discontinuation
syndromes or return of your original symptoms so it’s reasonable to anticipate that it may be a difficult
time. Beyond planning with your prescriber, it’s a good idea to have extra support in place from friends,
family, community, a therapist, or a psychedelic integration coach. Be kind to yourself in the process,
plan extra time to taper in case something emerges that slows you down, individualize your plan, and
attempt to approach any emotions that arise as practice or preparation for your ceremony or session.
Part IV of this guide includes a taper planning and monitoring support kit that will help customize your
taper plan and track your progress as you go.

While this portion of the guide presents some data and time frames for minimum times to be
antidepressant free or washout antidepressants before using psychedelics, longer times may be
considered, and the currently available data is far from complete. It may be a good idea to be off
antidepressants for an entire month before using a psychedelic, even if two weeks is the minimum time
frame necessary, such that any discontinuation syndrome can fully (or at least mostly) run its course and
you can accurately gauge your stability off antidepressants before engaging with powerful substances
like psychedelics. Conversely, being off your antidepressants for excessively long periods of time before
using psychedelics could also introduce risk of an unnecessary relapse or result in unnecessary suffering.
For an evidence-based chart categorizing interaction risks by types of psychedelics and
antidepressants, see section II of this guide.

Now that’s been said, there are two main concerns that we’ll walk through, the first is lack of
psychedelic effects and the second is physical safety. Lastly, we’ll touch on ketamine as it is compatible
with commonly used antidepressants.

Blunted Psychedelic Effects with MDMA, Mescaline, Psilocybin, and LSD

In general, when Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin Norepinephrine Reuptake
Inhibitors (SNRI) antidepressants are mixed with tryptamine or phenylethylamine psychedelics such as
MDMA, psilocybin, and LSD it has been reported that psychedelics lose their edge and don’t produce the
intense subjective effects characterizing psychedelic experiences [6-13]. There are a few different
mechanisms that may explain why this occurs, although reviewing them in detail is beyond the scope of
this guide [14]. This effect has been best established with MDMA, although some data also exists for
LSD. The other phenylethylamine (e.g. mescaline) or tryptamine (e.g. psilocybin) psychedelics
mentioned have some anecdotal reports of experience blunting with antidepressants, although have not
been conclusively demonstrated to interfere with psychedelic experiences.

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Table 1. MDMA and Antidepressants: Interaction Summary for Clinical Studies

There is no convincing evidence supporting that combinations of antidepressants with classic

phenylethylamine or tryptamine psychedelics that do not contain a monoamine oxidase inhibitor
(MAOI) present risk of severe physical toxidromes such as serotonin syndrome or severe serotonin
toxicity at therapeutic doses [14]. These observations also extend to the lesser used tricyclic
antidepressants (TCAs) since they work similarly to SSRIs and SNRIs, although observational studies have
curiously reported intensified effects when combining TCAs with LSD [15]. Other antidepressants such as
trazodone and mirtazapine may also produce blunted effects because they block 5HT2A receptors,
which are necessary for psychedelic experiences to occur. It may actually be more appropriate to
conceptualize interaction risks with these medications similar to those of atypical antipsychotics.

There are many other novel psychoactive substances (NPS) with psychedelic effects in phenylethylamine
(2Cx, DOx, NBOMe), tryptamine (5-MeO-DMT, 5-MeO-DiPT, DPT, AMT), and cathinone (methylone, 4-
MMC, MDPV, mephedrone) classes that share similar pharmacology with classic psychedelics, however
there may also exist significant differences between them. For example, some data suggests alpha-
methyltryptamine (AMT) and its analogs have significant MAO inhibition as part of their pharmacology
[16]. Therefore, the reader is cautioned against generalizing what’s known about classic psychedelics to
NPS.

So, if it’s not physically dangerous, why not just give it a try?

If you’re using a psychedelic with the intention of finding healing, gaining insight, or having a profound
experience, then may be a lower chance that you’ll have the subjective effect and subsequent
experience you’re hoping for. On a related note, if you’re using a psychedelic because you have a
refractory mental illness, then you may be at risk for ‘loss of hope’ if the experience is less than you

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thought you signed up for. Research has found an association between the degree of mystical
experience and therapeutic outcomes, thus if you have a dud experience, you’re probably less likely to
meet your intention or have the experience mediate therapeutic effects, which could lead to intensified
feelings of hopelessness [17]. So, it seems at the least it could lead you to falsely believe that
psychedelics don’t work and in extreme cases it could lead to severe consequences such as self-injurious
behaviors. Not to mention you likely wasted some of your time and money.

There are some other, more theoretical, reasons that antidepressants and psychedelics may not be a
good idea to combine. For example, in a neuroscientific model of antidepressant and psychedelic
effects, it has been postulated that antidepressants work by repressing emotion and increasing
tolerance to existing circumstances due to activation of ‘passive coping mechanisms’ [16]. Conversely,
psychedelics have been postulated to work by increasing emotional processing and catalyzing change
due to stimulation of ‘active coping mechanisms’. It is unknown if combining drugs with these differing
mechanisms are complementary or counterproductive, however intuitively it seems it may not be
advantageous to use drugs that repress emotion with drugs that bring up emotion simultaneously [18].

How long do I have to wait after stopping an antidepressant before a psychedelic will have an effect?

It is unknown the exact amount of time it takes and is probably dependent on the antidepressant used,
the time it was used for, and perhaps the dose taken. The good news is that it’s probably not a long
period of time. This is evidenced by existing trials of MDMA and psilocybin-assisted psychotherapies.
Some of the clinical trials of MDMA and psilocybin enrolled persons with refractory illness, which was
defined by trying and failing at least two antidepressants in the past. Persons taking antidepressants
were required to taper and discontinue antidepressants for 5 half-lives (generally accepted time-frame
for total elimination of drug from the body) plus an extra week to demonstrate stability. For most
antidepressants this equates to discontinuation approximately two weeks prior to psychedelic use [19-
23]. The table in this article has a list of times it takes to eliminate antidepressants from the body.
Another useful resource for antidepressant elimination times can be found in table 6 on page 59 of this
clinical trial protocol used by the Multidisciplinary Association of Psychedelic Studies (MAPS) [22].
Interestingly, one retrospective analysis of phase II trials of MDMA found that persons that had tapered
antidepressants had worse outcomes after two MDMA sessions spaced a month apart compared to
persons that did not taper for trial enrollment. However, in the first phase III trials of MDMA with three
MDMA sessions spaced a month apart, this signal was not observed [24, 25]. With the exception noted
in the previous sentence, in psychedelic trials to date, they’ve found significant therapeutic effects
without a signal for loss of effect in persons that had stopped antidepressants. Thus for SSRI or SNRI
antidepressants, literature supports an antidepressant-free period of a few weeks being sufficient to
restore psychedelic effects. An exception to this general rule may be fluoxetine (Prozac), which tends to
take a longer time to be completely eliminated from the body. For fluoxetine (Prozac) users the body
may need 6 weeks of antidepressant-free time before a full effect is restored.

Can I just take a bigger dose of psychedelic to overcome issues with ‘lack of effect’?

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This is a poor idea with phenethylamines such as MDMA because as it could lead to increased risks of
physical toxicities or increased risks of psychological harms. Even if the serotonergic effects of MDMA
are diminished from interacting SSRI/SNRI antidepressants, there may be risks of stimulant toxicities
with high doses associated with pharmacology of MDMA that is not blocked or diminished by
antidepressants.

With classic tryptamine psychedelics such as psilocybin or LSD, an attempt at using higher doses to
overcome diminished effects may be more reasonable, as these substances are physically safe even in
very large doses and are generally less likely to have diminished effects relative to MDMA due to
differences in their mechanisms of action. Anecdotally, some persons will have diminished effects while
taking SSRIs/SNRIs, however how much the effects are diminished seems quite variable and is not well
characterized.

Test Doses and Dose Finding: Combining Antidepressants with Psilocybin or LSD

The recommended two to six weeks of antidepressant washout in the chart found in section II of the
guide is based upon what has been done in clinical trials so far. So, when persons are hoping for the
kinds of results produced in trials, tapering and waiting at least two weeks as well as having solid
therapeutic support for their experiences is likely the best course of action. Data also supports a series
of sessions spaced 2-6 weeks apart will produce better results. This is evidence-based; however the data
is rather incomplete in that other protocols have not been tested.

