Weaning off Antidepressants: The Do’s and Don’ts
If things seem a little down lately it's not your imagination. Covid saw the world’s depression and anxiety levels rise by up to 25% in the first year. In the aftermath, 13% of the US is on antidepressants. The causes are manifold: financial hardship, social issues, and a pandemic hangover are just a few of the major ones.
Most antidepressants fall under the category of SSRIs (selective serotonin reuptake inhibitors). In short they work by increasing the amount of serotonin absorbed by the brain. Serotonin is one of the naturally occurring chemicals that helps us feel “good” or “ok.”
Antidepressants might help people get back on track, but do all patients need to stay on them indefinitely? Many don’t want to be permanently dependent. There are indeed side effects. Women may want to quit for a pregnancy, others may quit because of weight gain issues, the expense of the medication, sexual dysfunction, sleep disruption…and some may simply want to live med-free.
The first step is identifying whether ceasing antidepressants works for an individual patient. There are two general situations that may first be considered: is the patient’s depression episodic or chronic?
When and how to get off antidepressants
Chronic depression is biological, often hereditary. In this case, it may be harder to taper off medications because the depression results from a static imbalance of chemicals in the brain. Weaning can sometimes be successful, but it must be monitored extra closely.
Episodic depression is a different story. This type of depression is caused by an event or circumstance that triggered it in an otherwise non-depressed person. The episode usually lasts 3-6 months before starting to dissipate.
In the case of episodic depression a patient can wean off eventually. But stopping suddenly can cause what’s known as antidepressant discontinuation syndrome. It leaves sufferers dizzy, anxious, and shaky. Even when a depressive episode would have otherwise subsided, some patients become dependent on the medication and fear what would happen if they stopped. In fact the mental health impact of stopping right away can be as bad as the original depression.
Stop antidepressants with the help of your doctor, and never stop suddenly
A psychiatrist should assess each situation since every person is different but in all cases there is tapering to some extent. This means gradually reducing the dose - usually over the course of several months.
An interview with a psychiatrist will help determine what a patient’s near-future holds. For example, reducing antidepressants before stressful events like weddings, funerals, or similar occasions might be counterproductive. Then a doctor may want to consider the patient's progress before ending the regimen. The types of medication should also be considered (e.g Prozac, Paxil, etc.) A trusting relationship with one’s psychiatrist is vital to successful medication management.
When done properly many patients don’t relapse after weaning off antidepressants.
Red flags to watch out for when tapering include digestive and sleep irregularities, loss of movement control, unwanted feelings/intrusive thoughts, and strange physical or mental sensations.
Therapy can help patients through the weaning process and help them face the fear of becoming med-free. But sometimes it just means the time isn’t right yet to stop.
Advice for getting through the weaning process is basic but focused on creating the best mental and physical environment for becoming medication-free.
A consistent and restful sleep schedule will help your mind stay clear and vital.
A good diet will allow your bodily systems to work smoothly, so you feel your best during the process.
Exercise, while being generally good along with proper nutrition, is also known to increase serotonin and might help the mental health effects of tapering.
A good therapist can help you develop cognitive techniques and perspective that keep the spirits lifted when things get difficult.
Time itself is important when weaning off antidepressants. It takes patience to wait until it’s time to begin tapering, and then patience again because tapering doesn’t happen overnight.
Finally, professional help from a trusted psychiatrist will be needed. Please rely on expert knowledge and don’t try stopping antidepressants on your own.
Bregman Medical Group has decades of experience treating depression, anxiety, and many other related or common disorders. We offer psychiatry and therapy conveniently to your device! Simply schedule an appointment at www.bregmanmd.com or call 305-740-3340.
References: