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How to Stop Your Antidepressant

If you’ve been doing well on your antidepressant for some time and feeling stable for more than three months, you might be considering discontinuing your medication. This is not a bad idea, and sometimes it feels like a really good idea. But it should be done carefully and thoughtfully. It needs to be a team effort. The team consists of you, your doctor, and someone you talk to on a daily or almost daily basis. There is no right or wrong way to do this. There is no blood test to measure your mood. This is a time when you have to trust your own wisdom (and get some outside help.)

If you are handling stress well, as well as you’d like, it may be time. I generally don’t recommend stopping this type of medication in the fall or winter as the days are getting shorter, just because the confounding possibility of Seasonal Affective Disorder. But if that’s when you want to do it, then that’s up to you. It seems a bit easier to try this when the days are getting longer in the spring and summer.

Always keep in mind that exercise is absolutely THE BEST antidepressant ever studied. Please include DAILY exercise in the plan to come off of your medication. Talking therapies, relaxation or mindfulness techniques can also support your mood and should also be considered as part of the recipe to make this work.

So here we go.

You should have a person, whom I will refer to as your “mirror” person. This is the person with whom you speak daily. I always recommend weaning off of any depression medication, just so we can be careful and observant during the process. The weaning process can be as quick or as slow as you want. This is something that should be discussed with your prescriber. Some medicines are easier to stop than others. Prozac, fluoxetine, is easy because it takes a long time to come out of your system. Effexor, venlafaxine and Paxil are famously difficult. They need to be carefully decreased. And the path may have to be slowed or even backed up a bit, from time to time. Be ready to make an appointment, or several, serially, during this time to be able to re-evaluate and adjust the plan if it becomes necessary.

Before you begin decreasing your medication, the team agrees to be honest with each other and communicate regularly. If you feel like things are going well, but your “mirror” person thinks you’ve been more irritable or isolating your self, then we need to reconsider the plan.

What I always recommend is that you take a Post It Note and write on it “Dear, you seem uncomfortable.” And put that right on the fridge or some other prominent place. That’s the line that the “mirror” person says when he or she thinks things aren’t going well. It is important to stick to the script so that the communication is clear and kind. The “mirror “ person isn’t to be judging every action and utterance, but more like getting an overall view as things unfold.

Things can look very different from the outside, so both your perception and that of the outside observer are very valid, and both deserve consideration. It might seem completely justifiable to bite someone’s head off or run off crying for some minor infraction; he left the milk out, she forgot to close that door…again. If your “mirror” observer sees that kind of thing is getting to you more than it did while you were taking your medicine, it’s time to say “Dear, you seem uncomfortable.” It’s a little funny, because it’s awkward and a little over the top, so it lightens the situation a bit. Your observer may want to say something else, maybe something a little less gentle. “You need to be back on that pill.” “What is wrong with you?” See, not as kind, supportive and helpful. Stick with the script. It’s nicer.

By the same token, if you feel miserable, not coping well, you wonder, at the end of the day, why you said and did the things you did, even if your “mirror” person thinks you’re doing fine, the plan needs to be rethought. You might be really good at hiding your emotions or “behaving” so that no one else sees how unhappy you are. Be honest with yourself. Be gentle and kind to yourself, as gentle and kind as you’d be to anyone else.

If you or your “mirror” person feel that things aren’t going well, it’s time to talk to your prescriber. There should be a scheduled appointment within the first 4-6 weeks of this process, but you can ask to be seen sooner to reassess things if it’s necessary.

If the wean is going well, you can come off of your medications. Many people who have been treated for depression once, can come off medicines and be fine. Some people who have been depressed once, find themselves depressed again. If you’ve been depressed twice, it’s more likely that you’ll suffer depression again. So, it’s good to be aware and keep a look out. This is another area where your “mirror” can come in handy. “Dear, you seem uncomfortable.”

If your wean is not going well, if you or your “mirror” feel your symptoms of depression are returning, then it may be necessary to go back on your previous dose of antidepressant, or consider a change of medicines. The medicines are all a bit different and have different side effect profiles and can behave differently in individuals. Back to your prescriber and have that talk. Remember, depression is often just a chemical imbalance. There doesn’t have to be a reason to be depressed; sometimes it just happens, and we can do something about it.

Have a good “mirror”, but only one “mirror”. Be gentle with your self. Good luck.

 

 

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