While some people can discontinue antidepressants without problems, some individuals have difficult withdrawals, and some particular drugs seem harder to withdraw from.
My personal experience is that what follows a sentence that begins “The truth is…” is usually not the truth. But after making my way through the long feature article about withdrawal from antidepressants in the New York Times on Saturday, April 7, I was overjoyed to read those words in no little part because I thought they really did lead up to what for me has been the truth of a quarter-century on and off antidepressants.
Near the end of “Many People Taking Antidepressants Discover They Cannot Quit,” by Benedict Carey and Robert Gebeloff, the authors quote Dr. Derelie Mangin, a family medicine professor at McMaster University in Hamilton, Ontario. She said:
“The truth is that the state of the science is absolutely inadequate. We don’t have enough information about what antidepressant withdrawal entails, so we can’t design proper tapering approaches.”
Over the years I’ve had countless talks with friends and acquaintances dealing with depression—some of those talks constituting the best treatment my ongoing depression got—that tell me that there is no one size fits all answer to questions about getting on, staying on, and getting off antidepressants.
Before we proceed, let’s stop a moment with those words “getting off.” In common parlance, the phrasal verb suggests a high and likely pleasurable, even ecstatic, experience with something intense, and more often not a drug.
If you think some version of the idea that “antidepressants are happy pills,” or that stopping taking them is consequence-free, you may want to stop reading here, or read on for some dissenting ideas and experiences.
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What I realized long before I finished reading the Times story—which I strongly recommend—is that in my case there were some thing I had to “get off” my chest. Not that I haven’t spoken them to individuals. This is their debut in a public forum.
For starters, if you think antidepressants are “happy pills,” your view is so far outside that of people with depression and their experience with medication(s), I’d be tempted to respond with one of text language’s four-letter words. Instead, I’ll say: Read on, or don’t, but I don’t even want to see your lips moving.
And you’re going to have to take my word for it for now that what follows is the shortest account of my experience that I could make while remaining coherent, and that I consider it nothing more global than my own personal experience. Deal?
My first year in a well-known recovery program were so good for me, and I felt so good, that my long-lasting “pink cloud” was alienating my best friends in recovery. I was 100% “on the natch” and elated most of the time. I tremble now to think how obnoxious I must have been.
Year two saw the emergence of some non-situational anxiety—the kind they call “free-floating,” which is the opposite of what people with it feel it as—with some intermittently demobilizing depression hard on its snapping heels. My daily commute to work was across the Gold Gate Bridge, and every day I thought of jumping because it seemed the most comprehensive solution. I was, by that point, jumpy as hell, and I did not want to be alive.
My San Francisco physician—who has remained the one consistent voice that has helped me through the following quarter-century—diagnosed clinical depression and prescribed Prozac, and talk therapy with someone qualified. Leaving out a lot here, I did just that.
In what I thought might have been a conspiracy, my doctor and therapist, both women, talked. Conferred, really; both were busy and neither a gossip. When I finally made it to the couch (sitting up), my therapist assured me that she would not have taken me if I had not been on an antidepressant. Oh.
The two consistent qualities of my seven years of therapy were its professionalism and its fundamental politeness. The only time my therapist and I even interrupted each other in all those years was at my year-and-half point with the Prozac—whose sole, then-welcome side effect was the demolition of my libido (no “getting off” for this guy, which was fine by me)—we both chimed in with “maybe it’s time to try going off.”
I asked her how and she said, just stop. “The same way it took a month for you to get the effects, its half-life will be about that long and self-regulating.” The only withdrawal symptom I had was a slight loss of the gained weight. I once again became a near irritant to friends in the program who also wanted to “go off,” though I couldn’t see why if it was working. Still, they confided that they’d tried and couldn’t and felt either frustration or shame, or both.
One of them later went off cold turkey and killed herself. I learned not to generalize from my own experience.
Ten years later—now living halfway around the world from doctor and therapist—I fell into another, initially less agitated depression. I did not trust the Bangkok resources (rightly, at the time, but that's changed) and got through, such as I did, talking on the phone with a similarly depressed old and great friend.
I was now in another recovery program that forbade antidepressants, but I saw myself approaching the brink. Prozac is over the counter here (as I believe it should be everywhere; it’s demonstrably non-addictive, which is a separate issue from teh difficulty some people have with "discontinuance"), but I was sure that by now it was passé, that better meds had taken its place. My friend was taking teh Effexor, so I marched off to the local hospital psychiatrist, asked what he thought about Effexor (“good mood,” he said) and started taking it as soon as the prescription was filled.
It was great until it wasn’t. At pretty much the same time, my friend and I were having spikes of acute anxiety that were clearly related to taking Effexor, reliably peaking a half-hour or so after ingestion, then not tapering off much. I was horrified when my friend said he had resorted to a “technique” many people in the Times article have talked about.
He was taking the capsules apart and throwing out some of the white and green little balls. Sometimes the white ones, sometimes the green ones, with no difference in effect. Eventually, his steadily lowering count of the little buggers no longer discriminated by color. I knew my latent OCD was not the equal of that “plan.”
I assumed that what my therapist had said about the Prozac—which bore out—applied to all antidepressants, so I stopped cold turkey, sweating turkey rather, but that seemed a separate matter. As luck would have it, I was also seeing a superb Chinese medicinalist at the time—who was, if anything, more eager than I was for me to go off the Effexor—and he put me on a concoction that stopped the withdrawal symptoms cold.
When, months later and back in San Francisco on holiday, I told my doctor there that I had quit Effexor without tapering off, she was, uncharacteristically, speechless. Once she collected herself, she said, “You have no idea how lucky you are.”