When persons can't or don't want to taper for whatever reason, a strategy that persons may find helpful
would be to pick a time they have 4-8 hours to relax in a safe setting and try a test dose of around 0.5g
dried mushrooms or 20-35 μg of LSD. This is larger than a standard microdose (0.1-0.3g dried
mushrooms or 5-15 μg of LSD) and will likely/hopefully produce some mild effects without being
overwhelmingly intense. Note that these doses can and have produced anxiety in microdosing trials
[26]. If persons feel 'absolutely nothing' or 'very little' from this dose then perhaps it's reasonable to
think they will need larger doses to achieve strong effects.

A 'standard full dose' is 2-4g dried mushrooms or 100-250 μg of LSD, so if the test dose is very weak they
may increase that to 3-5g or 150-300 μg of LSD to begin with. If that dose turns out to be mild then they
can wait 1-4 weeks and use higher doses (increase in 0.5-2g increments with psilocybin mushrooms or
50-100 μg increments of LSD) until they find something that feels potent. I don't recommend persons
skip their antidepressants completely before attempting a full experience because many will begin to
have or even enter a severe withdrawal syndrome within 1-3 days and could create risks in that they
could come down from their experience and attribute feeling horrible to their experience, feel an
amplified withdrawal during their experience, or make the days integrating immediately afterward
colored by withdrawal. It could be reasonable to take a first step in tapering (5-25% dose reduction of
the antidepressant) a week or two prior to attempting a full experience as this may 'lighten the load' and
bring some emotions to the surface for them without pushing so far that a full withdrawal syndrome
occurs.

What about bupropion, is it the same as SSRI and SNRIs?

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Bupropion works by inhibiting dopamine and norepinephrine reuptake and has no appreciable affinity
for serotonin receptors or the serotonin reuptake pump, therefore phenylethylamine and tryptamine
psychedelics should still produce effects while taking bupropion. In fact, one study found that bupropion
actually boosted MDMA concentrations and prolonged its subjective effects without increasing
cardiovascular effects [27]. In that study, concentrations of bupropion were also increased by MDMA.
This doesn’t mean that they should be combined or that there are no risks as bupropion can lower
seizure thresholds and MDMA has some pharmacological effects that may increase seizure risk [28]. For
example, one observational study of mortalities associated with MDMA found bupropion to have the
highest odds ratio of death compared to any other antidepressant [29]. It does, however, mean that
bupropion doesn’t carry the same risk of ‘loss of effect’ compared with SSRI or SNRIs. Bupropion was
disallowed to be used in the 2 weeks prior to MDMA or psilocybin clinical studies. It may be a good idea
to reflect on what your goals of psychedelic use are and what level of risk tolerance you have when
trying to decide whether to stop bupropion or not before psychedelic use. It may also be reasonable,
particularly with MDMA, to reduce the dose of MDMA used given it’s expected to have a longer
experience with higher MDMA blood concentrations if taken concurrently with bupropion [27]. It is also
worth noting withdrawal syndromes when stopping bupropion have not been reported to be as severe
as SSRI/SNRIs in medical literature so stopping or holding doses may be easier to accomplish overall.

Are there any other concerns with using antidepressants and psychedelics?

Most certainly. Many psychedelics are metabolized by an enzyme in your liver called CYP2D6, while
several antidepressants (fluoxetine, paroxetine, bupropion, duloxetine) are known to inhibit this
enzyme. This means that they could block the metabolism of some psychedelics and lead to higher
blood concentrations. This is likely the mechanism by which bupropion boosts MDMA blood
concentrations [27]. While this may not be the biggest problem with some psychedelics and
antidepressants due to blunting of subjective and cardiovascular effects, others could be hazardous [30].

Physical Safety Issues with Ayahuasca or MAOI Containing Psychedelics

The combination of antidepressants with serotonin reuptake inhibition (as well as other commonly used
drugs or substances) and MAOIs can lead to serious toxidromes such as serotonin-related toxicities,
hypertensive crises, or even death [14, 31-33]. The most commonly encountered psychedelic containing
MAOIs is ayahuasca. Other MAOI containing psychedelic concoctions may contain Syrian rue or
moclobemide and are collectively termed ‘pharmahuasca’. Dried plant or herbal materials can be laced
with MAOIs and DMT, which are known as ‘enhanced leaf’ Changa [34].

While there are differences in the amount of time harmala alkaloids such as those found in ayahuasca
inhibit MAO compared with pharmaceutical MAOIs, it is well established that the harmala alkaloids are
potent MAOIs with the potential for serious drug interaction [14]. You may find people that insist
ayahuasca is “not a complete MAOI” or that the risks are overstated, however please ignore them as
they are not correct and spreading dangerous misinformation. It was first reported by Callaway that
SSRIs and ayahuasca are capable of producing prolonged and serious toxidromes [31]. While it’s
unknown and unclear what combinations of drugs were involved, poison control calls in the US related

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to ayahuasca have resulted in placement of breathing tubes, seizures, and death [32]. The signs,
symptoms, and outcomes in these poison control cases are suggestive of unsafe drug combinations and
severe serotonin toxicities.

Got it, I don’t want to experience toxicity, how long should I be off my SSRI or SNRI before using a
MAOI?

Since MAOIs were the first antidepressants on the market, we actually have extensive research and data
on how long you need to wait to safely be able to use a MAOI. For the SSRI and SNRI medications with
the exception of fluoxetine (Prozac), the recommended and safe time frame is at least two weeks. For
fluoxetine (Prozac), it’s at least six weeks [35].

What other drugs should I be off before using an MAOI?

Other drugs that are contraindicated with MAOIs involve those that increase serotonin release or block
serotonin reuptake such as phenylethylamines (MDMA, 2Cx, DOx, NBOMe) and the tryptamine 5-MeO-
DMT [36-38]. Drugs that increase dopamine or norepinephrine levels (amphetamine, methylphenidate,
cocaine, bupropion) may introduce risk of high blood pressures (hypertensive crisis) and associated risks
like heart attack, stroke, or kidney failure. There are several other drug classes that are contraindicated
or cautioned to be used only with expert oversight in conjunction with MAOIs including tramadol,
methadone, trazodone, pseudoephedrine, dextromethorphan, anti-Parkinson’s medications among
others. Some herbal products or supplements are also contraindicated with MAOIs include St. John’s
Wort, L-tryptophan, and 5-HTP. This is not an all-inclusive list and recommend seeking guidance if
planning to use psychedelics containing MAOIs with existing medication, supplements, or herbal
products.

Ketamine: The Antidepressant Friendly Psychedelic

Ketamine has not traditionally been considered a psychedelic and is usually categorized as a dissociative
anesthetic [39]. However, ketamine can produce profound mind-altering effects and classic psychedelic
experiences such as the ‘mystical experience’ have been reported with ketamine use [40]. Furthermore,
ketamine has been shown to produce neuroplasticity similar to classic psychedelics such as DMT
[41][36]. Whether you consider ketamine a psychedelic or categorize it as an anesthetic or analgesic is
perhaps a semantic debate or a function of dose and route of administration. Ketamine differs from
most psychedelics in that its mechanism doesn’t directly affect serotonin neurotransmission and it
appears that it works to primarily modulate glutamate systems with relatively minor effects of opioid
and monoamine neurotransmitter systems [42]. Therefore, ketamine retains its mind-altering effects
when combined with traditional antidepressant therapies without introducing risks of physical toxicity.
Early trials of ketamine for depressive states required participants to be off their antidepressant
medications for two weeks prior to use [43]. However, several studies from real-world clinics document
retained benefits when combined with antidepressants [44]. Additionally, the newly approved intranasal

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form of ketamine is intended to be used in conjunction with antidepressants and contains language
recommending concurrent use in its manufacturer produced drug information.

What advantages does ketamine offer compared to other psychedelics?

Probably the most significant advantage ketamine offers is that it’s regulated as a controlled substance
instead of an illicit substance in the United States, meaning that it can be accessed through traditional
medical providers and does not introduce risks associated with clandestine treatments or carry the same
level of stigma that other psychedelics do. It is also a shorter acting drug than other psychedelics, which
could be considered advantageous to some. Recently, an intranasal applicator for a form of ketamine (S-
ketamine or esketamine) was approved for the treatment of refractory depression. This approval sends
a clear signal to the greater medical community that the use of ketamine for management of refractory
depression is acceptable and within the ‘standard of care’ for refractory illness. Another significant
advantage of ketamine is that it has been successfully used in the management of depression associated
with bipolar I illness, whereas bipolar disorder is currently considered to be a contraindication to use of
phenylethylamine or tryptamine psychedelics with serotonin-based mechanisms of action [43]. For
persons hoping to have a therapeutic experience with an altered state of consciousness that are not
ready to taper antidepressants or have bipolar disorder, ketamine is the best existing option.

What are some disadvantages of ketamine compared to other psychedelics?

