My name is David Fox, and I am a registered Psychologist living in Sydney, Australia. In the past five years, I’ve focused predominantly on counseling people with anxiety, depression and a range of other issues. I was also on antidepressants, myself, until a few months ago. I’d like to share a bit about what happened to me after being placed on these medications, and how I successfully got off. Until recently, I was embarrassed to talk about my personal experiences publicly, as I’m a professional who specializes in anxiety and depression. Today, medication free, I feel better than ever before, and I am now on a mission to help my current clients get off medications, and to inform others through my writing about the dangers and pitfalls of starting antidepressants. This has not been an easy story to share as the stigma of depression and anxiety disorders remains strong, but I feel compelled to do so, in the hope that it will help others.
I was born and raised in Johannesburg, South Africa and when I was twenty-three years old, I suffered from a panic attack when I received my Master’s thesis back from my supervisor with a range of corrections on it. I felt a wave of panic wash over me and I can remember thinking something like, “I will never get this done; I have just spent five years of my life for nothing and I will not be given my degree because my thesis is no good.”
It had been two long and hard years of studying for my honors and masters degrees one after the other. Our lecturers joked with us before we started our honors year that we should take a photo of ourselves and give it to our family and friends because that would be all they would see of us for the next year! (They weren’t entirely wrong either.) I was very fatigued after not only completing the honors year but then, to my great surprise, being accepted to do my masters degree right afterwards. I can now see why I experienced a panic attack on that fateful day in February 2000: two years of intense studying, pressure, lectures, papers, exams, theses to complete, and all the while managing this with an underlying propensity for anxiety and stress. I remember curling up on the bed and shaking, thinking I might be having a heart attack. It shocked me to my core.
In addition to worrying about the thesis itself, I’d had two unsuccessful interviews for internships, which were highly competitive. My thoughts once again began to rumble: “What if I don’t find an internship? How will I ever fully qualify as a psychologist if I can’t get one?” I vividly remember cold-calling organisations to ask them about taking me on as an intern. I got an interview at one of them, and on the morning of the meeting, I was in the depth of my anxiety and depression and found it an incredible struggle to get out of bed and make my way to the interview. I was so worn out by the time I got there that I was sweating with anxiety and fear, convinced that the interviewer thought I was on drugs or just plain crazy. This sent me even further into despair.
After this experience, I got a referral to see a psychiatrist. She took a brief history and then suggested I start a course of antidepressants known as Ciprimal (Citalopram, or Celexa). At the time, Ciprimal was a newer antidepressant and I remember one of my close friends saying that he’d spoken to his GP about me, and was told that I would feel better taking them than I’d ever felt in my whole life. I took this to be an encouraging thought from a GP whom my best friend swore by and said was one of the best diagnosticians in Johannesburg! I have made that mistake more than once now: trusting doctors or other “professionals” without much questioning. Never again.
What happened next was something I was simply not prepared for, whether by my psychiatrist or anyone else for that matter. I went from feeling anxious and somewhat depressed to feeling like I had fallen into a deep, dark mental hole that I could not get out of. Every morning I awoke with abject panic in my body and mind at the thought of getting up to face the unknown day. It would generally ease somewhat towards the late afternoon and I would often feel almost normal in the evenings when everyone came home. Each night, I was so shocked by the dramatic change to my thinking and moods that I’d be absolutely convinced I’d feel better in the morning. However, every morning for the next six weeks, I struggled with my thoughts, deep feelings of anxiety and lack of ability to motivate myself to do some of the most basic things. Having a shower seemed like an ordeal to me. Shaving seemed like an impossibility! I remember thinking I would not wish this kind of anguish on my worst enemy. I feel the same way today.
So, what was happening to me? Well, I now know that in the first few weeks getting onto antidepressants, they completely alter the neurotransmitters in the brain, which then goes into defensive mode by decreasing the amount of serotonin receptors, which can actually create more anxiety and depression. I started to feel better after the six-week adjustment period and at the same time managed to secure an internship at a company in their human resource department. I ended up staying on Ciprimal for about a year before slowly tapering myself off it. I did not start taking antidepressants again until May 2004.
So what happened that led to me going back on? I’d flown from London back to South Africa to have a major jaw operation called an osteotomy (a nightmare of an operation that involves going in through the top of your teeth, slicing your skull and moving your top jaw forward so as to align better with the bottom jaw). The recovery was one of the worst physical experiences of my life, and I was due back to London in a few weeks. The operation had set us back financially, and I was determined to make our London experience what we had initially imagined it would be, which including traveling a bit in Europe, and saving some money in order to immigrate to Australia. However, I was in intense pain, and was struggling psychologically with the changes that had been made to my face, and the fact that the trusted family surgeon we used had done some major nerve damage.
