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The good, the bad, and the ugly of coming off antidepressants

The world has changed a lot in the three and a half years since I started taking antidepressants. I’ve changed a lot, too.

Like most people who are prescribed medication to manage their mood, taking selective serotonin reuptake inhibitors (SSRIs) — a type of antidepressant — was never really my Plan A. Nor was it my plan B, or even C. it was more like a Plan Z — after all other options had been exhausted.

And I was exhausted, too. Crippled by acute anxiety, sleeplessness, intense panic attacks, and unable to cope with even the most basic of my day-to-day responsibilities, SSRIs looked like a raft to safety. 

But like many other people I feared that once I began taking them I’d never be able to stop – that I’d become dependent. That I wouldn’t be able to function without them. It is only now that I feel ready to confront that fear head on – so this month I decided to finish my prescription for the last time. 

My life has changed so dramatically and in such a positive way since I began taking them that I had started to wonder. Had I really changed all that much? What was down to me and what was down to the drugs? 

What started as a small curiosity soon felt much more like a burning question. Added to that was the side effects of the drugs, which though not life-altering, I’d prefer not to experience if I don’t need to. These included lethargy, weight gain, jaw grinding and issues reaching orgasm. 

They were tolerable, and small sacrifices for being able to live a full and healthy life — but I wanted to feel energised again.

While SSRIs protected me from the intensity of the shocks and blows of life, they also had the same blunting effect on the highs. After meeting someone during lockdown (I know) and suddenly being in the throes of a new romance, I felt ready to be more present with my feelings. I wanted to make sure I experienced them in all of their colour, depth and intensity.

When I began taking antidepressants, there was no doubt that I needed help. After being sent home from work after a particularly dramatic panic attack that caused me to collapse in the middle of my office — I was no longer able to pretend. 

‘You can continue battling this yourself and be patient,’ my GP said to me, ‘and you will feel better eventually…. or you can take these pills and within six weeks things are likely to feel much, much more manageable.’

I was under pressure to return to work and in my desperation, lacking the requisite confidence to even believe I could get better alone — this felt like a glimmer of hope, some relative certainty onto which I could cling. 

And so I took the drugs. I surrendered to the help offered, went back to work alongside regular therapy, and quietly waited to feel the effects.

Things really did get better — not because the pills somehow removed my sadness or anxiety, but because I was finally strong enough to be able to do the work

A lot of people assume that taking antidepressants will make you happy. That you’ll wake up one day and everything will be great without you having had to work for it. It would be nice, wouldn’t it? I didn’t know what to expect, but reasoned that anything would be better than the tortuous panic that had taken over my life.

I can’t speak for everyone, but for me the road to recovery was much, much messier. One of the side-effects that’s less well known to those without personal experience is that in the first six weeks or so of beginning treatment, your symptoms can actually get worse. 

Eventually though, things did get easier. The weight of panic began to lift a little from my chest — although it never truly disappeared. I was able to laugh for the first time in months, to concentrate for long enough that I could begin to vaguely follow the plot of TV shows (although only ones I’d seen before).

I could engage in conversation and hear about other people and challenging things that were going on with them, without then fearing that the same thing would happen to me. But my brain was still alert – like fly paper where new ideas of things to worry about could get stuck and cause me to overthink.

Eventually, CBT – a therapeutic process that helps you to challenge negative thinking patterns and therefore change your emotional responses and behaviour – helped me to get to a place where I could recognise that what was going on with me was more than just a spell of difficult mental health.

This allowed me to feel comfortable enough to get a formal psychiatric assessment, where I was diagnosed with post-traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD) — the latter of which had become a coping mechanism to deal with the former.

My meds were increased and things really did start getting better — but not because the pills somehow removed my sadness or anxiety. It’s because I was finally strong and stable enough to be able to do the work involved to feel better.

They cushioned the blows, but didn’t eliminate them altogether. And staying healthy was – and still is – a lot of work.

I’m being explicit here because – despite progress in our general understanding of mental health as a society – there is still so much misinformation, particularly when it comes to medical intervention and prescription drugs.

Popular culture and mass media have done a lot of damage to the common perception of antidepressants as ‘happy pills’ – and I therefore bear a large amount of responsibility for correcting this, one column at a time.

There’s never a good time to come off antidepressants, but there definitely is a bad time. Many mental health professionals would advise you not to come off them in the winter (particularly in the northern hemisphere), because Vitamin D plays such a huge part in boosting your mood.

You will also be advised to titrate as you come off – which means to slowly reduce your dose over a long period of time to avoid any extreme fluctuations in mood.

There have been three times over the past three years when my plans to come off the meds have been interrupted by stressful life events, either in my personal life  or, most recently, by  the Covid-19 pandemic. 

It’s not that I needed to come off them – many people stay on them forever, and that is up to them and their own needs. It’s an incredibly personal thing and everyone feels different. There’s no ‘one size fits all’.

But there was one morning about a month or so ago, after numerous conversations with my best mate, my doctor and my therapist about whether or not it was the right time, when I suddenly felt ready. And so instead of taking the full dose with my breakfast as usual, I snapped the pill in two and only took half.

I made sure to tell those closest to me so that they could keep an eye on me over the next few weeks as things were likely to get pretty bumpy emotionally.

A month has passed and I feel OK. I don’t feel catatonic, nor jubilant. Just OK.

I’ve felt the return of some intense feelings, for better or worse. I’ve had moments when my emotions feel a lot like looking out the window of an accelerating car as the outside world starts to blur into a mess of indistinguishable colours and shapes. I’ve had moments of crying where I can’t imagine ever feeling less sad. 

I’ve felt the return of some obsessive thinking and been crippled by indecision on a number of occasions. But in each and every such moment, I have used the tools and experience learned over the past few years to steady myself until things begin to feel more solid again.

I don’t know what the future holds, but I do know I’d never rule out going back on antidepressants.

And while I’m excited to close the door on what was an incredibly challenging period of my life and move forward with more awareness and healthier habits – there’s comfort in knowing those little pills would be there if ever I needed a helping hand again. 

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