Coming off antidepressants

Last week I saw my psychiatrist and finally won the argument on antidepressants. I’ve wanted to reduce them for quite some months now, but have always been talked out of it by the people who supposedly know better. While I am confident they understand how the drugs work and their interactions, I’m not so sure they competently measure the success of this kind of treatment.

I’ve been taking Mirtazapine for almost two years now. There are a number of reasons why I want to stop.

  1. There is no evidence that it works to reduce the symptoms of my depression.
  2. The longer I take it for, the harder it will be to eventually come off it.
  3. It gives me terrible food cravings that have caused me to gain weight.
  4. I hate taking pills every day. It’s a constant reminder that I am not well.
  5. I want to know who I am without medication, whether there is something left of my old self.
  6. If I’m totally honest, I’m also just curious to see what happens (yes I know that’s stupid).

I came across a really useful article from the Royal College of Psychiatrists today. They ran some research into patients’ antidepressant withdrawal experiences and produced this interesting summary on the various effects of reducing different drugs. The article also included some advice on the process, which I wanted to share here for anyone thinking of stopping taking antidepressants.

Plan and make an informed decision

  • Discuss the options with your doctor
  • Be aware of possible withdrawal or return of depression
  • Make a plan and choose a good time
  • Decide the speed of reduction
  • Who will you contact if there are problems?
  • Seek support from friends and family
  • Work – will you need some time off?

Take care over the process

  • Reduce slowly
  • Stay in touch with your doctor
  • Be prepared to stop the reduction or increase your dose again if needed
  • Keep a diary of your symptoms and drug doses.

Research suggests:

  • If treatment has lasted less than 8 weeks, stopping over 1-2 weeks should be OK
  • After 6-8 months treatment, taper off over 6-8 weeks
  • If you have been on maintenance treatment, taper more gradually: e.g. reduce the dose by not more than ΒΌ every 4-6 weeks.

I’m a week into taking half my usual dose. So far the only change I’ve noticed is that the lower dose is more sedating, so I’ve had trouble waking up in the mornings. I’m sure there will be more to deal with as my brain adjusts to the changes.

I would be really interested to hear about your experiences of withdrawing from meds; how long it took, whether it was a success, and if being without drugs is better or worse. Any advice would be most appreciated!

 

Photo: Rob Ireton, Creative Commons.

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17 Comments Add yours

  1. Pots of Tea says:

    When I came off sertraline for the first time, I had what people called ‘brainzaps?!’ My head felt very weird, but I don’t remember it well enough to describe it, as it was sometime ago.

    I’ve recently ran out of my latest tablets, and haven’t bothered seeing the doctor again as they didn’t seem to work, but I haven’t notice much of a withdrawal as they seemed to not be doing anything anyway.

    I think my above comments are pretty stupid and a bit reckless, so take no notice of me. πŸ™‚

    Like

    1. Laura Black says:

      Oh I’ve heard about the zaps! In an weird way I’m kind of looking forward to them…
      None of that sounded stupid or reckless to me. But then I may not be the best person to judge on recklessness!

      Liked by 1 person

    2. That’s a shame, sertraline works for me. What dose were you on? Maybe try a different type of antidepressant? X

      Liked by 2 people

      1. Laura Black says:

        I used to be on a combination of Sertraline and Mirtazapine. The Sertraline gave me terrible vivid nightmares and also a lot of hot sweats. I came off it about six months ago now and haven’t noticed any difference in my moods as a result. My psych suggested trying another, but I have little faith that medication will really help me. I am on a mixture of antidepressants, sleeping meds and mood stabilisers. I’m reluctant to add anything new, as I’d really like to be reducing the chemicals I’m putting into my system every day.

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      2. Yes, Sertraline has given me crazy dreams-but luckily, mine aren’t unpleasant. I can understand why you’d want to come off them, but it’s okay to use a bit of a chemical boost to get you through as well :). It is a very personal choice.

        Liked by 1 person

      3. Pots of Tea says:

        I have been switched to Citalopram. When I changed to a higher dose it really didn’t work, but the lowest dose did seem to work for a while. Now I’m on nothing. But I am trying to keep level headed all the same πŸ™‚

        Liked by 2 people

      4. Yeah, it’s such as individual thing, meds seem to work differently with different people. Citalopram has been great for some friends, and others-including my mum-have had terrible experiences with it x

        Liked by 1 person

      5. Pots of Tea says:

        Last night I found a box a Sertraline, so I might give those again. We’ll see. (Again… Just as a warning, don’t follow my lead. Consult a doctor. I’m just silly and going to the doctors is a huge effort, so I’ll just do what I see fit for the time being) πŸ™‚ x

        Liked by 2 people

      6. I know what you mean-waiting can be irritating as well :). What dose have you been prescribed, by the way? πŸ™‚ x

        Like

  2. I’ve commented before how difficult I found it. The first time I was only on citalopram for 6 months and had no trouble at all coming off it. The second time I was on it for 13 years and it ended up taking about 8 months to come off it.

