I first started an antidepressant regimen at 17 years old. Overwhelmed by high school relationships gone bad, family dynamics I couldn’t control, a poor body image, and an innate drive for perfection, I succumbed to distorted thinking patterns that paved the way for my first “diagnosis,” the eating disorder anorexia nervosa.
After seeing my primary care doctor and a psychotherapist, I pursued the typical treatment model: nutrition counseling, therapy, and medication. I started taking the SSRI Prozac at a dose of 20 mg, which my doctor eventually increased to 60 mg, while also seeing a registered dietitian who promoted the good ole’ food pyramid, packed with daily doses of grains and wheat. Fortunately, I responded to treatment pretty quickly and many of my symptoms subsided over time. My bodyweight returned to normal and I eventually started having regular periods again. I continued to struggle with anxiety, obsessive tendencies, cold hands, and mood swings, but these symptoms were manageable.
I remained on my SSRI during my senior year of high school and into my college years. I was told by my parents, doctors, and society that I needed this drug, that my brain was serotonin deficient. That I was bound to be on this medication, perhaps indefinitely, in order to stay well. I initially welcomed this perspective, as it lessened the burden of owning responsibility for my overall mood and mental health. After all, if my brain was deficient in some way, then I couldn’t help it, and I could blame my social anxiety, obsessive mannerisms, and mood swings on my “illness.”
My First Attempts to Wean
Enter my senior year of college. I was about to embark on a new journey in life, and after five faithful years of staying on my SSRI, I wanted to explore the idea of finally getting off. While the medication had helped with many symptoms, I felt blunted in my emotions and personality and wanted to uncover the “real” Elizabeth, who had been somewhat masked for those years. However, I attempted to wean off my then-dose of 10 mg of Lexapro very quickly, within about a week, which left me feeling very agitated, anxious, and deeply distressed.
My obsessions kicked into full gear and I ruminated constantly over major and minor things — like what to do with the leftover cafeteria lunch in my fridge, and whether or not I was in the “right” relationship with my boyfriend at the time (now my husband). I tried to stay off of the medication as long as I could, but these symptoms were really interfering with my life. I soon started back with my SSRI again, more convinced that I needed this medication and that all of this anxiety was solely related to relapse rather than to withdrawal.
Flash forward to 2017. I was recently married and had just finished graduate school. I was working in my first big-girl job as an outpatient therapist for children and families. At the time, I was taking 75 mg of yet another SSRI, Luvox, and a starting dose of Wellbutrin. My psychiatrist from the university recommended these specific psych meds to help with the sexual side effects that I was experiencing with my husband. I had little to no sex drive and it devastated me as a newlywed.
After working at my new job for about three months, I decided to come off my medications once again, believing that I was in a more stable place overall. I had also recently watched the documentary “What the Health” and decided to become a vegetarian/vegan, thinking that I could heal my body through dietary changes. I started eliminating all animal proteins and welcomed soybean burgers, tofu, and whole-wheat pasta and bread. Despite feeling worse overall, I was convinced that this diet could cure my anxiety, preserve the planet, and help me achieve an SSRI-free life. Then, over the course of about three weeks, I weaned myself completely off of all medications (except my birth control pills, of course). Soon after, however, my well-known friends of anxiety, panic, and extreme obsession returned. I started experiencing crying spells and emotional meltdowns both at home and at work.
After a few weeks of this chaos, and without acknowledging any other factors that could be at play (poor diet, thyroid issues, hormonal imbalances — which were actually lurking under the surface at this time), I soon returned to another well-known friend: the SSRI.
The Last Straw
My next weaning attempt came in October 2018, 10 years since I’d first started my antidepressant regimen. This one was far different from the others. I had recently started seeing a new psychiatrist, who’d recommended that I add a low dose of the antipsychotic Abilify to “help” the Luvox better manage my residual anxiety. This, however, was my tipping point. One of my internships in grad school had been in a psychiatric hospital, where many of the residents were pumped full of high doses of Abilify and other antipsychotics. My psychiatrist recommended this medication with such certainty and ease, but I saw red flags everywhere. I filled the prescription, but couldn’t bring myself to actually purchase the drug, and told my pharmacist I’d take only the Luvox.
Even more frightening, I discovered inconsistencies among mental health professionals regarding how these drugs worked. I could no longer keep taking my Luvox with a clear conscience. During my next session with my psychiatrist, I advocated ending my SSRI treatment. She didn’t agree but was willing to work with me. I was instructed to lower my Luvox dose to 50 mg immediately and then stop taking it completely after 10 days. I was skeptical. “Are you sure this isn’t too quickly?” I asked. After all, I had tried tapering on a similar time frame before. My psychiatrist assured me that 10 days was the “standard” protocol for a wean like this. I faced the initial wave of discontinuation symptoms, but they soon passed about a week after finishing my last dose.
However, right at the six-week mark of being totally off Luvox, I hit a brick wall: insomnia. Prior to this, I had always slept relatively well; I maintained solid sleep hygiene routines, averaging about eight or nine hours per night. But this night paved the way for a new challenge I was not prepared for. In addition, each time I tried falling asleep, I experienced strange electric-shock sensations that originated in my brain and coursed through my entire body, causing my legs to jolt, heart to race, and sweat to pour over my skin in a matter of moments. I tried explaining these sensations to my friends and family, but no one could really understand what I was talking about.
I began averaging about two or three hours of sleep a night, with about one or two days of no real sleep at all each week. Around this time I also experimented with CBD oil, which provided relief from stress but didn’t appease the insomnia itself. It seemed like nothing could touch this beast of a thing (yes, I tried melatonin). I spent hours in the sauna and inhaled multiple essential oils. I took various supplements while drinking sleepy-time tea into the night.
Each morning I painfully rolled out of bed and forced myself on long morning runs, hoping to tire myself out enough to fall asleep the next night. My job became incredibly challenging as I struggled to keep up with documentation and assessments, and I started taking hours and hours of work home with me each week to stay afloat. I also started experiencing new symptoms, including heart palpitations, neck throbs, and weight loss.
My behavior was also getting out of control. Some nights at 2:00 or 3:00 a.m., after realizing that I would miss sleep once again, I would angrily stomp around the house and throw random cups and objects, frightening the dogs and scaring my husband. At times I would hit myself out of annoyance, feeling like I needed to punish myself to appease the rage in me. After two months of intense sleep deprivation, I knew something had to change.
Functional Medicine: A Different Approach
Knowing that my psychiatrist and other “standard” medical professionals would insist I start back on my SSRI to end the sleeplessness, I continued to stay clear of the drugs. I did some research for myself and discovered the Functional Medicine movement, a form of integrative medicine that focuses on addressing the root causes of a person’s symptoms rather than merely treating the symptoms themselves. I made an appointment at a holistic clinic in Fort Mill, South Carolina run by functional medicine practitioner Dr. Kristien Boyle and his team. After my initial meeting with Dr. Boyle, he sent me on my way with a Whole 30 cookbook and instructed me to give up all forms of gluten, dairy, and my processed soy burgers, which he told me were causing inflammation and wreaking havoc on my gut. I also had extensive lab work done, and the results were mind-boggling.
My blood work indicated a host of issues that had been lurking under the surface of my “psychiatric diagnoses” for years. Some of the major culprits included thyroid dysfunction (Hashimoto’s thyroiditis), Pyroluria (a genetic abnormality which can lead to deficiencies in zinc and B6, leading to symptoms of depression and anxiety), elevated histamine and copper (which can contribute to anxiety, OCD tendencies, depression, and sleep disorders), and low cholesterol (which can affect mood and mental ill-health). In addition, a saliva test ordered by Dr. Boyle showed that I had hormonal imbalances, including low levels of estrogen and progesterone, which had sent me into an early, mini menopause.
Later on, I came to think, “Where were these tests when I first entered treatment as a 17-year-old?” And why was I the one to initiate these tests by seeking out Dr. Boyle and his team? I’ve seen various mental health professionals (therapists and psychiatrists), and none have recommended these types of tests, or stopped to think about any underlying factors, aside from the well-known “serotonin myth.”
I was provided with a detailed supplement protocol and instructed to steer clear of all forms of gluten, as this was a major trigger for my Hashimoto’s. I also engaged with an amazing practitioner who introduced me to the Emotional Freedom Technique (sometimes called a psychological version of acupuncture) and the Alpha-Stim device (an electrotherapy device designed to relieve symptoms such as depression, anxiety, and insomnia). All of these changes did help with my mood and anxiety overall, but they didn’t relieve the ongoing churn of insomnia.
At this point, though, it may have been too late. Nothing would relieve my sleepless nights; it was as if my mind had forgotten how to sleep. I also switched jobs, which decreased stress but didn’t touch the insomnia. Sleep deprivation was taking its toll on my mental and physical health. After six months of averaging two to three hours of sleep per night, I was wiped out, hopeless, and suicidal. I entertained thoughts of driving off bridges, running away, and stabbing myself with knives. In my 27 years of life, these thoughts had never before occupied my mind.
A Return to SSRIs… Plus Benzos
Six months. The longest time I had been off SSRI’s since starting them, roughly 10 years ago. After an intense, bloody battle, I waved the white flag. During my next session with my psychiatrist, however, I needed some questions answered. “Do you think all of this insomnia could have been avoided if I had weaned off slower… like over the course of a month rather than two weeks?” I asked. She shook her head and confidently denied this as a possibility. I was stunned and highly annoyed. It was reinforced instead that I needed to be on this medication to balance certain chemicals in my brain that were contributing to my anxiety, depression, and insomnia. I also asked how my hormones might be playing a role in my symptoms, specifically with my going off of birth control pills a couple of months earlier. Again, she shook her head.
I felt frustrated and bitter, not just because I had to get back on the SSRI, but also because of the lack of consensus within the mental health community at large. “How could one practitioner say one thing, and another recommend something totally different?” I thought. Regardless, I was out of options, and so that night I swallowed my pride along with my medicine.
A Better Life
Fast forward about six months later. I’m still following the meal plan and detailed supplement protocol my functional medicine practitioner prescribed for me. My thyroid levels are back in range, among other improvements that were indicated in my final blood work. And I can tell because I feel so much better. I also started seeing a new psychiatrist, who proposed a better plan for trying to taper off SSRI’s a final time by going a bit slower than before. After two months of tapering, cutting the starting dose of the Luvox pill into small pieces, I recently stopped taking the drug completely. And guess what? I’m doing well overall.
On one of my more trying days, Dr. Boyle asked me in his English accent, “Do you believe there are always some sort of lessons that can be learned?” “Yes…” I choked out through my tears. “I think so.” Since then, I’ve embraced a new narrative, one that rises above the notion that I am inevitably flawed and broken. I am not ruled by my anxiety or any other psychiatric labels assigned to me. Sure, I go through phases where I’m scared straight, fearful of repeating the same pattern again. But this round, things feel a bit different, for the better. I’ve chosen to embrace boldness, vulnerability, and persistence, while not running from the uncertainty this process seems to hold. After all, I’d rather swallow that instead.