Ketamine produces significant, rapid, and robust antidepressant effects, although it tends to not
produce the durability in results that have been observed with other psychedelic-assisted
psychotherapies such as those with psilocybin or MDMA. Ketamine usually produces beneficial effects
that last, on average, 5-7 days. It also it usually given as a series of treatments, approximately 2-3x
weekly for a few weeks. Therefore, if wanting to use ketamine therapeutically, you may need to get
several treatments in a short period of time. While substance use disorders with ketamine have not
developed from use in clinical studies, it is generally a higher risk drug for development of substance use
disorders than serotonin-based psychedelics, particularly tryptamines like psilocybin or LSD. The
approved ketamine nasal applicator was also not studied within a wider framework that incorporates
adjunctive psychotherapy and there is variability in provider perspectives of the utility of the altered
state ketamine produces. There are some that are practicing ketamine assisted psychotherapy (KAP),
while others simply administer the drug and monitor from a distance, without providing much support
for the experience or integrative psychotherapy post-experience [40]. It is encouraged to seek a
ketamine provider that is well-versed in drug-assisted psychotherapy modalities and provides support
before, during, and after the experience.

Summary & Conclusions

There are many things to consider when taking antidepressants and considering psychedelic use. It
appears with phenylethylamine and tryptamine psychedelics without an MAOI that there is a risk of loss
of subjective psychedelic effects whereas with psychedelics that contain an MAOI there are risks of

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physical toxicity. Ketamine appears to be well tolerated and retains effectiveness in combination with
antidepressants.

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controlled phase 3 study. Nature Medicine, 2021.
26. Bershad, A.K., et al., Acute Subjective and Behavioral Effects of Microdoses of Lysergic Acid Diethylamide
in Healthy Human Volunteers. Biol Psychiatry, 2019. 86(10): p. 792-800.
27. Schmid, Y., et al., Interactions between bupropion and 3,4-methylenedioxymethamphetamine in healthy
subjects. J Pharmacol Exp Ther, 2015. 353(1): p. 102-11.
28. Giorgi, F.S., et al., MDMA and seizures: a dangerous liaison? Ann N Y Acad Sci, 2006. 1074: p. 357-64.
29. Cohen, I.V., et al., Concomitant drugs associated with increased mortality for MDMA users reported in a
drug safety surveillance database. Scientific Reports, 2021. 11(1): p. 5997.
30. Shen, H.W., et al., Psychedelic 5-methoxy-N,N-dimethyltryptamine: metabolism, pharmacokinetics, drug
interactions, and pharmacological actions. Curr Drug Metab, 2010. 11(8): p. 659-66.
31. Callaway, J.C. and C.S. Grob, Ayahuasca preparations and serotonin reuptake inhibitors: a potential
combination for severe adverse interactions. J Psychoactive Drugs, 1998. 30(4): p. 367-9.
32. Heise, C.W. and D.E. Brooks, Ayahuasca Exposure: Descriptive Analysis of Calls to US Poison Control
Centers from 2005 to 2015. J Med Toxicol, 2016.
33. Malcolm, B.J. and K.C. Lee, Ayahuasca: An ancient sacrament for treatment of contemporary psychiatric
illness? Ment Health Clin, 2017. 7(1): p. 39-45.
34. Smokeydaze, D.N.-. A Guide to DMT Enhanced Leaf (Changa). 5/2/19]; Available from: https://wiki.dmt-
nexus.me/Changa.
35. American Psychiatric Association (APA), Practice Guideline for the Treatment of Patients With Major
Depressive Disorder. 3rd edition. Arlington (VA); 2010 Oct. 152 p. [1170 references], 2010.
36. ICEERS, Risks associated with combining Bufo Alvarius with ayahuasca. 2017.
37. Pilgrim, J.L., et al., Serotonin toxicity involving MDMA (ecstasy) and moclobemide. Forensic Sci Int, 2012.
215(1-3): p. 184-8.
38. Vuori, E., et al., Death following ingestion of MDMA (ecstasy) and moclobemide. Addiction, 2003. 98(3): p.
365-8.
39. Molero, P., et al., Antidepressant Efficacy and Tolerability of Ketamine and Esketamine: A Critical Review.
CNS Drugs, 2018. 32(5): p. 411-420.
40. Dore, J., et al., Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes
in Three Large Practices Administering Ketamine with Psychotherapy. J Psychoactive Drugs, 2019: p. 1-10.
41. Olson, D.E., Psychoplastogens: A Promising Class of Plasticity-Promoting Neurotherapeutics. J Exp
Neurosci, 2018. 12: p. 1179069518800508.
42. Wang, M. and A. Kaplin, Explaining Naltrexone's Interference With Ketamine's Antidepressant Effect. Am J
Psychiatry, 2019. 176(5): p. 410-411.
43. Ryan, W.C., C.J. Marta, and R.J. Koek, Ketamine and Depression: A Review. International Journal of
Transpersonal Studies, 2014. 33(2): p. 40-74.
44. Feifel, D., et al., Low-dose ketamine for treatment resistant depression in an academic clinical practice
setting. Journal of Affective Disorders, 2017. 221: p. 283-288.

12
Section II. Antidepressant & Psychedelic Drug Interaction Chart
This chart is not intended to be used to make medical decisions and is for informational purposes only. It was constructed using data whenever possible,
although extrapolation was also used to inform risk. Data sources range from high quality clinical data to observational studies. Decisions to start, stop, or taper
medication and/or use psychedelic drugs should be made in conjunction with your healthcare provider(s). It is recommended to not perform any illicit activity.

