A Therapist Navigating Antidepressant Withdrawal: Nelson Lee on the Power of the Present Moment

Nelson Lee is a therapist and mental skills coach with a master’s degree in clinical mental health counseling and an MBA. In 2024, he attempted to get off antidepressants that he’d been on for 15 years. This led to significant long-term medication withdrawal that Nelson is still navigating at the time of this interview.

As a therapist, Nelson specializes in helping clients transform their relationships with themselves and others and overcome anxiety and OCD. He loves helping people rise above their challenges and proactively maintain long-term healing and growth. He believes it’s never too late or too early to improve your mental health.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

Brooke Siem: Nelson, you are a therapist — and a therapist in withdrawal. That’s one of the more interesting combos because so often it feels like patients are fighting against the mental health experts. If you could start by sharing a little about what you do professionally and what’s going on in your life personally.

Nelson Lee: I’m a therapist — somewhat of a new therapist. I started out going the business route, which is where the MBA comes in. I worked in the corporate world for a while, then eventually got into some coaching around mental health and decided to fully pivot into the therapy world. I’ve been out of school now for almost two years.

That has put me in a unique position, working with clients while navigating withdrawal. It’s been a really interesting experience — navigating something that, in my mind, is bigger than anything else I’ve been through. It’s not just emotional; it’s very physical. Holding space for the people I work with while going through this has been incredibly unique.

Siem: Just so we have a little context, can you tell us what drugs you’re on and a little about why you got on them, your medication history, and what happened when you started tapering? I think that’s an angle we need to dive into.

Lee: I started with fluvoxamine — Luvox — and was on that for probably five years. I eventually experienced an increase in anxiety. How I got into working with OCD clients is that I experienced OCD myself, and working my way out of it got me into the mental health world. I started as a coach before going back to school.

After Luvox, I switched to sertraline and have been on it ever since. After a few years, I learned some good skills and decided I didn’t want to be on the medication anymore. It was sold to me as a very soft medication, so I thought it would be no big deal to get off.

I tapered pretty rapidly — from 100 milligrams to 75, then 50, then 25. Dropping from 25 to zero triggered my first withdrawal experience. It came on quickly. After a week, I was fine — then suddenly one night I stopped sleeping. I thought, this is weird, maybe it’ll go away in a few days. I pushed through with zero sleep and felt strange — adrenaline pumping through my veins. I went back on the medication, and it resolved almost immediately.

At that point, I figured I just needed to taper more carefully. Over a couple more years, I tapered to around six milligrams, jumped off again, and had the same withdrawal happen. I went back on and decided to wait longer before trying again.

Then, I heard it’s easier to taper by switching to a liquid, so I did that and dropped my dose at the same time. Two or three weeks later, withdrawal symptoms hit. They were less severe than previous times, so I thought it would just be a few weeks — which is what you often hear when you Google it. I figured I’d stick it out.

Here we are about 10 months later, still in the thick of it. It got significantly bad in the middle. It’s been an experience.

Siem: How many years has it been since you first decided to step down from the 100 milligrams?

Lee: If I had to estimate, probably six years.

Siem: Where are you at in the process now?

Lee: I’m at about five and a half milligrams — technically 5.6.

Siem: On the liquid?

Lee: On the liquid, yes.

Siem: What’s the strategy moving forward?

Lee: Right now, I’m trying to stabilize. The plan is to do a microtaper — maybe 5% to 10% a month — depending on what my body can tolerate and move down slowly each month.

Siem: I’m curious in how this has affected your practice. Withdrawal is interesting because we can almost put a smile on our face and act normal while inside everything is a complete mess.

I was in a position where I just had to sell cupcakes — I didn’t have to be the calm one in the room. You’re in a different place. What’s going on inside versus what’s happening on the outside?

Lee: That’s such a good question. It brings me back to when things were really difficult. I remember sitting with clients, giving them everything I had. Thankfully, I’ve been able to show up for them. I’m grateful it hasn’t gotten so bad that I haven’t been able to work.

