Searing stomach pain, racing heart, hair loss, missed periods, flared psoriasis, burning fingers, constipation, confusion, frequent upper respiratory infections, and nine months of intractable insomnia.
No, this is not why Rachel went on Zoloft in the first place. No this is not a “relapse.” She came to me at the end of her rope, hanging on for dear life, at a point of desperation that she had never known possible when she filled that prescription six years ago after a breakup left her heartbroken. Now four months from her last dose, Rachel could spend the rest of her days visiting specialists and garnering new diagnoses chasing the elusive thread that links them all: psychiatric medication withdrawal.
I was trained to tell patients like Rachel that this is evidence they should remain on medication. I was taught to tell her that the medication was long out of her system given its “half life” and that these symptoms were unrelated to the fact that she stopped taking her Zoloft; and her distress around her condition, evidence that she should restart it.
Ten years ago, the recent New York Times article entitled “Many People Taking Antidepressants Discover They Can’t Quit” would have shocked me. I would have dismissed serious medication withdrawal as rare if I acknowledged it at all.
But with ten years of experience in the wild unknown of psychiatric medication tapers, I tell my patients something different today. And I have accumulating scientific evidence to support my message about the seriousness of discontinuation.
In the first systematized review of SSRI withdrawal, Fava et al. examined 23 studies and 38 case reports leading them to conclude that the euphemistic term “discontinuation syndrome” must be abandoned in lieu of a more accurate depiction of the habit-forming qualities of antidepressants — withdrawal. Yes, just like Xanax, Valium, alcohol, and heroin.
Relatedly, Chouinard and Chouinard state: “Patients can experience classic new withdrawal symptoms, rebound and/or persistent post-withdrawal disorders, or relapse/recurrence of the original illness. New and rebound symptoms can occur for up to 6 weeks after drug withdrawal, depending on the drug elimination half-life, while persistent post-withdrawal or tardive disorders associated with long-lasting receptor changes may persist for more than 6 weeks after drug discontinuation.”
They even provide a handy chart of the horrors that can befall unsuspecting patients ranging from those who miss a dosage to those who taper carefully.
How could this be happening? Medications aren’t addictive! They’re therapeutic. In an interesting twist in the history of allopathy, an inconvenient truth is emerging: we have a nation overrun by drug dealers. Only today’s most lethal and disabling drug dealers have advanced degrees and Walter White-level biochemical acumen. Today, urban lyrics are replete with the tales of trafficked pharmaceuticals, artists are raging at their prescribers, and the opioid epidemic is impacting everyone from CEOs to grandmothers.
Sure, Xanax and oxycontin are addictive, but Prozac?
I have stated and will again, that psychiatric medications, and specifically antidepressants, are the most habit-forming chemicals on the planet. I’ve seen patients who have been disabled by a Celexa taper progressing at 0.001mg per month — I challenge you to find me comparable instances of crack cocaine, heroin, alcohol, or others meds that demand this level of care and caution to simply come off them.
In order to wrap our minds around this possibility, we have to first disabuse ourselves of the assumption that antidepressants are “fixing” anything biochemically. They are not correcting an imbalance, a genetic defect, or healing the brain.
As Dr. Joanna Moncrieff has stated, antidepressants create imbalances. One that the body then adapts to, and one that specifically recruits the stress response system, one possible explanation for how and why withdrawal from these medications sets off alarm bells that reveal every weakened link in your physiology.
Andrews et al have detailed the propensity of these medications to induce withdrawal, a phenomenon that relates not to the patient’s clinical history, but to the chemical profile of the drug.
Unfortunately, we also know that it can take longer than 17 years for basic science research that challenges consensus practice to trickle into the hands of the average clinician.
So, now that we know this, why would someone even consider tapering? Why not just leave well enough alone?
Because medication is not a long-term solution. For some, it’s not a solution at all, as evidenced by placebo-level efficacy attended by an extreme list of unintended effects ranging from gastrointestinal hemorrhage to impulsive homicide.
All of the long-term naturalistic data available cautions that those who are treated with psychiatric medication for longer than two months function more poorly than those who were never treated. In fact, it was the long-term data reviewed in Robert Whitaker’s book, Anatomy of an Epidemic, that made me put down my prescription pad forever.
Since that time, I have been supporting patient transitions to medication-free living and have outcomes including those published in the peer-reviewed literature that defy the dogmatic presumptions around mental illness as a chronic medical condition.
These individuals come off of medication and come alive in a new way.
They dare to ask WHY. Why were they symptomatic to begin with? What was really beneath their diagnosis, sometimes made after a ten-minute visit with a college health center doc. We move through a process of self-healing and personal reclamation that triages imbalances.
First we heal the physical body and address gut-brain inflammation, a well-recognized driver of psychiatric pathology. Through this process of a month-long lifestyle change protocol, we address many reversible drivers of symptoms ranging from panic attacks to fatigue to obsessive compulsions. These drivers include blood sugar imbalance, food-based autoimmunity, nutrient deficiencies, and medication-driven effects including from common meds like antibiotics and birth control pills.
Then we take an emotional inventory of the relationships and elements of one’s life that are simply no longer working. With the renewed energy now reclaimed from the white noise of physical imbalances, these patients are ready to begin addressing what they may not have felt capable of turning toward in their life earlier — a toxic marriage, an oppressive job, a lack of community.
Invariably, there is an emergence of the deeper spiritual elements of healing that these med-free seekers encounter. They begin to explore the big questions: what am I here for? How can I give back? And the deeper why of their conditioned and patterned behavior — their childhood experiences and traumas.
Through this process, they become whole. And they understand that, as Rumi says, the wound is the place where the Light enters, and that we must make room for sadness, grief, and pain, in order to expand our capacity for joy and fulfillment.
As these survivors exit the birth canal of their tapering experience, the most common sentiment I am reported is: I finally feel like myself. Who knew that this was all we ever wanted.
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.