Antidepressant Phenethylamines Tryptamines MAOI-containing Ketamine Ibogaine

SSRIs
· Paroxetine (Paxil)
· Sertraline (Zoloft)
· Citalopram (Celexa)
· Escitalopram (Lexapro)
· Fluxoetine (Prozac)
· Fluvoxamine (Luvox)
SPARI
· Vibryyd (Vilazodone)
· Trintellix (Vortioxetine)
SNRI
·Venlafaxine (Effexor)
·Duloxetine (Cymbalta)
·Desvenlafaxine (Pristiq)
·Levomilnacipran (Fetzima)
DNRI
· Bupropion (Wellbutrin)
· Mirtazapine (Remeron)
SSRI = selective serotonin reuptake inhibitor SPARI = serotonin partial agonist and reuptake inhibitor SNRI = serotonin norepinephrine reuptake inhibitor
norepinephrine reuptake inhibitor MAOI = monoamine oxidase inhibitor SERT = serotonin reuptake pump
-MDMA, mescaline -Psilocybin, LSD -Ayahuasca, Syrian Rue
Taper & discontinue 2-6 weeks Consider taper & Taper & discontinue at least 2 Has been studied and Taper & discontinue at
prior due to loss of psychedelic discontinuation at least 2 weeks weeks prior (all except found effective both with least 2 weeks prior (all
effect [1, 2] prior (all except fluoxetine) or 6 fluoxetine) or 6 weeks prior and without concurrent except fluoxetine) or 6
weeks prior (fluoxetine only) (fluoxetine only) due to use of antidepressants weeks prior (fluoxetine
MDMA is unable to cause due to potential loss of potential risk of serotonin only) due to risk of
release of serotonin when the psychedelic effect toxicity additive QTc interval
serotonin reuptake pump is Recommended prolongation,
blocked. This leads to drastically Chronic antidepressant use may Life threatening toxicities can to be used in conjunction arrhythmias, or
reduced effects [3-9] result in down-regulation of occur with these with oral antidepressants cardiotoxicity
5HT2A receptors and blunted combinations and is strictly by esketamine
psychedelic experiences [10, contraindicated [12-14] manufacturer Some antidepressants are
11]. This does not seem to affect liver (CYP2D6) inhibitors
psilocybin for some and have been shown to
double ibogaine blood
concentrations [15]
Increased effects of MDMA with Loss of effect not predicted to Taper & discontinue at least 2 Taper & discontinue at
higher blood concentrations for occur, consider taper & weeks prior due to potential least 2 weeks prior to use.
longer [16]. May increase risk of discontinuation depending on of adverse effects, however May increase risk of
seizures or death in combination goals of psychedelic use serotonin toxicity unlikely to seizures in combination.
[17]. Caution in combination. occur [18]
Consider taper & CYP2D6 inhibitor with
discontinuation of bupropion. potential to increase
Alternatively, a 25% reduced ibogaine blood
dose of MDMA if bupropion is cocnentrations
continued.
Taper & discontinue at least 2 weeks prior due to loss of psychedelic effect Taper & discontinue at
least 2 week prior due to
Mirtazapine does not block the serotonin reuptake pump like SSRI, SPARI, or SNRI antidepressants. It risk of additive QTc
blocks the 5HT2A receptor, thus is predicted to cause a blunting or loss of psychedelic effects. It has interval prolongation,
not been associated with serotonin toxicity with MAOIs [18] arrhythmias, or
cardiotoxicity
DNRI = dopamine
5HT2A = serotonin 2A receptor
13
 Antidepressant
Tricyclic Antidepressant (TCA)
· Amitriptyline (Elavil)
· Nortriptyline (Pamelor)
· Clomipramine (Anafranil)
· Imipramine (Tofranil)
· Desipramine (Norpramin)
· Chlorpheniramine
Trazodone (Desyrel)
Buspirone (Buspar)
MAO-A Inhibitors*
· Phenelzine (Nardil)
· Isocarboxazid (Marplan)
· Tranylcypromine (Parnate)
· Moclobemide
*chronic use
MAO-B inhibitors
· Selegeline (Emsam)
SSRI = selective serotonin reuptake inhibitor SPARI = serotonin partial agonist and reuptake inhibitor SNRI = serotonin norepinephrine reuptake inhibitor
norepinephrine reuptake inhibitor MAOI = monoamine oxidase inhibitor SERT = serotonin reuptake pump 5HT2A = serotonin 2A receptor
Phenethylamines Tryptamines MAOI-containing Ketamine Ibogaine
-MDMA, mescaline -Psilocybin, LSD -Ayahuasca, Syrian Rue
Taper & discontinue at Consider taper & Taper & discontinue at least 2 Has been studied Taper & discontinue at
least 2 weeks prior due to discontinuation at least 2 weeks prior due to potential risk of and found effective least 2 weeks prior due
loss of psychedelic effect weeks prior due to potential serotonin toxicity. Risk is highest both with and to risk of additive QTc
intensified effects with clomipramine, imipramine, without concurrent interval prolongation,
MDMA is unable to cause and chlorpheniramine [18] use of arrhythmias, or
release of serotonin when Chronic TCA use was reported antidepressants cardiotoxicity
the serotonin reuptake to increase the subjective Life threatening toxicities can
pump is blocked. This leads effects of LSD [19] occur with these combinations and Some antidepressants
to drastically reduced is strictly contraindicated Recommended are liver (CYP2D6)
effects to be used in inhibitors and have
conjunction with been shown to double
oral antidepressants ibogaine blood
by esketamine concentrations
Taper & discontinue at least 5 days prior due to loss of psychedelic effect manufacturer Taper & discontinue at
least 1 week prior due
Trazodone blocks 5HT2A receptors at lower doses (25-150mg) and starts blocking the serotonin to risk of additive QTc
reuptake pump (SERT) at >150mg [18]. It has an active metabolite that also blocks 5HT2A receptors interval prolongation,
as well as modulating many other 5HT receptors arrhythmias, or
cardiotoxicity
Taper & discontinue at least 5 days prior due to loss of psychedelic effect Taper & discontinue at
least 5 days prior due
Buspirone is a non-psychedelic partial agonist at serotonin receptors, thus may display blunting of to potential risk of
psychedelic effects due to competitive inhibition when used in combination with psychedelics [20]. toxicity
It does not inhibit the reuptake of nor release neurotransmitters, thus risk of serotonin toxicity with
MAOIs is low
Taper & discontinue at Consider taper & Taper & discontinue at least 2 Taper & discontinue at
least 2 weeks prior due to discontinuation at least 2 weeks prior least 10 days prior due
potential risk of serotonin weeks prior due to potential to potential risk of
toxicity or hypertensive loss of psychedelic effect [19] Additive use of MAOIs may cause toxicity [24]
crisis [21] intensified experiences or
Contraindicated with cardiovascular collapse (fainting or
tryptamine 5-MeO-DMT [22, dangerously low blood pressure)
23]
Intensified effects, risk of Intensified effects possible, risk
serotonin toxicity at doses of serotonin toxicity at doses
≥9mg/day ≥9mg/day with 5-MeO-DMT;
psilocybin or LSD likely have
Taper & discontinue at low risks of physical toxicity in
least 2 weeks prior, combination
especially if dose ≥9mg/day
DNRI = dopamine
14
References:

1. Feduccia, A.A., et al., Discontinuation of medications classified as reuptake inhibitors affects treatment response of MDMA-assisted psychotherapy. Psychopharmacology, 2020.
2. Mitchell, J.M., et al., MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine, 2021.
3. Farre, M., et al., Pharmacological interaction between 3,4-methylenedioxymethamphetamine (ecstasy) and paroxetine: pharmacological effects and pharmacokinetics. J Pharmacol Exp
Ther, 2007. 323(3): p. 954-62.
4. Hysek, C.M., et al., Duloxetine inhibits effects of MDMA ("ecstasy") in vitro and in humans in a randomized placebo-controlled laboratory study. PLoS One, 2012. 7(5): p. e36476.
5. Liechti, M.E. and F.X. Vollenweider, The serotonin uptake inhibitor citalopram reduces acute cardiovascular and vegetative effects of 3,4-methylenedioxymethamphetamine ('Ecstasy') in
healthy volunteers. J Psychopharmacol, 2000. 14(3): p. 269-74.
6. Piper, B.J., et al., Dissociation of the neurochemical and behavioral toxicology of MDMA ('Ecstasy') by citalopram. Neuropsychopharmacology, 2008. 33(5): p. 1192-205.
7. Stein, D.J. and J. Rink, Effects of "Ecstasy" blocked by serotonin reuptake inhibitors. J Clin Psychiatry, 1999. 60(7): p. 485.
8. Tancer, M. and C.E. Johanson, The effects of fluoxetine on the subjective and physiological effects of 3,4-methylenedioxymethamphetamine (MDMA) in humans. Psychopharmacology
(Berl), 2007. 189(4): p. 565-73.
9. Gudelsky, G.A. and J.F. Nash, Carrier-mediated release of serotonin by 3,4-methylenedioxymethamphetamine: implications for serotonin-dopamine interactions. J Neurochem, 1996. 66(1):
p. 243-9.
10. Bonson, K.R., J.W. Buckholtz, and D.L. Murphy, Chronic administration of serotonergic antidepressants attenuates the subjective effects of LSD in humans. Neuropsychopharmacology,
1996. 14(6): p. 425-36.
11. Carhart-Harris, R.L. and D.J. Nutt, Serotonin and brain function: a tale of two receptors. Journal of Psychopharmacology (Oxford, England), 2017. 31(9): p. 1091-1120.
12. Callaway, J.C. and C.S. Grob, Ayahuasca preparations and serotonin reuptake inhibitors: a potential combination for severe adverse interactions. J Psychoactive Drugs, 1998. 30(4): p. 367-
9.
13. Malcolm, B.J. and K.C. Lee, Ayahuasca: An ancient sacrament for treatment of contemporary psychiatric illness? Ment Health Clin, 2017. 7(1): p. 39-45.
14. Malcolm, B. and K. Thomas, Serotonin toxicity of serotonergic psychedelics. Psychopharmacology (Berl), 2021.
15. Glue, P., et al., Influence of CYP2D6 activity on the pharmacokinetics and pharmacodynamics of a single 20 mg dose of ibogaine in healthy volunteers. J Clin Pharmacol, 2015. 55(6): p. 680-
7.
16. Schmid, Y., et al., Interactions between bupropion and 3,4-methylenedioxymethamphetamine in healthy subjects. J Pharmacol Exp Ther, 2015. 353(1): p. 102-11.
17. Cohen, I.V., et al., Concomitant drugs associated with increased mortality for MDMA users reported in a drug safety surveillance database. Scientific Reports, 2021. 11(1): p. 5997.
18. Gilman, K., Monoamine oxidase inhibitors: A review concerning dietary tyramine and drug interactions. PsychoTropical Commentaries, 2017. 1(1): p. 105.
19. Bonson, K.R. and D.L. Murphy, Alterations in responses to LSD in humans associated with chronic administration of tricyclic antidepressants, monoamine oxidase inhibitors or lithium.
Behav Brain Res, 1996. 73(1-2): p. 229-33.
20. Pokorny, T., et al., Modulatory effect of the 5-HT1A agonist buspirone and the mixed non-hallucinogenic 5-HT1A/2A agonist ergotamine on psilocybin-induced psychedelic experience. Eur
Neuropsychopharmacol, 2016. 26(4): p. 756-66.
21. Pilgrim, J.L., et al., Serotonin toxicity involving MDMA (ecstasy) and moclobemide. Forensic Sci Int, 2012. 215(1-3): p. 184-8.
22. Callaway, J.C., et al., A demand for clarity regarding a case report on the ingestion of 5-methoxy-N, N-dimethyltryptamine (5-MeO-DMT) in an Ayahuasca preparation. J Anal Toxicol, 2006.
30(6): p. 406-7; author reply 407.
23. ICEERS, Risks associated with combining Bufo Alvarius with ayahuasca. 2017.
24. Global Ibogaine Therapy Alliance. Clinical Guidelines for Ibogaine-Assisted Detoxification. 2015 [cited 2017 June 27th ]; Available from: https://www.ibogainealliance.org/guidelines/.