I could hardly feel my bottom lip and very little from my bottom lip to my jaw, and I was experiencing electric shock-like sensations running along the left side of my face and every time the tip of my tongue touched anywhere in my mouth. His response to this had been “Don’t worry boykie [a South African colloquial term for young man], it takes six months to heal properly.” Nine years later, I still experience the same unsettling sensations, but am now used to them, and have accepted them as part of my experience of life. At the time, however, I was desperate to resolve my pain, and wanted to get back to London and my wife as soon as possible, so I agreed with the doctor’s recommendation that I begin taking antidepressants for a short while to help me achieve this. And so in May 2004, I started taking them again.
Things settled down in London and after another six months we immigrated to Australia. Not long after being in Australia and finding a job, I started tapering off the antidepressant, but not without major withdrawal reactions. I started seeing a psychiatrist in Sydney and he seemed to be very helpful, but—and this is a very big ‘but’—he never once suggested that I look at coming off the antidepressants. I told him about the withdrawal reactions when I did try to come off and his view was that it was the depression returning or that I needed to be on them because of my “Generalized Anxiety Disorder.” Seriously, knowing what I know now, I could scream! It was the antidepressants themselves driving my anxiety and the withdrawal symptoms making it all but impossible for me to get off. We tried Aropax (Paroxetine, or Paxil, which I now know is considered to have incredibly difficult withdrawal symptoms, including agitation and anger). I knew something was wrong when I yelled at my two-year-old son one day and I went straight back to the psychiatrist and told him I needed to switch. Again, he agreed to switch but it never once entered his mind to suggest coming off or how it could be done in the most safe manner possible.
So, here I was, trapped with anxiety that was being sustained for the most part by the actual medication that was supposed to be helping me. And I couldn’t seem to get off no matter how hard I tried or how slow I tapered off. I remember once using Dr. Joseph Glenmullen’s worksheet and process for getting off. I did it step-by-step and painstakingly slow, but when I stopped taking that last quarter of a tablet, the withdrawal reaction was too much to handle. But again, there was still doubt and confusion as to whether it was withdrawal or my “underlying condition” returning.
This went on for years and years. In looking back, I see that another trap I fell into with getting off antidepressants was thinking, “I can’t get off now, it’s not a good time.” But there was never a good time for me to come off antidepressants; something always came up, even this very last time, when I ended up successfully doing it.
Part of the reason that I was determined to get off the antidepressants was that I was starting to have some strange things happen, including thrashing at night and talking or yelling in my sleep. This was becoming somewhat dangerous for my partner! I had also noticed that my memory of the previous year was very sketchy in terms of simple things like whom I had been to a movie with, or what I or others had said, and it was starting to worry me. I went back to see the psychiatrist and told him about these issues. I specifically asked him if there was a connection to the antidepressants, and his reply was that he’d never heard of what I’d described as being related to the medication. Unsatisfied, I went to Google to do some research, and typed in “thrashing out and antidepressants,” or something to that effect. Sure enough, it came up. I also read through Dr. Joseph Glenmullen’s Prozac Backlash and right there in broad daylight was a discussion of how antidepressants and anti-anxiety medications can cause memory loss. Not only that, but there is a legitimate concern that these medications might cause more permanent damage to the hippocampus, the site in the brain that is responsible for memory (see page 58 of Glenmullen’s book for more on this.) I was also very concerned that after being on antidepressants for nearly nine years, my brain might have experienced structural changes or permanent damage that would render it impossible for me to ever get off. These were very real concerns for me.
Around this time, I was in a training session to become a national workplace facilitator for Beyond Blue, an organisation in Australia whose primary purpose is the de-stigmatization of depression and anxiety. One of my colleagues happened to ask me if I’d read a book called Anatomy of an Epidemic by Robert Whitaker. I hadn’t heard of Robert but was intrigued. She didn’t tell me exactly what it was about aside from it being a brilliant account and history of psychiatric drugs themselves: where they came from, how the psychopharmaceutical industry started, etc. I thought this would be interesting and help develop my knowledge of the whole field in greater detail.