But there were times when the internal dialogue in my head was, if only you knew what was happening on the other side. I remember thinking, I almost wish I had their nervous system right now, like my client who’s coming to me for help. Those were challenging moments for sure.

Siem: How did you even begin to show up and regulate during that time with a client?

Lee: I look back, and there’s something about just doing it. That’s where some of the skills I’ve learned have come into practice — things like mindfulness. Before going to work, I couldn’t focus on how am I going to get through the day — it was more let me stay here right now.

When I’m with a client, I have the awareness to know what’s showing up for me, and that gives me the ability to show up for them. I can be having a visceral emotional experience, and with withdrawal, that’s been all over the place. I’ve had days of intense anxiety, almost terror surging through my veins, and days of being completely numbed out.

There’s an emotional bluntedness that comes with withdrawal I haven’t experienced with anything else. It feels like being a pressure cooker — emotions are in there, but they can’t move through. They hit a bottleneck, and my body is the bottleneck. There’s overwhelming pressure that can’t get out.

In these moments with clients, I just notice that. I sit with it and mindfully navigate it. That’s really been the story of the last 10 months — trying to come back to the present and not let my thinking create too much fear about the future. I just try to be here as much as possible and use the skills I have. I feel like I’ve been able to do that, which I’m so thankful for.

Siem: When you say “mindfully navigate,” can you dig into what that feels like? Is it a specific strategy?

Lee: It’s very case-by-case. More generally, mindfully navigating is noticing the thoughts and emotions showing up for me in real time, even in conversation.

For example, with you right now, I can notice I have a little bit of antsy interview energy if I pay attention to my body, but I can notice that and stay engaged. That’s what I do with clients — noticing whatever is there. Being mindful is really just being aware of it. I don’t need to change it or judge it. I can allow it to be here while I practice the skills I have as a therapist — guiding people through experiential work, asking questions, being present even while these things show up.

Siem: Are you able to only do this with clients, or can you take this ability into the rest of your life? How is it affecting the withdrawal experience?

Lee: I hope I don’t sound too zen mastery here because I’m not at that level for sure. Withdrawal has been so up and down. Symptoms have gone in waves — I’ll have a week or two where I feel somewhat okay, then I’ll dive for a couple of weeks.

Luckily, since December, it’s had a slow upward trajectory, but there’s been a lot of back and forth.

Siem: As you’ve been stabilizing on the 5.6 mg?

Lee: Yes. There have been days that were horrendous — taken me to the edge of what I thought was possible to contain in terms of pain and ongoing suffering, further than I thought possible. I’ve never experienced anything like it.

There were moments of panic — is this it? Am I going to be in this forever? — really dark days questioning whether it’s worth it to keep going. If I’m being honest, it’s taken me to that edge multiple times. But every time, I came back to: people get better from this. I’m going to take a chance on that. I lean into doing what I can now, and that usually loops me back to acceptance.

I have panic, it takes me to a dark place mentally, and then it’s a decision: either tap out of life or accept this and move forward — take a chance on the future and uncertainty.

Siem: Now that you’ve been through this for a few years, what makes you want to keep going rather than just stay on 5.6 mg indefinitely?

Lee: I’ve certainly considered that. My previous withdrawal symptoms were years ago, but this 10-month stint has been the worst.

I really don’t want to feel like a prisoner to this medication. I don’t want to be beholden to something that has this kind of grip on me. It’s scary to think about what could happen if there was a shortage — I don’t want my wellbeing tied to a bottle or a pill. For me, that trade-off isn’t worth it right now.

Siem: How old were you when you were first put on these drugs?

Lee: I was 19.

Siem: What was going on in your life at that point?

Lee: That was when I had my first real dip into anxiety and OCD. I don’t feel like I’m a very depression-prone individual — it takes a lot of being worn down. I went far enough down the anxiety and OCD path that I was worn out. My body was done. I ended up seeking help, and medication was the frontline thing offered.

Siem: What were your thoughts on it at the time?

Lee: I was in a really dark place, so I thought, this is what you do. I trusted the experts. The chemical imbalance narrative was still alive then, and I looked to that.