15
 Section III. Safely and Successfully Stopping Antidepressants

Ready to Stop Antidepressants?

The decision to stop antidepressants is individual and should involve and be supervised by a qualified
provider whenever possible. There are several factors that can help make the decision or weigh into the
decision if it is a good time to taper. Some factors include how well the medication is working or
effectiveness, how well tolerated the medication is (side effects), symptom history, sensitivity to
withdrawal, life-timing and ongoing stressors, personal growth and development, as well as therapeutic
support and planning. See section IV of this guide for a taper planning and monitoring support kit, that
can help you assess these factors and create customized plans to stop antidepressants.

A Growing Problem: Long-Term Antidepressant Use

Antidepressants were designed and originally studied for the treatment of major depressive disorder,
which is characterized by episodes of depression. While some persons do feel depressive symptoms
chronically and may benefit from continuous therapy, most persons experience discrete episodes.
Therefore, antidepressants were never designed to be used as chronic maintenance medications.
Rather, they were designed to be used over the course of an episode, which typically lasts 9-12 months.

Since the approval of the first selective serotonin reuptake inhibitors (SSRI) Prozac in 1988 there has
been a steady increase in the number of antidepressant prescriptions. At this point around 13% of the
US adult population takes antidepressant medication, with whites, females, and persons over 60 seeing
the most dramatic rises in use. It is mostly long-term use prescribed by general practitioners that
account for the increasing number of antidepressant users [1]. Unfortunately, many prescribing
providers are unprepared to help their patients discontinue antidepressants [2, 3]. In the US, around 2/3
antidepressant users have been taking the medication longer than 2 years and it’s estimated that 30-
50% of long-term users have no evidenced based indication to continue them [3].

Roadblocks to Stopping Antidepressants

There are many potential obstacles to stopping antidepressants, although a few themes emerge when
browsing the literature. One is confidence and knowledge in ability to safely discontinue
antidepressants. Patients often look to their providers for this information, however treatment-
guidelines as well as manufacturer prescribing information lack evidence-based recommendations on
how to discontinue antidepressants. Subsequently and unfortunately, it’s an area that providers often
do not feel confident in themselves.

An interrelated theme are fears of antidepressant withdrawal syndromes. Persons may at time forget to
take their antidepressant with them on vacation or attempt tapering or discontinuation of
antidepressants themselves and run into bothersome and sometimes destabilizing withdrawal
symptoms. Antidepressants work over a period of weeks to months to improve mood and likely induce

16
neuroadaptation events that leave the user with a physical (and at times psychological) dependence on
the medication.

Another common fear is return of original illness. This occurs commonly and may be expected given
antidepressants rarely treat the etiology of mental illness. Return of symptoms of the original illness
occurs in many persons that stop antidepressants within a year, thus requires close attention and an
alternative therapeutic plan is reasonable to be developed ahead of time. In this vein, persons are less
likely to discontinue antidepressants when they’re working well, however treatment-refractory
depression (defined as failing therapy with at least 2 antidepressants) is prevalent at around 30%.

Essentially, users find themselves ‘trapped’ on antidepressants due to mediocre efficacy, presence of
significant withdrawal, and lack of knowledge as to how to taper and discontinue them [2,3].

Antidepressant Withdrawal Reactions

Much can happen in the time immediately after stopping or decreasing the dose of an antidepressant,
creating confusion as to what the correct course of action is. Antidepressant Discontinuation Syndrome
(ADS) has been defined by symptoms such as fatigue, insomnia, nausea, feeling off-balance or dizzy,
sensory disturbances such as feeling abnormal sensations or ‘brain zaps’, as well as anxiety and
irritability [4]. Beyond symptoms of ADS which may be distinct and recognizable compared to symptoms
of original illness, persons can also experience ‘rebound symptoms’ [5]. Rebound symptoms are similar
to those of original illness, however they are experienced almost immediately upon dose decrease and
occur with greater intensity than those of original illness. Additionally, rebound symptoms resolve as the
antidepressant withdrawal reaction completes itself whereas return of original symptoms may arise
more slowly and after a longer time period from stopping or decreasing the dose of antidepressants.
The diagram below depicts temporal differences in rebound symptoms vs. return of original symptoms.

16
Providers and persons taking antidepressants may take a dose step down, experience lower moods or
increased anxiety almost immediately, and falsely conclude there was a return of original illness and
reinstate the antidepressant. When symptoms rapidly resolve after reinstating or increasing the dose of
an antidepressant it is a helpful sign in understanding that the user was having trouble related to
withdrawal of medication rather than exacerbation mental illness.

Timeline and Severity of Antidepressant Withdrawal Reactions

There are considerable amounts of variability in the types of reactions persons experience when
lowering their dose of antidepressant. Persons using longer than the minimum 6 weeks required to
understand if the antidepressant will have a therapeutic effect are at risk for antidepressant withdrawal.
Persons taking higher doses, agents with shorter-half lives (paroxetine, venlafaxine), or use of an
antidepressant for a condition such as panic disorder can increase risks of withdrawal syndromes. It is
reasonable to believe withdrawal symptoms emerge as the antidepressant leaves the users system. For
most SSRI and related serotonin reuptake blocking antidepressants (SNRIs) onset of withdrawal occurs
within 2-5 days of a dose decrease or stopping use. Withdrawal symptoms typically peak within 5-14
days and gradually resolve over 2-3 weeks in most users. Depending on the sensitivity of the individual
to withdrawal and the size of the dose decrease severe symptoms (e.g. suicidality) or reactions that last
longer are possible [6, 7].

16
Rate of Antidepressant Taper

Current or ‘normal’ recommendations for antidepressant tapering in persons with major depression
suggest ‘tapering slowly over 2-4 weeks’ [8]. This rate of taper is too fast for most antidepressant users
resulting in intolerable withdrawal syndromes and reinstatement of antidepressant use. Ideally, the rate
of taper would be slow enough that the antidepressant user does not notice that they are tapering or
withdrawal symptoms are limited to being mild and not bothersome. For most persons tapering over a
period of 2-3 months is reasonable, although for some 4-6 months or even longer may be necessary.
Antidepressant tapers are traditionally accomplished with linear step-down dosing of the antidepressant
(e.g. a 25% decrease in dose every 2-6 weeks). Persons may find that they need smaller dose decreases
(5-10% per step) the closer they get to being completely off the medication or that subsequent step
downs are more difficult than initial ones. This is because while linear decreases in doses result in linear
decreases in blood concentrations, they can result in exponential decreases in serotonin reuptake pump
occupancy. This becomes especially true once antidepressants are lower than what literature terms
‘minimum effective doses’. Alternative and emerging tapering strategies involve tiny decreases of the
antidepressant on an almost daily basis (microtapering) or decreasing rapidly initially and slowing down
as the taper progresses (hyperbolic dose reduction) [9]. There is no data to clarify if one method works
better than another.

Creating Appropriate Step-Down Doses

One difficulty that persons may face is finding step-down doses of their antidepressant small enough
that the dose reduction doesn’t result in moderate-severe withdrawal syndromes. Antidepressants in
immediate-release tablet forms can be cut using pill splitters to create smaller doses. Antidepressants in
capsules or extended-release tablets cannot but cut, crushed, or chewed because it will destroy the
extended-release mechanism and result in unwanted spikes and crashes and blood levels of
antidepressant during the taper phase. Extended-release capsules can often be opened, contents
weighed, and an amount discarded to create a smaller dose. The user should swallow extended-release
beads whole in a spoonful of applesauce. Obviously, this type of solution is imprecise, tedious, and
involves tampering with the medication thus is far from ideal and not recommended by most sources
due to these factors. Some antidepressants are available in liquid formulations which can be used to
create customized doses. One helpful solution are ‘tapering strips’ which involve custom compounded
blister packs of antidepressants that have smaller and smaller doses as the taper progresses. Tapering
strips can be customized depending on sensitivity to withdrawal and desired rate of step-down. They
can be ordered by prescribers and shipped worldwide from https://www.taperingstrip.com/prescribing-
and-ordering/

Monitoring the Taper

Due to the variability in individual responses to tapering antidepressants as well as confusion between
rebound symptoms or original illness it clarifies the pattern of withdrawal and planning subsequent
step-down doses to monitor the taper closely. Monitoring parameters may include depression (mood),
anxiety, sleep, as well as symptoms specific to antidepressant discontinuation syndrome. It is reasonable

16
to record other interventions used or a short journal entry about the days events or other stressors that
are influencing the picture. By doing this daily one can then plot their antidepressant withdrawal
reaction and see it as a predictable pattern. By knowing the pattern, subsequent steps are easier as
alternative interventions and support can be planned for times predicted to be rough.

