July 19, 2019 at 04:00AM by CWC
Two years ago, I decided to go off of my antidepressants. I had been taking Lexapro for most of my adult life, but it seemed like I didn’t need an antidepressant anymore—I felt like I was in a good place mentally, I was happier, and I had a great support system in place. Plus, I’d been hearing a lot as a wellness editor about how Americans are over-reliant on prescription meds, and wondered if that was the case for me, too. It was a lot of work—I had to very, very slowly reduce my dosage under the supervision of a psychiatrist, and it took a while to fully get the medication out of my system—but at the time, it felt like the type of mental health project that would ultimately be a big accomplishment with great rewards.
I wrote about my experience for Well+Good, and still to this day get messages from readers looking to stop taking antidepressants who say that my story has inspired them. The words of affirmation are nice (who doesn’t like to be praised for their work?)… only, I feel like a fraud. Why? Because I decided to get back on antidepressants a few months after I got off of them.
Although I had diligently followed the instructions of my psychiatrist to wean myself off my pills over the course of several weeks and did all the “right” lifestyle things (like trying natural supplements like magnesium and evening primrose, getting plenty of exercise, and going to talk therapy), my depression symptoms came back with a vengeance. Dark, cryptic thoughts drifted back into my head like storm clouds in the middle of a summer day. I had excessive mood swings. I began to cry at the most minute occurrences in my life, which didn’t bode well for my relationships or my work life. I even had thoughts of suicide. I knew I had to see a psychiatrist ASAP.
Unsurprisingly, my doctor immediately put me back on Lexapro. I’ve been taking it consistently ever since. But honestly, this is the first time I’ve felt comfortable enough to talk about it publicly.
Why “going off” antidepressants can be difficult for many
Depression can be broadly categorized into two groups, says Neeraj Gandotra, MD, chief medical officer at Delphi Behavioral Health Group: situational depression or major depressive disorder (clinical depression). “If the cause of the depression is situational, it can be that once the situational stressor is removed, perhaps the depression will get better,” says Dr. Gandotra. “But if there is an imbalance or a deficiency in those [brain] chemicals, [the depression] didn’t occur overnight. If it’s truly what we call a depressive disorder, that was present either before a situation or persists after the situation has been relieved.” Common symptoms of clinical depression include appetite issues, low energy, feelings of worthlessness, guilt, and recurrent suicidal thoughts, he explains. That’s the type I have.
Antidepressants work to essentially rebalance a person’s brain chemistry, which reduces a person’s depressive symptoms, says Dr. Gandotra. “For instance, an SSRI [serotonin re-uptake inhibitor] like Zoloft, Prozac, and Lexapro works by rebalancing the serotonin in your brain… which means there’s more serotonin in the synapse between nerves, and over time that leads to antidepressant effects,” he says. Other antidepressant types work on other brain chemicals; serotonin and norepinephrine reuptake inhibitors (SNRIs) like Cymbalta, for instance, target both serotonin and norepinephrine, and norepinephrine and dopamine reuptake inhibitors (NDRIs) like Wellbutrin target norepinephrine and dopamine.
Once someone has reduced their depressive symptoms to more manageable levels and stabilized their mood via an antidepressant medication, they’re often able to attempt to discontinue the medication and slowly taper down, says Dr. Gondatra. “Of course, this is with the understanding that if the symptoms return, they should restart the medication,” he says.
“There are high rates of relapse and recurrence of depression after stopping an antidepressant medication.” —Meredith Bergman, MD, holistic psychiatrist
However, once someone has stopped taking antidepressants completely, a number of things can happen. “There are high rates of relapse and recurrence of depression after stopping an antidepressant medication—50 to 80 percent. Continuing on medications cuts your risk of relapse in half,” says Meredith Bergman, MD, a holistic psychiatrist. (She’s the very psychiatrist who helped me taper myself off of my medication in the first place.) It’s also possible to experience medication withdrawal, which Dr. Bergman says can be mistaken for a relapse of depression symptoms. It can be tricky deciphering between the two since they have overlapping symptoms, such as tiredness and insomnia.