But there was a fire in me that resisted a lot of the narratives. I remember seeing psychiatrists and therapists, and the overall message was: this is something you’ll have to struggle with for the rest of your life, manage it with medication.

It felt like being diagnosed with a permanent disease. Sure, my brain will always be prone to anxiety, but I didn’t agree with the weight they put on it. I kept looking, and that eventually led me to the skills that helped and got me into coaching and therapy.

Siem: What were those skills?

Lee: A lot of it, in the beginning, was basic mindfulness. Practices like meditating 10 minutes a day were game-changing. When I first read about meditation, it felt impossible — but when I started, I could watch thoughts, and my brain would calm down. I could watch thoughts and feelings move through without reacting to them.

At the root of my anxiety and OCD was constant reaction to thoughts. I was just reacting to thoughts all day, and that’s what was feeding so much of the anxiety. Pull back the reaction, and it’s like a pond that settles — stop throwing rocks, and it naturally calms over time.

Withdrawal has made it a deeply personal experience. I’m seeing how I relate to myself at a much deeper level. It’s shown me gaps I missed previously.

For example, I’m learning the power of stepping out of constant self-development and moving toward becoming a creator. I realize how much time I’ve spent trying to gain certainty about my future — getting the MBA, another postgraduate degree, going from coaching to therapy because I thought I had to be more legitimate. Withdrawal has opened my eyes to the ways I’ve been performing for the world.

Siem: This is fascinating to me on multiple levels. Most of the people who reach out to me about withdrawal are educated and have spent their lives taking and passing tests, using their big smart brains to succeed.

Then you get to withdrawal, and none of that works anymore. At least for me, it was an exercise in learning that I wasn’t going to think or learn my way out of this — and being confused, shocked, and scared that I didn’t know what that meant. That led to a spiritual awakening. How does that look for you?

Lee: As soon as you said that, I immediately wanted to ask you questions. Even recently, you made a post about a painting you did, helping someone else in withdrawal. The caption mentioned they were close to awakening but hadn’t crossed the threshold. As soon as I saw that, the problem-solver part of me was like, what is that? how do I get there?

I feel something similar. It feels like I’m bumping up against an edge — I can’t see the other side, but something’s there. I’m really interested to hear what your experience has been.

Siem: For me, I was pulled off my drugs cold turkey by a psychiatrist. I was on the lowest dose of Effexor XR, and she just told me to stop. There was no long-term tapering, no chance to put the brakes on — we just ran the car into a brick wall.

The only thing that kept me going was how pissed off I was. I had no clue how much these drugs were influencing everything I believed and felt, beyond just keeping me not depressed — which they never really did. I made the decision that I would rather feel withdrawal for the rest of my life than give one more cent to the pharmaceutical industry on this topic.

I didn’t know how long it was going to last. At the time, there wasn’t much information available. Now you can easily Google and find stories that can uplift or defeat you, but I didn’t have that.

That ignorance meant I sought out the moments where I felt better and paid attention to them. I’d find the component of a moment where I didn’t feel the worst, and rinse and repeat until the moments stacked. I also completely blew up my life in the process.

At the time, I wouldn’t have said I was awakening, but I felt more connected to everyone — the horrible and the beautiful parts — and that felt like spirituality to me. Not about religion, just connection to the bigger world.

The real awakening came later, once I wasn’t as blinded by the pain of withdrawal and could see the learning, beauty, creativity, and gratitude that came from it. What I didn’t realize is that all the bullshit you go through is also part of the awakening process.

Lee: How did that change your trajectory? You mentioned blowing up your life — what did that look like, especially after reaching a place where you had access to gratitude and higher-level emotions? What was it like to chart your path in the real world, not just internally?

Siem: Just destruction everywhere. It felt like ending an important relationship — that long buildup to finally saying, I love you, but this isn’t working. It was like doing that in every aspect of my life — friendships, the city I lived in, my job, my business, my business partner. One horrible conversation or decision after another.

Ultimately, it came down to: the alternative was tapping out. I thought, as dark as it is, I can always tap out later. I may as well try blowing everything up first and see what happens.

