How I Dealt with Antidepressant Withdrawal
And how it changed my understanding of depression
The first time I tried to taper off antidepressants, at age twenty-two, my psychiatrist gave me the typical advice and a prescription for half my regular dose. A few days later I was sobbing on my bedroom floor as I called her and begged to be put back on my regular dose.
There were two huge mistakes here I see in retrospect:
- Reducing a dose by half is a gigantic move. Tapering in tiny increments would later prove better for me.
- No one told me that depression and suicidality were symptoms of withdrawal. So I was left believing that my unmedicated self was a chronic floor-sobber.
In fact, it took me seven more years before I tried to quit them again. And only then did I learn that the pain I had felt all those years earlier hadn’t been proof that I was unhinged without them, but rather that the process of coming off of them made me unhinged.
Shifting perspective
I was on various antidepressants for fourteen years, from age fifteen to age twenty-nine. I believed the pills had saved my life and that they must be continually saving my life — how could I stop? Should I stop? What were the long term effects? Did it matter as long as I was alive?
I didn’t know who I was without the pills, and the times I forgot a dose or took a lower dose, it threw me into such a sudden and dark mindset, I was afraid to fully quit. I eventually accepted that I would need to be on them forever. But then, I changed my mind — and my brain.
This process shattered my entire concept of depression.
My antidepressant journey
Everyone reacts differently to different types of antidepressants. For me, I had been on SSRIs (Lexapro, Prozac) at first, but they made me sleepy and sluggish. I spent about a decade on an SNRI (Wellbutrin) which gave me the energy to live, but also included a hefty dose of nervous energy too. Then I tried Effexor in the hopes of getting that good energy but thwarting the nervousness that accompanied it. After a few days on it, I found that without some level of nervousness I had zero personality and felt dead to the world. It was eerily freeing to suddenly not care about anything, but that apathy also seemed immensely dangerous. I asked my doctor to change it ASAP, and then I spent a couple of years on the SSRI Zoloft.
The gastrointestinal clue
During that last year on Zoloft, I began to notice that I was having gastrointestinal symptoms that didn’t let up no matter what I ate or avoided. Desperate for solutions, I finally thought to search “Zoloft stomach side effects.” Nausea, diarrhea, constipation, and abdominal pain were listed. This was the beginning of everything I thought I understood about antidepressants and depression being flipped on its head.
The side effects of antidepressants speak to how they impact our bodily systems, including neuromuscular, neuromotor, sensory, cardiovascular, and central nervous systems. For example, my doctor verified that the heart palpitations I’d previously dealt with had been caused by Wellbutrin. In researching my gastrointestinal symptoms, I learned that about 90 percent of our serotonin (a feel-good chemical often discussed in relation to depression) is in our stomach and intestines. I realized that antidepressants were not just assisting some happiness ratio in my brain, but were messing with whole other parts of my body.
My concept of depression began to crack.
Scientists don’t fully understand depression or antidepressants
I had really believed the overly simplistic commercials that explained depression as a chemical imbalance in the brain which could be properly balanced with a pill. The more reading I did, the more I finally saw the fine print that had been there all along: this was all an unproven theory.
What did it mean that feel-good chemicals were created in various other parts of the body? What did it mean that these pills have system-wide effects, but in ways that scientists admit they don’t actually understand? What did it mean that depression, while its pain was very real, was not in and of itself an objective, measurable medical condition like having a tumor or diabetes? I had clung to the concept that it was like those things because it had been such a relief to give the collection of symptoms a name. It had made me feel justified in attending to that pain, as if it needed a name to be valid. It had comforted me to believe I knew what was wrong and how to fix it. But upon zooming out, what I used to see as the full story I now saw as a tiny part of a much bigger picture.
It occurred to me that just because chemicals might be involved in an experience, doesn’t mean we can reduce the entire experience to a chemical function. For example, take love.