To help with antidepressant tapers I created an Antidepressant Monitoring and Support Kit. The
Antidepressant Monitoring and Support Kit allows persons taking antidepressant to clearly track
themselves over the course of a month and plot their individual withdrawal reaction. They can then
share the results with their provider to plan the next step of their taper.

Managing Original Illness: Emerging Treatments with Psychedelics

Antidepressants treat symptoms of depression as well as other psychiatric conditions which can increase
a user’s functionality and significantly improve their quality of life. However, antidepressants are not
thought to treat the underlying etiology and it is realistic of users stopping antidepressants to expect
that they will need to grapple with symptoms of their illness once more. For some, antidepressants were
effective for some time although waned in benefit over time and they are already managing illness that
could be compounded by withdrawal. Identifying alternative interventions and gathering resources to
treat symptoms of illness prior to tapering is a sage choice.

One emerging strategy for management of depression, anxiety, PTSD and other disorders that
antidepressants are currently used for is psychedelic-assisted psychotherapy. Psychedelic therapies are
intermittent and do not involve regular use. They are conducted in supervised settings and involve
extensive therapy outside of psychedelic use. There is no data to support that psychedelics are helpful
with antidepressant withdrawal syndromes, however there is increasingly supportive high-quality data
suggesting psychedelic therapies to have high rates of success where antidepressants have previously
failed. Therefore, particularly if you have tried several antidepressants without helpful effects or know
you will need to treat your original illness it may be prudent to explore their healing potentials.

Summing Up

Antidepressant withdrawal reactions and tapering can be complex, and many persons find it much more
challenging than they had expected. Learning about withdrawal and how to manage it as well as
planning, monitoring, and supporting antidepressant tapers are key ingredients for success.

References
1. Mojtabai, R. and M. Olfson, National trends in long-term use of antidepressant medications: results from
the U.S. National Health and Nutrition Examination Survey. J Clin Psychiatry, 2014. 75(2): p. 169-77.
2. Scholten, W., N. Batelaan, and A. Van Balkom, Barriers to discontinuing antidepressants in patients with
depressive and anxiety disorders: a review of the literature and clinical recommendations. Therapeutic Advances in
Psychopharmacology, 2020. 10: p. 2045125320933404.
3. Maund, E., et al., Barriers and facilitators to discontinuing antidepressant use: A systematic review and
thematic synthesis. J Affect Disord, 2019. 245: p. 38-62.

17
4. Warner, C.H., et al., Antidepressant discontinuation syndrome. Am Fam Physician, 2006. 74(3): p. 449-56.
5. Henssler, J., et al., Antidepressant Withdrawal and Rebound Phenomena. Dtsch Arztebl Int, 2019. 116(20):
p. 355-361.
6. Fava, G.A., et al., Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor
Discontinuation: Systematic Review. Psychother Psychosom, 2018. 87(4): p. 195-203.
7. Fava, M., Prospective studies of adverse events related to antidepressant discontinuation. J Clin
Psychiatry, 2006. 67 Suppl 4: p. 14-21.
8. American Psychiatric Association (APA), Practice Guideline for the Treatment of Patients With Major
Depressive Disorder. 3rd edition. Arlington (VA); 2010 Oct. 152 p. [1170 references], 2010.
9. Horowitz, M.A. and D. Taylor, Tapering of SSRI treatment to mitigate withdrawal symptoms. Lancet
Psychiatry, 2019. 6(6): p. 538-546.

18
Antidepressant Taper Planning and
Monitoring Support Kit

SPIRIT PHARMACIST

Benjamin Malcolm, PharmD, MPH, BCPP

SPIRIT PHARMACIST
Section IV. Antidepressant Taper Planning and Monitoring
Support Kit

Purpose
Discontinuing antidepressants can be challenging to navigate for several reasons including
antidepressant discontinuation syndrome, rebound symptoms, and return of original illness.
This taper planning and monitoring support kit is intended to be used in conjunction with the
prescribing provider to aid in optimizing the safety and success when antidepressant discontinuation is
a goal. It is not intended be medical advice or a ‘do it yourself’ replacement for medical care.
The planning and monitoring support kit was designed to be used alongside materials from the course
Antidepressants and Psychedelics: A Course in Tapering Antidepressant Therapies in Preparation for
Psychedelic Experiences

The Kit Allows the User To

• Understand courses of antidepressant therapies further and gain insight into personal
readiness to taper
• Create a support plan for their taper process
• Take a daily inventory of antidepressant withdrawal symptoms as well as overall mood and
anxiety levels
• Generate a summary of their antidepressant withdrawal pattern over a monthly basis
• Use the generated information and data along with the prescribing provider to individualize
their taper

Contents and Instructions

1. Take the ‘Antidepressant Course of Therapy and Taper Readiness Quiz’
2. Complete the ‘Pre-Taper Reflection and Support Planner’
3. Arrange initial visit with provider to complete assessment of taper readiness
4. Begin tracking taper with the ‘Daily Antidepressant Withdrawal and Mood Tracker’
5. Summarize month after dose step-down with the ‘Antidepressant Taper Monthly Dashboard’
6. Review with provider and plan next step
7. Repeat steps 4-6 until antidepressant discontinued

22
Antidepressant Course of Therapy
and Taper Readiness Quiz

Benjamin Malcolm, PharmD, MPH, BCPP

SPIRIT PHARMACIST
 Antidepressant Course of Therapy and Taper
Readiness Quiz

This quiz is designed to inform and educate persons taking antidepressants about
the course of therapy as well as factors that can be part of the decision to taper
and discontinue antidepressants. There are no right or wrong answers to the quiz.
An explanation to each question can be found following the question. The quiz is
not medical advice. It is recommended that you do not change your
antidepressants or attempt tapering without the supervision of the prescribing
provider.

Please answer the questions or rate your level of agreement with the various
statements:

1. How long have antidepressants been used or taken

a. Less than 3 months
b. 3-9 months
c. 9-18 months
d. Longer than 18 months

The recommended duration of antidepressant therapy to treat a major depressive

episode is 6-9 months after initial improvements are made, which typically
equates to a course of therapy between 12-18 months. If you have been taking an
antidepressant for less than 3 months it may not have had sufficient time to work,
if you are taking it 3-6 months and feeling well you are right on track, if you are
taking antidepressants longer than 12 months, it may be time to re-evaluate the
therapy with your medical provider.

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 2. I have tried two or more antidepressants and NOT received adequate help
or effects from them
a. Agree – that’s me
b. Disagree – I’ve tried a few but they’re helpful
c. I haven’t tried two or more antidepressants

The definition of 'treatment refractory depression' is depression that has not

responded to at least two trials of antidepressants at an adequate duration and
dose for effects to be seen in most. If you've tried two or more antidepressants
and have not received adequate help from them, it could be time to consider
interventions for treatment refractory depression. Similar definitions of treatment
refractory often apply to PTSD or anxiety also.

3. The last time I had my antidepressant use evaluated with my prescribing

medical provider was _____________
a. Less than 3 months ago
b. 3-12 months ago
c. Over a year ago
Data supports that the longer a user is on an antidepressant, the lower the
likelihood it will be brought up in conversation or re-evaluated by your prescribing
medical provider. If you have not had a conversation about your antidepressant
therapy in the last 6 months, it may be time to give your medical provider a nudge
and discuss the risks and benefits of use

24
 4. Do you find antidepressant use helpful?
a. No, not really
b. Unsure
c. Yes, only a little though
d. Yes, they’re significantly helpful
If you've been taking antidepressants for an adequate amount of time and at least
the minimum effective dose then you should be getting a benefit from
antidepressant therapy. Unclear benefits or lack of benefits should be a signal that
therapy requires re-evaluation

5. Do you have side effects to your antidepressant?

a. No, not that I’m aware of
b. Yes, but they are mild and I don’t mind
c. Yes, they are bothersome
Side effects range in whether they are present and how bothersome they are.
When side effects are absent, there is less incentive to change therapies. When
side effects are mild and tolerable, an attempt at managing them can preserve
benefits of therapy. When side effects are bothersome, they need to be addressed
as minimizing problems is an important part of successful therapy.

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 6. I have found alternative ways of coping or managing my struggles since
starting antidepressants
a. Disagree
b. Neutral
c. Agree

There is a real chance that symptoms of the original illness will return after some
time when discontinuing an antidepressant. Having done the hard work of finding
and utilizing effective alternative ways to cope with struggles improves chances of
staying well off antidepressants.

7. I have addressed ways I used to cope that were negative for my health
since starting antidepressants (e.g. excessive alcohol use, overeating etc.)
a. Disagree
b. Neutral
c. Agree

There is little data to suggest that antidepressants effectively treat substance use
disorders (except for bupropion for quitting cigarettes), however substance use
and the negative aspects of coping with substances can be large factors in
depression, anxiety, PTSD, and other psychiatric conditions. When negative coping
mechanisms have been addressed, there are better chances of staying well off of
antidepressants in the future. Re-emergence of negative coping mechanisms is
also an important aspect of monitoring and planning interventions for if
attempting antidepressant taper and discontinuation.

26
 8. I’ve had significant personal growth or changes in my life circumstance
since starting antidepressants
a. Disagree
b. Neutral
c. Agree
When persons have undergone significant personal growth or their life
circumstances have changed such that many of the pressures or stresses that
made them feel unwell are no longer present, it may be more reasonable to
consider an attempt at tapering and discontinuation of antidepressants

9. I’ve experienced bothersome withdrawal symptoms when trying to lower

the dose of my antidepressant previously
a. Disagree – It’s not an issue
b. Unsure – Never tried to decrease dose
c. Agree – it’s noticeable but manageable
d. Strongly Agree – It’s severe or very bothersome

Withdrawal symptoms are variable among individuals and even among

antidepressant agents. Unfortunately, many persons remain on their
antidepressants simply because they fear the withdrawal symptoms or do not feel
their medical provider has the expertise to help them taper safely and successfully.
Continuing antidepressants in order to simply avoid withdrawal symptoms is a
poor reason to stay on them overall and additional help, information, or resources
on how to taper antidepressants may be necessary for success.

27
 10. I experience chronic or severe symptoms (e.g. attempted suicide,
hospitalized for psychiatric reason, symptoms that are difficult on an
ongoing basis)
a. Disagree
b. Agree

Symptoms such as suicidal ideation, suicide attempt, hospitalization for psychiatric

reasons, or severe and chronic symptoms of illness signals that treatment is more
urgent. Data suggests that when symptoms are chronic or severe, antidepressants
may provide benefits or be indicated to be used for longer than a standard course
of therapy. Additional monitoring, planning and support is required if therapeutic
changes are being considered.

11.Ultimately, antidepressants have brought me closer to achieving my goals

regarding my mental health
a. Agree
b. Disagree
All things considered; mental health treatments should move you closer to your
therapeutic goals. If they aren't and you've really given them a 'good try' then it
may be time to consider other modalities that may help you achieve your goals.

28
 12.Which of the following do I have in place for my support network if I were
to attempt tapering and discontinuing antidepressants? (select all that
apply)
a. Prescribing provider
b. Therapist or counselor
c. Peers tapering antidepressants
d. Coach or trainer
e. Alternative medicine practitioner
f. Information resources on tapering
g. Tapering plan and monitoring strategy
h. Love ones and friends
i. Other ____________
At minimum, a supportive prescriber is necessary to attempt tapering and
discontinuing antidepressants. However, there is a whole lot more out there that
could be directly beneficial, a welcome distraction, or helpful in supporting and
coping with the turbulence of antidepressant tapering and discontinuation.
Exploring and planning these options ahead of time is a critical factor in long term
success of antidepressant tapers.

Reflection on Readiness:
After answering the questions, reflect upon the answers and record your thoughts
about the antidepressant course of therapy you have undergone so far. If feeling
ready or considering a change to medication share the results and discuss with
your supervising provider:

29
References
1. Taylor MJ, Freemantle N, Geddes JR, Bhagwagar Z. Early Onset of Selective Serotonin Reuptake Inhibitor
Antidepressant Action: Systematic Review and Meta-analysis. Arch Gen Psychiatry. 2006;63(11):1217–
1223. doi:10.1001/archpsyc.63.11.1217
2. Hu XH, Bull SA, Hunkeler EM, et al. Incidence and duration of side effects and those rated as bothersome
with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician
estimate. J Clin Psychiatry. 2004;65(7):959-965. doi:10.4088/jcp.v65n0712
3. Gelenberg, AJ, Freeman, MP, Markowitz, JC, et al. American Psychiatric Association Practice Guidelines for
the Treatment of Patients With Major Depressive Disorder. American Psychiatric Association. 2010.
doi:10.1176/appi.books.9780890423387.654001
4. Haddad PM. Antidepressant discontinuation syndromes. Drug Saf. 2001;24(3):183-197.
doi:10.2165/00002018-200124030-00003
5. Sinyor, M., A. Schaffer, and A. Levitt. 2010. 'The sequenced treatment alternatives to relieve depression
(STAR*D) trial: a review', Can J Psychiatry, 55: 126-35.
6. Fava GA, Gatti A, Belaise C, Guidi J, Offidani E. Withdrawal Symptoms after Selective Serotonin Reuptake
Inhibitor Discontinuation: A Systematic Review. Psychother Psychosom. 2015;84(2):72-81.
doi:10.1159/000370338
7. Henssler J, Heinz A, Brandt L, Bschor T. Antidepressant Withdrawal and Rebound Phenomena. Dtsch
Arztebl Int. 2019;116(20):355-361. doi:10.3238/arztebl.2019.0355
8. Cosci F, Chouinard G. Acute and Persistent Withdrawal Syndromes Following Discontinuation of
Psychotropic Medications. Psychother Psychosom. 2020;89(5):283-306. doi:10.1159/000506868
9. Groot PC, van Os J. How user knowledge of psychotropic drug withdrawal resulted in the development of
person-specific tapering medication. Ther Adv Psychopharmacol. 2020;10:2045125320932452. Published
2020 Jul 10. doi:10.1177/2045125320932452
10. Scholten W, Batelaan N, Van Balkom A. Barriers to discontinuing antidepressants in patients with
depressive and anxiety disorders: a review of the literature and clinical recommendations. Ther Adv
Psychopharmacol. 2020;10:2045125320933404. Published 2020 Jun 10. doi:10.1177/2045125320933404

30
Pre-Taper Reflection and Support
Planner

Benjamin Malcolm, PharmD, MPH, BCPP

SPIRIT PHARMACIST
Pre-Taper Reflection
Take some time to reflect and respond to the following questions prior to beginning an
antidepressant taper. The answers to your reflection can identify strengths or assets you have
to aid in your success or weaknesses that can inform further support planning. Tapering
antidepressants and managing life without them is a process of transformation – you can
expect turbulence or obstacles and will likely need to make other life changes for long-term
success. Charting your course, taking inventory of your tools and support, and approaching the
process as an opportunity for growth can be game changers.

1. What are your biggest underlying reasons or motivations for considering antidepressant discontinuation?

2. Are you ready to undergo a process that could be challenging or emotionally difficult at times? What makes
you ready now?

31
3. Are you willing to make other lifestyle changes or engage with additional treatment in conjunction with
antidepressant tapering to facilitate the process? What modalities may be most useful for you?

4. Do you have the ability for extra flexibility in work, family, or other responsibilities and obligations to give
yourself a little more ‘space’ during the taper process? Could this be arranged ahead of time?

5. What kinds of thoughts, emotions, or behaviors occur when your symptoms are worsening? What could be
done to pro-actively address them?

32
 6. What additional support tools are you planning on leveraging to succeed? Is the plan in place and ready?

7. What is my plan if crisis emerges? Who will I contact? What will define a crisis for me?

Support Planner
Now that you’ve taken the time to reflect on the taper process it’s time to organize your
resources and plan your support. Tapering antidepressants could present challenges and the
preparation you put in here can pay dividends down the line when the road gets difficult.
Undergoing this process is an opportunity to assess and improve all areas of your life. It makes
sense that continued work is likely necessary for long term success!

33
Consider each of the life sectors and examples below. Use the space to list your plan for the
area. After finishing the support planner be sure to make appointments, block off calendar
time, and make other arrangements needed for success.

Support Planner
Professional Alternative
Psychiatrist, psychologist, mental health provider Aromatherapist, acupuncturist, naturopath, chiropractor
etc.

Physical Diet
Outdoor activities, exposure to nature, exercise, sports, Healthy meal plan, nourishing foods, watching for
yoga or other mind-body practices emotional eating, limitation of junk foods, intermittent
fasting etc.