But it was highly unpleasant. You don’t get to keep everything; you have to leave a lot behind. The process teaches you that.

For me — and I find this is true for most people in withdrawal — once you control for things like a dose change or switching from capsule to liquid, if you’re just watching symptoms, they tend to increase when you’re in situations that no longer work for you. Withdrawal becomes a barometer for your life.

When people become more confident in recognizing, I feel worse around this person, or in this job, or in this city, and then they make a change, their withdrawal symptoms often get a little better. Our nervous systems are so sensitive — they’ll tell you everything that’s wrong. If the air quality in your house isn’t great, suddenly your eyes are puffy. It’ll tell you everything you might not have noticed before.

Lee: Hearing that is the most peculiar thing about all of it. It’s not just symptoms — it’s your nervous system being affected by withdrawal.

I’ve read on forums about neuro-emotions — emotions that are really big — and I’ve definitely experienced that. But I remember someone pointing out there’s still a grain of truth in each of them. Sure, my emotional response might jump to a 10 instead of a 3, but now I can see what’s actually making it rise, rather than blowing past it like I normally would.

Siem: I agree. If you’re lucky, you get windows and waves, so things that feel good, feel really good.

But I struggle with what to say to people whose windows are short or non-existent. It’s hard to have these discussions with them — you don’t want to magnify their suffering by saying, maybe it’s your bad marriage that’s making this worse. They’ve already had enough suffering. But sometimes, we do have to change our situation for our physical symptoms to improve.

Lee: Yeah. It’s that dance between our external environment and our internal, and external definitely has an impact.

Siem: How has your OCD and anxiety been affected since dropping and tapering?

Lee: It’s been way worse. There’s no dancing around that.

I’ve realized they’ve been subtle coping mechanisms behind the scenes for most of my life. I can remember being anxious and having OCD symptoms as far back as I can remember. Withdrawal exacerbated that — the uncertainty is huge.

Even now, I don’t know where the light at the end of the tunnel is. It’s especially scary when you’re descending and symptoms are getting worse. Anxiety and OCD are about control — wanting to control anything. Whether that’s ruminating, contamination OCD, washing hands — it finds something to latch onto.

That’s the thing with anxiety and OCD — it’s limitless in what it can attach to. In my practice, I don’t even focus on themes — I focus on the pattern. And in withdrawal, those patterns show up more because the nervous system is so sensitized.

When anxiety hits, it’s way more convincing — more powerful and overwhelming. Wading through that is harder than with a fully functional nervous system.

Siem: I’d love for you to speak more on the OCD angle. I get questions from people who were put on antidepressants for OCD. I don’t have experience with that, so I don’t have much to offer.

The symptoms seem so different and crippling compared to depression or anxiety. Can you speak on strategies people can use while tapering?

Lee: The strategies for tapering would be similar to facing OCD symptoms in general — just more intense during withdrawal.

The gold standard for OCD is exposure and response prevention. The best practice is to find a therapist trained in it. It’s not super complicated — it’s facing the things that scare you.

Personally, I like to align exposures with where the person wants to go. It’s not just about exposing yourself to fear for fear’s sake — it’s about pursuing an adventure, something meaningful, and facing the fears inherent in that.

My favorite modality is acceptance and commitment therapy (ACT). It weaves exposure into the pursuit of your values. It’s about learning to process emotions and let thoughts move through while pursuing the life you care about. In a nutshell, OCD recovery is: can I notice thoughts without reacting, and can I do that while building the life I want?

Siem: If you’ve got a client who isn’t medicated and starts talking about going on medication, how do you navigate that professionally?

Lee: I want to be careful. This experience has definitely tainted my view of medication. I’m really upset about it.

But working with a client, I’d make it clear: know the risks. It’s their decision, and I’m not going to vilify it, but they need to be informed. I might self-disclose — I don’t do that often, but if it’s helpful, I’ll share some of my story and the stories of others I’ve met through this process.

I’d encourage them to try other things first. If they’re not in imminent danger, if we have some wiggle room, let’s try some other approaches before turning to medication. Let’s take a chance on that.

