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Brain zaps are just one of the sensations some long-term users can experience when they discontinue antidepressants.
Inside the leafy grounds of the Ashburn Clinic, a 144-year-old private psychiatric hospital in Dunedin, patients on antidepressants will find something rare in New Zealand.
The non-profit clinic offers what some in the mental health field say is the country’s only deprescribing service for those struggling to come off antidepressants.
That journey, especially if a patient has been on medication for only a few months, can be relatively straightforward, and many patients won’t need a specialist service.
However, for those who have been on an antidepressant for years, it can be perilous, with discontinuation effects ranging from dizziness, body sweats and brain zaps, to symptoms that look a lot like depression: low mood and increased anxiety.
“Really, we have people that come and they say, ‘I do want to get off, but it’s been so incredibly difficult, and you know, can I come off?’” says Marleen van Oeveren, a clinical pharmacist who heads up the clinic’s deprescribing, or tapering service.
“Because sometimes they have the belief that they may not be able to.”
The clinic’s service that started in 2025 points to a growing global conversation around deprescribing from antidepressants. The crux of the conversation is that the medical industry is great at getting increasing numbers of people on these medications without planning an exit strategy for if and when patients no longer require them.
For the last two decades, a grassroots community that lived largely online filled that information and support vacuum. However, support from medical bodies and professionals, like van Oeveren, is starting to bridge that gap.
The Ashburn Clinic, an inpatient and outpatient facility for mental health issues and addiction, already had a light touch when it came to antidepressants. Often, the clinic guides patients to lower doses of the medication, with the idea that side-effects like tiredness and the numbing of emotions are unproductive in dealing with trauma or thought patterns that might have led to depression, says van Oeveren.
“So we're saying, well, actually, we want you to be fully online and to learn to cope with your feelings rather than to sort of put this band-aid on.”
The staff at Ashburn began to realise how difficult it was for patients to move to a lower dose or come off entirely. It organically grew into a separate service, available in person and online, van Oeveren says.
Initially, “we see people for an assessment, sort of trying to tease out why they're having problems [deprescribing]. Is it suitable for them to taper? What might come up for them? What are the risks?”
Van Oeveren then draws up a tapering plan, including how slowly a patient should shrink their dose, which is done over months or even years.
In some European countries, ready-made tapering strips are available to patients deprescribing from antidepressants. No such product exists in New Zealand, van Oeveren says.
Instead, Ashburn uses specialist compounding pharmacists to create capsules of various strengths or turn the antidepressant pill into a liquid, so patients have greater control over dosage at home.
“... that's what the evidence suggests, that good successful tapering requires a slow and flexible approach.”
But all this comes at a cost. An initial assessment is $310, and monthly patient check-ins cost $215. Medication from the compound pharmacy starts at $150 for a three-month supply. Ashburn is currently helping dozens of patients to deprescribe from antidepressants, says van Oeveren.
Recently, the clinic hosted a free information seminar for clinicians and the public on safe deprescribing. The 100 tickets for the event were snapped up within 24 hours.
“There's a lot of interest in this.”
Health New Zealand is not aware of any nationally funded programmes that are focused on deprescribing antidepressants, says Dr Leeanne Fisher, the agency’s national chief of mental health and addiction.
Between 2019 and 2023, the number of New Zealanders on antidepressants grew by 15 percent from about 537,000 to just under 619,000, according to data from Pharmac. It is unclear what the average time is for a New Zealander to take antidepressants. In Australia, patients on average take the medication for about four years.
However, clinical guidelines only support taking them for six to 12 months for “a single episode of major depression”, says Professor Katharine Wallis, a former New Zealand GP who is now at the University of Queensland. She helped develop the RELEASE guidelines, a resource for the public and doctors on safe deprescribing.
Professor David Porter, a psychiatrist from the University of Otago, called the Ashburn Clinic a “very good resource but beyond most people’s financial means”. He is currently supporting several deprescribing patients in his clinical practice, and the logistics of shrinking the dose of antidepressants is difficult.
“I've got patients who are trying to cut tiny little bits themselves or crush them up and weigh them on little micro scales and all sorts of things.”
Cole Robertson, a 39-year-old in Auckland, deprescribed from an antidepressant over three years without medical supervision, using internet forums as a guide. He had previously gone off it cold turkey with disastrous effects that included feelings of electricity in his brain and dizziness.
“It was a traumatising experience,” says Robertson, who was on various antidepressants for 12 years.
He found a local pharmacist in the Auckland suburb of Titirangi who was able and willing to dispense the antidepressant in liquid form, which can make tapering easier. There were a few times he ran out when the pharmacist wasn’t available to compound the liquid, “and I went all around Auckland, and no one knew how to do it”.
Turning a medication into a liquid can be complex, and not all antidepressants can be crushed or turned into a liquid, according to New Zealand pharmacist Rhiannon Braund, who is now a professor at the University of Queensland. It can also be time-consuming, and “the small payment they receive as a dispensing fee doesn't cover anywhere close to the staff time needed”, she wrote in an email to RNZ.
However, “most pharmacists (particularly for their regular patients) will help once they understand the situation, even if they don't fully get paid for it”, Braund wrote.
Dr David Codyre, from the New Zealand branch of the Royal Australian and New Zealand College of Psychiatrists, says there is a much greater focus on prescribing than deprescribing. GPs and psychiatrists need better information and training, but it doesn't need to be “over-complicated”.
“Pharmacists are also an important source of advice about this to patients, because they're obviously dispensing the medicines.
“They'll be fronting questions.”