Pharmacologic Daily relaxation and self-work

Other medications, and plans for use while taper is in Meditation, reading, journaling, avoidance of screen time
progress or media content, gratitude ritual

Connection Soul-warming
Social activity with friends, family, or partner. Attending Volunteering, giving, engagement with causes of passion
support groups, community center, library, meet-ups

34
Organization and Accountability Creative or Hobby
Life coach, personal trainer Painting, gardening, drawing, coloring, pottery

35
Daily Antidepressant Withdrawal and
Mood Tracker

Benjamin Malcolm, PharmD, MPH, BCPP

SPIRIT PHARMACIST
Within this packet you will find materials to monitor antidepressant withdrawal reactions,
mood, anxiety, and sleep patterns as you take a step down in dose of your antidepressant over
the course of one month.

Directions:
1. Complete a page of the packet for each day of the month in the evening time
2. Review the information you record daily and plot a monthly dashboard. You can do this
day by day as you go or on a weekly basis
3. Use the information you have collected to understand your individual response to taking
a step-down dose of your antidepressant
4. Meet with your provider to discuss what you have learned and plan subsequent steps of
your taper

Suggested Interpretation
The goal of tapering is to decrease the dose slowly over time to minimize withdrawal
reactions, preserve stability in mental health, and increase the chances of learn term success
off of antidepressants. Daily withdrawal scores rating moderate or high as well as depression
or anxiety scores 7 and above likely indicate serious difficulty and interpreted as warning
signals that an intervention is necessary (e.g. temporarily increasing dose, seeking out help
from prescriber or therapist etc.)

Disclaimer: This packet is not medical advice. It is recommended to taper antidepressants in

conjunction and under the guidance of the prescriber provider

***If you experience any sudden suicidal thoughts, thoughts of self-harm or harming others;
please visit the nearest emergency services facility or call the Suicide Prevention Lifeline at 1-
800-273-8255 for immediate help***

36
Daily Check-in: Day 1 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

37
Daily Check-in: Day 2 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

38
Daily Check-in: Day 3 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

39
Daily Check-in: Day 4 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

40
Daily Check-in: Day 5 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

41
Daily Check-in: Day 6 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

42
Daily Check-in: Day 7 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

43
Daily Check-in: Day 8 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

44
Daily Check-in: Day 9 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

45
Daily Check-in: Day 10 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

46
Daily Check-in: Day 11 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

47
Daily Check-in: Day 12 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

48
Daily Check-in: Day 13 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

49
Daily Check-in: Day 14 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

50
Daily Check-in: Day 15 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

51
Daily Check-in: Day 16 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

52
Daily Check-in: Day 17 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

53
Daily Check-in: Day 18 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

54
Daily Check-in: Day 19 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

55
Daily Check-in: Day 20 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

56
Daily Check-in: Day 21 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

57
Daily Check-in: Day 22 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

58
Daily Check-in: Day 23 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

59
Daily Check-in: Day 24 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

60
Daily Check-in: Day 25 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

61
Daily Check-in: Day 26 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

62
Daily Check-in: Day 27 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

63
Daily Check-in: Day 28 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

64
Daily Check-in: Day 29 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

65
Daily Check-in: Day 30 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

66
Daily Check-in: Day 31 Date: _______ Days since dose change: _______ Current dose and directions: _______

Antidepressant Withdrawal Tracker

Check the box next to the symptom category; you may also circle specific symptoms that are bothersome
Flu-Like Symptoms
Aches and pain in the body, fatigued,
chills, headache
Gastrointestinal Symptoms
Cramps, diarrhea, nausea, or vomiting
Aggression or Irritability
Feeling restless, impulsive, agitated
Sleep Disturbances
Insomnia, nightmares, intense and
vivid dream
Abnormal Sensations
Electric shocks, brain zaps, tingling or numbness, changes to
smells or tastes, ringing in the ears, sensitivity to light or sound
Emergent Symptoms
Excessive energy, mania, visual or auditory hallucination, suicidal
or homicidal thoughts
Changes to Movement
Dizziness, motion sickness, unsteady movement, difficulty
speaking, unusual movements of mouth
Other
Sweating, confusion, memory problems, or __________

Global Antidepressant Withdrawal Rating

Based on how you responded above and the severity of what you’re feeling, please rate the withdrawal for today by
circling the option that best describes how you’re doing.
No withdrawal Minimal Some withdrawal Moderate Moderately Severe
withdrawal withdrawal severe withdrawal
withdrawal

“I don’t feel “I have one or “I’m feeling “I’m struggling, “This is awful, I “This is an
anything two things I can bothered by I’m not sure if I need to do emergency; I’m
different” notice, but withdrawal but can continue with something else having a mental
they’re mild” tolerating it ok” this much longer” now” health crisis”

Depression Rating Please circle a value between 0 and 10 where a score of 0 indicates no depressed symptoms and
10 indicates symptoms of severe depression. Examples of depression symptoms include low mood, tearful, low
energy, difficulty concentrating, appetite changes, sleep changes, or thoughts of self-harm and suicide
0 1 2 3 4 5 6 7 8 9 10

Anxiety Rating Please circle a value between 0 and 10 where a score of 0 indicates being calm and 10 indicates feeling
severe anxiety. Examples of symptoms of anxiety include feeling on edge or stressed, racing heart, feeling panicked
or short of breath, muscle tension.
0 1 2 3 4 5 6 7 8 9 10

How many hours did you sleep last night? __________

Notes about today – please describe anything else you did or happened that impacted you:

67
Monthly Antidepressant Taper
Dashboard

Benjamin Malcolm, PharmD, MPH, BCPP

SPIRIT PHARMACIST
Use the results from your ‘Daily Antidepressant Withdrawal and Mood Tracker to summarize
your month

Within this packet you will find materials to monitor antidepressant withdrawal reactions,
mood, anxiety, and sleep patterns as you take a step down in dose of your antidepressant over
the course of one month.

Directions:
1. Use the daily results from the ‘Daily Antidepressant Withdrawal and Mood Tracker to
summarize your month
2. Plot your daily results for withdrawal, mood, anxiety, and sleep
3. Use the information you have collected to summarize your individual response to taking
a step-down dose of your antidepressant
4. Meet with your provider to discuss what you have learned and plan subsequent steps of
your taper

Suggested Interpretation
The goal of tapering is to decrease the dose slowly over time to minimize withdrawal
reactions, preserve stability in mental health, and increase the chances of learn term success
off of antidepressants. Daily withdrawal scores rating moderate or high as well as depression
or anxiety scores 7 and above likely indicate serious difficulty and interpreted as warning
signals that an intervention is necessary (e.g. temporarily increasing dose, seeking out help
from prescriber or therapist etc.)

Disclaimer: This packet is not medical advice. It is recommended to taper antidepressants in

conjunction and under the guidance of the prescriber provider

68
 ***If you experience any sudden suicidal thoughts, thoughts of self-harm or harming others;
please visit the nearest emergency services facility or call the Suicide Prevention Lifeline at 1-
800-273-8255 for immediate help***

Dose adjustment log: Summarize any dose adjustments that occurred over the month

Dose: Date:

Dose: Date:

Dose: Date:

Dose: Date:

Dose: Date:

Global Antidepressant Withdrawal Rating: Plot your antidepressant withdrawal rating from the ‘Daily Antidepressant
Withdrawal and Mood Tracker’

Severe withdrawal

Moderately severe withdrawal

Moderate withdrawal

Some withdrawal

Minimal withdrawal

No withdrawal

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Day of the month

69
Depression: Plot your daily depression rating from the ‘Daily Antidepressant Withdrawal and Mood Tracker’
10
9
8
Depression rating

7
6
5
4
3
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Day of the month

Anxiety: Plot your daily anxiety rating from the ‘Daily Antidepressant Withdrawal and Mood Tracker’

10
9
8
7
Anxiety rating

6
5
4
3
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Day of the month

Sleep: Plot the amount of sleep you had from the ‘Daily Antidepressant Withdrawal and Mood Tracker’

70
 14
13
12
11
10
9
Hours slept

8
7
6
5
4
3
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Day of the month

Reflection on the month – Now that you can see your antidepressant withdrawal response alongside your
overall mood, anxiety, and sleep pattern you can plan your next dose decrease. Some things to consider:

1. Am I back to a place close to baseline? If not, you may not be ready to take another step-down yet

2. Should I consider a smaller dose decrease next time? If moderate withdrawal experienced with
previous decrease or nearing the end of the taper and experiencing more difficulty it is reasonable to
consider slowing down the taper

3. What interventions should I plan for next month given I know my pattern and when to anticipate
difficulty? For example, I noticed intense anxiety in days 5-10, I plan to schedule some extra down time
for myself and make an appointment with my therapist for day 7 on my next step-down

71