Yes, chemicals (serotonin, norepinephrine, dopamine, oxytocin) are part of the love experience. But love is a much larger, more cumulative experience of who we are and how we relate to others. Sometimes the chemicals help drive the experience, but sometimes the chemicals are a consequence of the experience. To reduce depression to a chemical imbalance is akin to saying love is just a set of chemical reactions.
Depression was messier and more complex than I had wanted to believe. This shook up my personal narrative and identity. But in loosening my grip on my admittedly uninformed belief system, I was able to consider that maybe there were a multitude of ways to heal, and maybe I didn’t need to be on antidepressants forever.
Suppressing symptoms versus addressing root causes
I was beginning to see the effects of my antidepressants as parallel to the effects of pain relievers on my headaches: temporarily helpful for symptoms but not indicative of the underlying cause. Just as my headaches are helped by ibuprofen but not caused by ibuprofen deficiency, maybe my depression was helped by Zoloft but not caused by Zoloft deficiency, nor by “chemical imbalance.”
To continue this parallel, ibuprofen may indeed soothe my headache symptoms. But suppressing or muting symptoms is different than addressing the root cause. The root cause of my headache might be dehydration, stress, eye fatigue, muscle tension, and so on. Turns out, the root cause of my depression symptoms could be a whole host of things that each need addressing, from nutrition and movement to childhood conditioning and social belonging.
Thinking critically about the role of pills
To be clear, I know on a deeply personal level that the pain and symptoms of what we sum up as “depression” are very real. What came undone for me was the belief that those symptoms were caused by a singular neurotransmitter issue or chemical imbalance, as well as the belief that these drugs were the only way to heal.
This is not to say that mental illness isn’t real; these struggles are real in ways that deserve more than oversimplified pseudo explanations and quick-fix pills, with adverse effects barely being studied. And while antidepressants are credited with saving lives, the complexity is that adults who start antidepressants are 2.5 times more likely to attempt suicide than those given placebos. The FDA’s warning about antidepressants causing suicidality in teens and children is continually being revised as they learn more.
This is not to say there is any shame in taking medication — this is to say: those of us who are in need of help deserve better.
Yes, antidepressants have helped people like me, but they are so powerful and potentially dangerous that they should be handled with far more critical thinking and caution. Not, for example, a psychiatrist meeting fifteen-year-old me, doing a five-minute literal checklist, and writing a prescription that random doctors would automatically renew for over a decade with zero observation, explanation, or warning.
The side effects of withdrawal
No doctor warned me thoroughly about the side effects and suicide risk associated with both starting and stopping antidepressants.
Because long-term antidepressant use and withdrawal haven’t been widely studied, doctors aren’t always prepared to help. Upon trying to quit their antidepressants, many patients are instructed to simply halve their dose for a few weeks and are only warned about the possibility of mild discomfort. This backfires for a significant number of patients. Researchers are only beginning to understand the severity, length, and effects of withdrawal.
The misunderstanding of withdrawal has been linked to pharmaceutical companies who prefer the term “discontinuation syndrome” — which minimizes the seriousness of it, according to psychiatric researchers who recommend the term “withdrawal syndrome.”
New studies on SSRI withdrawal and SNRI withdrawal provide more thorough explanations of what to expect.
Relapse and withdrawal can look the same
One major thing that kept me from quitting antidepressants sooner was how bad I felt when I missed a dose. I’d be standing in the grocery store, noticing the fluorescent lights and linoleum tile and suddenly I’d feel insane. The concept of living would strike me as violently absurd. Then, I’d realize, Oh, I forgot to take my meds. I figured moments like that were a glimpse into the “real” me that was lurking below my medicated self. I now know that those times may have actually been temporary withdrawal reactions.
It’s essential to understand how to differentiate relapse and withdrawal, since they can both appear as depression, anxiety, and suicidality. To complicate it even further, antidepressant use can eventually trigger actual depression relapse if the suppression of the symptoms had led root causes to go unattended. Understanding all of this and putting effort into preparation made a huge difference when I attempted to quit again.