There’s also a lot of work a person has to do once they’ve tapered off their meds in order to keep their mood stable—it’s not just throwing out a pill bottle and hoping everything will be okay. “A patient may discontinue medications after a remission of depression, but risk of relapse would increase if they did not put other support structures into place—like psychotherapy, socialization, lifestyle modifications such as nutrition and exercise, or if they did not deal with the primary driver of their depression, like developmental trauma, interpersonal relationship problems, or lack of meaning in their work,” says Dr. Bergman. A person could have all these support structures in place and still relapse (which is what happened to me), she says—a strong case for restarting medication.
Yet it’s very common to want to discontinue taking antidepressants, despite the risk for relapse or withdrawal. “Two-thirds of patients at some point contemplate coming off [of meds], particularly when they’re doing well,” says Dr. Gondatra. “[This may be] partly because they may have forgotten the pain and struggle from when they went through depression. But also from an underlying idea that the medication is in some way indicating a weakness in them.”
Meds are often part of a person’s mental health treatment—and that’s okay
The first few weeks after getting back on Lexapro, I didn’t tell anyone about it—I felt ashamed about my “failure” to go medicine-free. At one point, I finally shared my decision with my mom, who was really supportive and understanding about the whole thing. But my shame multiplied every time a message would pop up from a reader expressing gratitude for my story about getting off of antidepressants. That shame, and the disconnect between what people think they know about my depression journey and what is true now… I’ve been grappling with those feelings for nearly two years, which is why I finally decided I needed to tell this story.
It’s only been in the past few years that celebrities and public figures like Selena Gomez and Kristen Bell have opened up about their own struggles with depression and the fact that they’re on medication in order to deal with it, which is a sign that the stigma against mental illness is slowly melting away. But it’s 2019, and my use of antidepressants in order to function is apparently still viewed by others (including myself!) as a weakness or a crutch. Even my boyfriend doesn’t seem to understand that it’s not exactly my choice to be on Lexapro—I need it in order for my brain chemicals to be properly balanced.
Compounding this stigma is the way the many people in the wellness world can sometimes push back against Western medicine and prescription medication. Yes, it’s true that there has long been an over-reliance on (and overprescription of) medications like antibiotics and opioids, which has led in part to the rise of antibiotic-resistant diseases and the opioid crisis. There’s a growing consensus amongst mental health experts that lifestyle changes, from nutrition to exercise and meditation, are just as important for helping symptoms of depression as medication can be. And yes, mental health meds come with potential risks and side effects that everyone should understand (and discuss thoroughly with their doctor) before taking. But the idea that treating depression “naturally” without medication is inherently better than taking antidepressants is deeply misleading—and creates further stigma for those of us who use antidepressants.
“If you think that taking an antidepressant medication indicates an underlying weakness, that’s quite different then how we look at other biological diseases,” says Dr. Gondatra. “You wouldn’t say to a person with diabetes, ‘Well, your diabetes is well-controlled on insulin, so let’s stop it now.’” Yet, it’s a regular topic of conversation when it comes to mental health medication—a sign that there is an enduring misunderstanding of what depression is, he says. “Where there’s a deficiency of a particular chemical and there are mood symptoms as a result, why would we look at it as some kind of moral failing?” he asks. “It’s not a weakness to require a medication for rebalancing serotonin.”
Writing this story has helped me realize that I shouldn’t feel ashamed about needing antidepressants. Going without medication for depression may be effective for some people, and that’s totally valid. But I tried it—and I relapsed. Going back to Lexapro doesn’t make me weak, and it doesn’t make me unhealthy or wrong, either. Depression is a serious health condition, and it’s essential that the 17.3 million Americans like me who have it work with a doctor to determine the proper care for their needs. But obtaining and maintaining care is that much harder when you’re facing unfair judgement for the treatment choices you make. “Depression is a common and life-threatening illness, and we must abolish the stigma of obtaining treatment,” says Dr. Bergman—no matter what form it takes.
If you have depression and are on medication, know that you’re not alone. And if you’ve gone off medication but decide to go back on it, there are many of us in the same boat, too—and there’s nothing wrong with that. For my part, I’m content to be at a place where I know what works for me for staying relatively happy. It’s a pill I can swallow, both literally and metaphorically speaking.