I ordered the book and when it arrived I was absolutely gripped and enthralled from page one. I cannot recommend this book enough to anyone who is currently taking antidepressants or anti-anxiety medication. As the pages unfolded, I learned, for example, that the first antidepressants were discovered accidentally during research for other treatments. My life was changed forever when I read a very important fact that has been effectively hidden: these medications came before any understanding of why they appeared to help (or not help) people with anxiety and depression. And yet, we have all been told a very different story. Talk to a doctor or psychiatrist and they will likely tell you something along the lines of: “People with depression and anxiety need to take medication just as a diabetic needs to take insulin, because just as a lack of insulin causes diabetes, a lack of serotonin causes depression and anxiety.” And this story simply isn’t true.
What Anatomy of an Epidemic shows is that this theory of the cause of depression has never actually been proven. In fact, there are studies done that have found no difference whatsoever in the serotonin levels of depressed versus non-depressed people. How can this be, when it seems that every doctor, psychiatrist and pharmaceutical company is telling us that a lack of serotonin causes depression, and thus that these drugs are needed to cure depression and anxiety because they artificially increase serotonin? Well, in the case of the pharmaceutical companies, it seems pretty obvious to me why this is so. As for the doctors, I imagine this is what they’ve been told by the pharmaceutical companies and drug reps. Indeed, it seems like the easy solution: give the patient some tablets and they will be fine in four to six weeks, with no need to explore why the patient is depressed or anxious.
So, I told my psychiatrist that I was determined to come off no matter what. Very casually, he suggested that I go onto Prozac. Why? I asked. Because it has the longest half-life of all the antidepressants, I was told. The newer drugs take only a few days to leave one’s system, and thus can cause some major withdrawal reactions. In fact, Cymbalta (also made by the same company that makes Prozac, Eli Lilly) is the focus of a class-action lawsuit in the United States right now for not properly informing the public of the difficulty that patients have coming off it. Prozac, however, stays in your system for weeks. I was told that because of this, coming off of it can be easier than with other drugs. Whether this is true or not, I’m not sure, but I can say that in my experience, coming off of Prozac was different than my previous attempts at tapering off other drugs.
My usual experience after taking the last tablet involved electric shock sensations in my brain, vertigo (feeling like I might fall over), emotional upheaval, crying spells, massive anxiety and depressive thoughts. So, I was well-prepared for this and still determined to get off, because I wanted to see what happened on the other side. I needed to know if what I had been fighting against all those years—and seemingly losing the battle with—was actually antidepressant withdrawal and not an underlying condition or deficiency, whether physical or psychological.
Becoming Free and Finding Myself Again
I cannot at this stage tell you exactly why I was able to successfully come off. Was it the Prozac’s longer half-life, or was it because I completely shattered the belief that I had a lack of serotonin in my brain? Whatever the factors may have been, after I stopped taking Prozac completely, none of the usual physical withdrawal symptoms appeared. Some emotional reactions occurred, but I believe these were actually a part of my brain’s process of returning to its natural state, and my own process of becoming acutely aware of how I felt about things. I would get emotional about happy things as well as sad things. I also started to feel different in my body, almost like I was waking up. My physical senses seemed to be heightened. I just felt, well… like me again.
As I mentioned earlier, I believe there is never really a “good time” to come off antidepressants, and this was certainly true for me: just after I came off, my relationship of over one year ended quite abruptly, and it was quite complicated because a child was involved. If anything could have come along to take me down and force me back onto the medication it would have been this… but it didn’t. Yes, I grieved and went through the very difficult emotions of this situation, which included not being able to see my daughter more than once a week or once a fortnight. This could and should have caused me to fall apart if I were truly someone who suffered from anxiety and depression and who had a lack of serotonin, but this has not been the case. I have remained off the medication long past any potential for a recurrence. Each day that I’ve gone through without medication has felt like an absolute joy and personal victory.
I also attribute a lot of my successful withdrawal to using everything I teach and have written about in my book. Looking after myself physically with cardio-type exercise, and staying away from caffeine and other stimulants that can play havoc with moods and energy levels, has been helpful. Understanding my emotions and experiencing them instead of denying them. Using mindfulness and meditation to help me relax and achieve peacefulness in my life. Avoiding drinking too much alcohol, using CBT (cognitive behavioural therapy), and talking to people (including professional counselors).
I started to realize that there had never actually been anything wrong with me—and that I’d been put onto antidepressants for nine years because I’d been feeling anxious about a major life event—and I began to get angry. This anger has given me the determination to help people get off antidepressants and stay off them for life, because I know firsthand how hard it can be to get off, and the ongoing psychological and emotional trauma that it can put a person through.
The author has written a Part II to this story, which can be accessed here.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.