Withdrawing
How I prepared
This time, I prepared myself. I planned to reconceptualize any upcoming misery as a withdrawal symptom, not my true state without drugs, and not something to bow down to or give weight to.
The trick is getting through that safely. I had to make sure I was in a place where I could trust myself to wait out those possible mood changes without being overcome by them. Then I realized I couldn’t trust a version of myself I didn’t know, so I made sure to tell the people around me that I was tapering off and what the possible side effects of withdrawal could be, alerting them that a possible symptom is suicidality.
I used my stable self to prepare for my unstable self to potentially take over for a while. Some precautions I considered: enlist the help of people around me. If I have access to weapons, remove them. Make a plan for my daily routine so I don’t have to exert mental energy. And on top of doing my own research and preparations, try to work with a doctor, psychiatrist, or therapist.
To know what to expect, I listened to other people’s experiences and read their anecdotes. I read books and articles by psychiatrists and doctors who dug into the complexities of depression and the risks of psychiatric drugs. These resources also gave me insight for how to slowly taper. You’ll find these linked in my recommendations list.
Extremely slow tapering
General guides for tapering didn’t seem gradual enough to minimize the withdrawal symptoms that I had once experienced and that I was hearing so many people report. So I used those books and websites to accumulate an understanding of how to be as slow and safe as possible.
I got a pill cutter after researching my pills to make sure they were safe to split. Some kinds, such as extended-release tablets, are not safe to cut. Depending on pill type, people may separate out beads from capsules or request it in liquid form. There are many patient-sourced, DIY methods that have resulted from the need to wean in smaller increments than the lowest doses manufactured.
I used a calendar to delineate my tapering and keep track of my plan. Everyone’s tapering will differ by dosage, medication type, personal history, and reaction. Harvard Health’s general tapering guide offers a basic chart, and The Withdrawal Project offers more in-depth tapering guidance, with the caveat that it is for educational purposes, not formal medical advice. I tapered by reducing by a small percentage every two weeks, over a series of months.
Keeping a journal was also a good way to keep track of my reactions as well as to remind me that I am in this process, so I can step back and observe my thoughts and emotions instead of being swept away by them. For the same reason, it is beneficial to be able to talk to a therapist or counselor during this time. Planning to have friends check in is helpful too.
On my very first day of being fully tapered off, I felt wobbly in my emotions, like a fawn on its unused legs. For the final tapering day, some doctors prescribe a single, low dose of Prozac (for patients who had been on drugs other than Prozac) to act as a “bridge” because of the way a single dose of Prozac can leave the body more slowly and mildly.
Supplements that helped the transition
Doctors have reported that certain supplements can be helpful in the transition process without being harmful to the body. In addition to considering adding these, I also had tests done by my doctor to find out if I was deficient in any vitamins. My bloodwork showed I was deficient in Vitamin D.
(A note of warning: when combined with antidepressants, certain supplements can cause the dangerous “serotonin syndrome,” including St. John’s wort, ginseng, 5-HTP, and L-Tryptophan.)
Personally, I took:
- L-theanine, an amino acid, which helped with emotional stability. This is found in green and black tea and available in capsules.
- Vitamins B6 and B12 which are recommended for depression. I took these as pills but found I felt best obtaining them through food.
- N-Acetyl Cysteine (NAC) which helps your body replenish glutathione, one of the most potent antioxidants that exists in every cell and aids overall health.
- Magnesium glycinate which helps with sleep, something commonly disrupted during withdrawal. Melatonin is another option for insomnia.
- Vitamin D3 which is recommended for depression, and which helps absorb magnesium. I aimed to obtain it through sunshine but took a supplement as well.
- Fish oil (omega 3) which is considered a mood booster and a building block of the brain.
- Evening primrose oil (omega 6) for PMS/PMDD which may have been an unacknowledged piece of my depression all along.
- Milk thistle for extra liver support, since my liver had been doing the extra work of processing antidepressants for fourteen years.
- Holy basil tea as needed to ease my anxiety. Other adaptogens are also reported to help with calmness and mood.
Brain-rebuilding foods
Before tapering, I tried to understand which foods would help my mind/body function best. I made the mistake of making too many changes too soon — I went cold turkey on sugar, processed foods, alcohol, dairy, and gluten, and introduced too large of proportions of things like raw vegetables, which are not compatible with everyone’s digestive systems. The drastic change upset my body and was unnecessary, as some of those nutrition fads may just be fads. The research is always being updated and is worth reexamining. But as a guiding principle, foods that provide our essential amino acids, vitamins, and minerals improve brain function. I would recommend making dietary changes slowly, paying attention to how your body feels and reacts.
For me, I found that I felt best when I made sure to have:
- Protein containing vitamin B12 (eggs, chicken, turkey, beef, salmon)
- Healthy fats (avocados, nuts, coconut cream, olive oil)
- Cooked vegetables (kale, spinach, brussels sprouts, bell peppers)
- Fiber (raspberries, figs, brown rice, whole wheat bread and pasta)
- Fermented foods (sauerkraut, kefir)
Exercise
Don’t skip this section! I know I probably would. I hate exercise. I bristle every time I read the dreaded words “jog” or “yoga.” I desperately wish it wasn’t important. I’ve spent years searching for ways to get around it. I am so sorry to report that there is simply no alternative. Some kind of movement really does make your whole body, mind, and mood function better. But if you’re like me, you might have to trick yourself into doing it.
Some ways I’ve tricked myself into exercising include:
- Hiking and being distracted by plants, deer, and not getting lost
- Walking on urban trails or in neighborhoods and being distracted by architecture and saying “hello” to fellow walkers
- Lifting weights while listening to music or podcasts
- Playing tennis, even just against a wall, and chasing the ball without realizing I’m “running”
- Making plans to walk or jog with someone for accountability
- Dancing to music and playing musical instruments
- Doing Yoga with Adriene, whose down-to-earth presence makes me forget I’m doing something I thought I hated
I found it helpful to remember that one small thing is better than nothing. Taking a walk around the block counts. It also provides sunshine, fresh air, and fresh sights for our variety-seeking brains.
Healing the depression itself
The above is just what helped me with the withdrawal process, not to be mistaken with what helped me deal with depression itself. What had helped me with depression over the years included changing external factors like living situations, jobs, and friends; doing therapy including CBT, ACT, and EMDR; finding meaning by integrating into communities; challenging my childhood programming and internalized messages; practicing treating myself better and rewiring my neural pathways; and continuing to get outside support. It is impossible for me to know what role antidepressants played in conjunction with these methods, so I can’t fully credit or discredit the pills. Maybe the drugs gave me the energy to begin these healing processes. But in the end, these healing processes, not the drugs, were what I needed.
The results
For about the first year of being off of antidepressants, I felt more raw. Emotions were hitting me on a deeper level. I was more easily moved, more deeply touched, more tenderly hurt. I felt like an invisible layer of protection was gone and I was left sensitive and vulnerable, like an exposed nerve. This seems to align with theories that antidepressants can cause emotional blunting. It took about a year to settle into myself.
Two years after quitting, I feel clear-headed and solid. Instead of believing that my depression was singular and inherent, I believe it was caused by many factors that culminated in many symptoms — symptoms that resulted not from just a chemical imbalance, but from being a person in the world who gets hurt. Our brains and bodies are constantly adapting to navigate and survive harmful individuals and unjust systems, and sometimes the survival skills and defense mechanisms we come up with no longer serve us.
I feel my sense of agency when I look back and see the habits I would come to unlearn, postures I would retrain, nutritional lacks I would fill, self-torment I would rewire, childhood wounding I would heal, social disconnection I would reach out of, and hurtful narratives I would rewrite.
I think back to the time right before I was put on my very first antidepressant. My dad tried to tell depressed teenage me, “Being sensitive makes the world a hundred times more painful, but a hundred times more beautiful, too.”