    What I found was that each time I reduced the dose even by a little bit I’d get the sort of symptoms most people get stopping cold turkey: irritability and feeling jittery, sad feelings and crying, suicidal thoughts, visual lag and a weird sensation when I moved my eyes, diarrhoea. These symptoms would gradually improve over 3-4 days, and then I’d get the same pattern with the next dose reduction (charting your symptoms is very helpful here). After about 6 weeks more obvious depressive symptoms would kick in such as feeling unmotivated and more continuously down and more difficulty concentrating on work tasks (to the extent that other people would notice).

    The first couple of times I tried withdrawing (a few years ago) I gave up at that point and went back to my original dose. Eventually I decided that if I was ever going to come off I’d just have to push through all that, so on the third go I decreased the dose in very small amounts. I switched to a similar medication which was available in liquid form to make diluting it easier.

    Over the course of withdrawal I found that during the first half of the dose reduction the physical symptoms of withdrawal were more prominent, and during the second half mental symptoms were. I also had almost uncontrollable emotional outbursts e.g. getting enraged over a ticketing problem on the train and nearly punching a security guard, which is completely out of character for me. Some symptoms (e.g. anxiety) were actually worse than before I’d ever started the drug. It seems to be a little different for different people. I know some people get the brain zaps even after they’ve stopped, whereas I didn’t really have them at all.

    After I stopped completely I slid into a depressive episode that lasted a couple of months, accompanied by generalised anxiety to the extent I could barely leave the house except to go to work. Amazingly, my psychiatrist supported me through all of that without any pressure to go back on the drugs (unlike my GP, who tried to get me to go to another psychiatrist).

    The attitude of most psychiatrists and GP’s is that the withdrawal depression is part of your “illness”, proof that you need to be on drugs forever. Which is bullshit, really. Antidepressants are like any other mind-altering drug: if you’re on them for long enough your brain receptors adapt, it’s completely logical you’ll have withdrawal symptoms, and it’s logical that you may have ongoing symptoms for as long as it takes for those brain receptors to go back to normal (which may be months or even years).

    I didn’t want to go back on the drugs because I figured that even if they improved things temporarily I’d just have to go through the whole withdrawal process again later, and no way am I EVER doing that again.

    So the bad news is, it can be really difficult. The good news is you can eventually get through it. Now that I have been off them for over a year I don’t feel any more depressed than when I was on them. So I definitely think it’s worth trying.

    I know that not everyone is the same. Some people get really good results from being on the drugs, have tolerable side effects, and have no problems with the idea of being on them forever. That’s fine for them. I think the worst position you can be in is if the drugs stop working and you have to choose between staying on them and having horrible side effects for no benefit, or horrible withdrawal.

    Resources I found helpful:
    “Surviving Antidepressants” website,
    “Harm Reduction Guide to Coming Off Psychiatric Drugs”, available as free PDF: http://www.willhall.net/files/ComingOffPsychDrugsHarmReductGuide2Edonline.pdf

    Liked by 1 person

    1. PS sorry that I always end up writing such long comments. Please let me know if this is annoying.

      Liked by 1 person

      1. Laura Black says:

        No need for an apology. You always have something useful to say and I genuinely appreciate that you take the time to write so much.

        Like

    2. Laura Black says:

      Thanks for sharing your experience. It sounds like it was a very rough ride. I’ve heard a lot that the longer you’re on these meds the harder it is to stop taking them. It helps with my resolve to get through the withdrawal. I know if I put it off it will only be worse next time. And thanks also for the resources. Laura

      Like

  3. La Quemada says:

    I’ve been on various meds for probably 15 of the last 20 years. I’m again feeling I’d like to go off, and I’ve been feeling that way for a while. Mostly I realize that I’ve always had suicidal thoughts that start when I’m already on meds. So what is the point, really?

    I did manage to wean myself off clonazepam after 2 years this summer, gradually, over about six weeks. I am still on buproprion (Wellbutrin) and venlafaxine (Effexor) in the mornings and trazodone in a low dose at night. The other day I talked to the psych nurse again about reducing. She once again disagreed and somehow convinced me to ADD lithium, after I get back from my trip, because it can enhance the effectiveness of the anti-depressants. Somehow she always talks me into it again, and then I leave and think, why did I agree? She does it because she wants to help me and drugs are the main tool she knows (she does also recommend vitamins). But I am actually finding that mindfulness and trauma therapy seem to be more helpful.

    Anyway, please post about your experience. It’s a dilemma for sure.

    Liked by 1 person

    1. Laura Black says:

      Maybe the first step is to phase out one of the meds. That’s what I did with one of the antidepressants and I also reduced the doses of some of the others gradually. You probably understand the feeling of wondering what is left of yourself if you’ve been on all those meds for such a long time. I agree that therapy is what will make the difference in the long term. I’ve shared it here before, but someone told me once that antidepressants are like life jackets – they keep you afloat but don’t teach you to swim. I think the metaphor is perfect.

      Like

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