Without lecturing me, she reminded me that I had had success with Prozac, and yes it was still on the market, that being because it still worked for a lot of people. She predicted that I wouldn’t get through the rest of my life without a relapse into depression and counseled me to go back on Prozac when I knew it was time—and to be prepared for the possibility that I might be on it “for life. The only thing wrong with that is your resistance to the idea.”
And so it has turned out. DO NOT GENERALIZE FROM MY EXPERIENCE, whatever you do. But because it has been my experience, I’m willing to believe that it counts.
What I think about my experience
I’m not a doctor, but I do pay attention and sometimes even listen to doctors who have been consistently right and only helped me. I saw myself popping up here and there throughout the Times tory. My takeaways at the moment are:
Thanks for sharing. Now what did the Times say?
The Times article addressed so many issues, substantively, that it’s well worth a read. Cumulatively, its message rings true to mine in the single respect that different people have different experiences getting on and off antidepressants. That for some of them getting off is hard, sometimes hard to the point of unmanageable. That it’s nothing you should try at home alone, kids. And that the area warrants far greater attention from the specialists.
And, finally, that some people get through withdrawal much as I did from Effexor, by getting and staying in touch with others going through the same things. There are user groups and message boards all over the internet you may find immensely helpful—if you take what you read there as support, if you regard everything as an individual’s experience, and if you not make an online group your personal physician.
Other things from the Times
A huge proportion of the developed-world population, perhaps as much as a fifth, is currently taking antidepressants. Studies of “extended use,” or "open-ended use," increasingly the norm, are few and insufficient. Drug labels, on which both patients and many doctors rely, rarely provide guidance on discontinuance.
Most of the antidepressants in wide and current use have not been studied for their long-term effects or the effects of their being taken long-term. Compared to the treatment options of a half-century ago, these new, still-developing drugs are a godsend. But almost all of them were developed with the idea that they would be taken for short periods, i.e., months rather than years, to get people through crises of depression.
Large portions of the public are taking antidepressants because they are prescribed and taking them as directed. Be that as it may, sometimes they remain on these medications less because that’s indicated than because so little is known about either their long-term effects or appropriate and effective detoxing strategies. In the case of something as terrifying—and clingy—as depression, there are “reasons” both doctors and their patients are only too happy to kick the can of discontinuing them down the road.
There’s a new name for antidepressant withdrawal: “discontinuation syndrome.” The scientific-sounding name disguises the fact that antidepressant withdrawal has typical, even predictable features and aspects, none of which feels in the least abstract or clinical.
The common features/symptoms of antidepressant withdrawal include:
(Note that these are symptoms of withdrawal from many medications.)
Some particular drugs, and drugs by some particular drug makers, seem harder to stop than others. (Many brands are referred to in this lay-reader-friendly article.)
Some antidepressants have half-lives sufficient that stopping them all at once is feasible, if not advised in every case. Some antidepressants clearly need to be tapered off, and people withdrawing from them often complain that the prescribed tapering-off period is too sort and abrupt, causing difficult if not impossible withdrawal.
Some things the Times writers say (verbatim, and pretty much in order)
“Many, perhaps most, people stop the medications without significant trouble. But the rise in longtime use is also the result of an unanticipated and growing problem: Many who try to quit say they cannot because of withdrawal symptoms they were never warned about” …
“Some scientists long ago anticipated that a few patients might experience withdrawal symptoms if they tried to stop — they called it “discontinuation syndrome.” Yet withdrawal has never been a focus of drug makers or government regulators, who felt antidepressants could not be addictive and did far more good than harm.”
“[T]he medical profession has no good answer for people struggling to stop taking the drugs — no scientifically backed guidelines, no means to determine who’s at highest risk, no way to tailor appropriate strategies to individuals.”
“Still, it is not at all clear that everyone on an open-ended prescription should come off it. Most doctors agree that a subset of users benefit from a lifetime prescription, but disagree over how large the group is.”
“Antidepressants are not harmless; they commonly cause emotional numbing, sexual problems like a lack of desire or erectile dysfunction and weight gain. Long-term users report in interviews a creeping unease that is hard to measure: Daily pill-popping leaves them doubting their own resilience, they say.”
“The few studies of antidepressant withdrawal that have been published suggest that it is harder to get off some medications than others. This is due to differences in the drugs’ half-life — the time it takes the body to clear the medication once the pills are stopped.”
“At least some of the most pressing questions about antidepressant withdrawal will soon have an answer.”
What experts quoted in the Times had to say
“It has taken a long, long time to get anyone to pay attention to this issue and take it seriously. You’ve got this huge parallel community that’s emerged, largely online, in which people are supporting each other though withdrawal and developing best practices largely without the help of doctors.”
(Luke Montagu, a media entrepreneur and co-founder of the London-based Council for Evidence-Based Psychiatry)
“Some people are essentially being parked on these drugs for convenience’s sake because it’s difficult to tackle the issue of taking them off. Should we really be putting so many people on antidepressants long-term when we don’t know if it’s good for them, or whether they’ll be able to come off?”
(Dr. Anthony Kendrick, a professor of primary care at the University of Southampton in Britain.)
“What you see is the number of long-term users just piling up year after year.”
(Dr. Mark Olfson, a professor of psychiatry at Columbia University)
“There is a cultural question here, which is how much depression should people have to live with when we have these treatments that give so many a better quality of life. I don’t think that’s a question that should be decided in advance.”
(Dr. Peter Kramer, psychiatrist and author of several books on antidepressants)
“We’ve come to a place, at least in the West, where it seems every other person is depressed and on medication. You do have to wonder what that says about our culture.”
(Edward Shorter, historian of psychiatry at the University of Toronto)
Technical papers cited in the Times: