Deprescribing Digest – Issue #4: The Science – Withdrawal vs. Relapse

“Withdrawal is the horse; relapse is the zebra.” – Mark Horowitz, MD

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Hi everyone—Tonia here.

Welcome to Deprescribing Digest Issue #4. In Issue #3, we explored hyperbolic tapering—the biology-respecting method of 10% reductions of your *current* dose. This week, we tackle one of the most frustrating and harmful confusions in deprescribing: mistaking withdrawal symptoms for relapse of the original condition.

This common misdiagnosis keeps far too many people on these drugs longer than necessary, often leading to higher doses, new medications, feelings of failure, and confusion. Understanding the difference empowers you to advocate for yourself and taper with confidence.

Why the Confusion Happens

Many withdrawal symptoms overlap with anxiety, depression, or insomnia—the very reasons people were prescribed antidepressants in the first place. Doctors are trained to watch for relapse but often receive little education on withdrawal. As a result, symptoms that appear after a dose reduction are frequently labeled “your depression coming back” instead of being recognized as the brain adjusting to the change in medication.

Key Ways to Distinguish Withdrawal from Relapse

According to research by Mark Horowitz and others, here are the main clues:

Timing: Withdrawal symptoms often start within days (sometimes 1–7 days) after a dose reduction or cessation, though they can be delayed by weeks. Relapse tends to emerge more gradually, weeks to months later.

Symptom Pattern: Withdrawal frequently follows a wave-like pattern—onset, peak intensity (often within 1–2 weeks), then gradual resolution often taking weeks to years. It may include distinctive physical symptoms not present in your original condition, such as:

• Brain zaps (electric shock sensations)

• Dizziness or vertigo

• Flu-like feelings

• Nausea

• Akathisia (inner restlessness or agitation)

• Profound insomnia or sensory hypersensitivity

• Withdrawal often mixes psychological symptoms (anxiety, low mood, irritability) with physical or unusual ones. If symptoms include things you never experienced before starting the drug, withdrawal is more likely.

Withdrawal can also be delayed or come in waves long after stopping, especially in protracted cases—something rarely discussed in standard guidelines.

Featured Voices on This Topic

• Mark Horowitz, MD (psychiatrist and researcher): After his own severe withdrawal, he emphasizes that “withdrawal is the horse and relapse is the zebra.” His work in The Maudsley Deprescribing Guidelines (2024) and in papers on receptor occupancy helps clinicians and patients distinguish between the two.

• Adele Framer & SurvivingAntidepressants.org community: Thousands of real-world tapers show that slow, hyperbolic reductions dramatically reduce misdiagnosis and protracted suffering.

• Angie Peacock, MSW: Her practical videos and writings highlight how withdrawal can mimic new or returning disorders—and how to navigate the emotional side without panic.

Practical Tips to Protect Yourself

• Track symptoms daily (timing, severity, physical vs. mood-only) before and after any dose change.

• Use small reductions (10% of current dose) and hold long enough to observe the pattern.

• If intense symptoms appear, consider a small reinstatement or hold rather than assuming relapse.

• Share a clear symptom timeline with any healthcare provider—include pre-drug history and what changed after dose adjustments.

• Lean on peer communities for validation when medical support falls short.

Resources

• The Maudsley Deprescribing Guidelines* by Mark Horowitz & David Taylor

• Horowitz’s article: “Distinguishing Relapse from Antidepressant Withdrawal” (BJPsych Advances)

• SurvivingAntidepressants.org – symptom tracking and thousands of case histories

• The Withdrawal Project (Inner Compass Initiative) – free guides and symptom libraries

• Angie Peacock’s YouTube channel (@AngiePeacockMSW) – real stories on withdrawal vs. relapse

Withdrawal is not a moral failing or proof that you “need” the drug forever. It’s your nervous system adapting. With the right information and support, many people move through it and reclaim stability without returning to long-term medication.

Which clue for distinguishing withdrawal from relapse resonates most with your experience—or what question do you still have? Reply and share (anonymously if you prefer). I’ll address common ones in future issues.

Stay fierce,

Tonia

lifewithantidepressants.com | Read my Personal Essay on Mad in America

*P.S. Issue #5 is coming: Practical Support Tools & Peer Communities. Subscribe if you haven’t!