Siem: Based on your experience with the withdrawal community, do you have any feedback on how folks like me — who aren’t MDs or clinical psychologists — can better communicate to the public about the risks of these medications without vilifying them?

Lee: Where my mind goes is: just know what you’re getting yourself into. People who’ve been through it — regardless of credentials — have ground-zero experience. That is your credential.

I think honestly sharing that is enough without totally vilifying the medication. It’s a reality.
Even as a therapist, I want to be careful not to vilify it — for people still on meds or those in a dark place where medication might help. I try to bring a lot of curiosity to these conversations.

It feels messy and jumbled, but maybe that’s part of it.

Siem: I think that’s the point — it is messy and jumbled. People latch onto whatever they want to hear in this space.

It seems more pronounced in mental health than anywhere else. Maybe that’s because mental health is so subjective — there’s no true mean to measure against. As a therapist, you’re walking that line constantly, so I was curious if there’s specific language you’ve found that works.

Lee: I think the conversation is acknowledging how messy it is — that it has the potential to go sideways.

It’s about acknowledging the risks and the potential upside. If I were working with a client really struggling, and medication could help, I wouldn’t tell them they can’t do it. I’d encourage them to know the risks and create a plan with their doctor — maybe use it as a short-term booster while building skills to hopefully taper off later.

From what I’ve learned, it’s long-term users who tend to get hit hardest — people like you, people like me.

Siem: How has this experience affected how you view the world of mental health professionals?

Lee: It’s certainly impacted my view of psychiatrists, unfortunately. When I was desperate for help, I found few who even recognized withdrawal. Most psychiatrists I reached out to said, you’re not experiencing withdrawal, it’s relapse. But I knew it was different.

I did find one psychiatrist who understood, but to work with him long-term required enrolling in a big program, and it wasn’t the right fit.

Ultimately, I realized this would be a solo thing — me, and the information I could find from reputable sources who actually knew what withdrawal was.

Honestly, I’ve been more inspired by coaches — many of whom aren’t credentialed. It comes down to vetting sources yourself. Credentials don’t automatically equal credibility or discredit someone either.

Siem: My sense is there’s something so deeply unique about psychiatric drug withdrawal that if you’ve been through it, there’s an immediate recognition in another person. If you haven’t, it’s like speaking a different language you’ll never fully understand.

Lee: Exactly. The depth withdrawal takes you to is so unique. As a clinician, if a client’s experience is something I’ve lived through — anxiety, OCD — there’s a different familiarity, a different connection. Withdrawal is even deeper because it’s so misunderstood.

It’s worse than any mental health condition I’ve personally experienced. It’s beyond description — I could list the symptoms, but it wouldn’t capture the experience because it’s all at once, a melting pot of messiness.

Siem: It changes so frequently. You can look like a normal person, get a blood test, and your doctor tells you you’re fine — but you know you’re not.

Lee: Totally. It’s strange — even now, I’m in withdrawal. The last few days were really difficult, but today I’m starting to ascend a little.

Someone listening would have no idea. That’s the nature of it.

Siem: I’ve spent more time recently talking to men in withdrawal. Before that, most of my interactions were with women. Women are allowed to be emotional, hormonal — it’s more accepted.

If you’re open, I’d love to hear your thoughts on going through this as a man and the challenges masculinity brings to withdrawal.

Lee: Thank goodness I took the path of mental health work — becoming aware of emotions and making that a huge part of my life. Without that, this would have been much harder.
So many of the symptoms are emotional. An emotion that might normally hit you at a three goes to a ten — sadness, anger, anxiety. Even joy can be intense, but for me, it’s the negative emotions that hit harder.

One of my biggest symptoms is that twice a day, I have to let out what’s essentially a crying spell. It’s different than normal crying — more like the waves of grief when you’ve lost a loved one.

Morning and night, for months now, I sit with it and let it out. Emotionality has increased in my everyday life, and crying spells — especially for men — are definitely stigmatized. But it’s part of the process.

One of my favorite modalities is Internal Family Systems. The idea is we all have this intrinsic version of ourselves with access to compassion, light, kindness, creativity, courage. Withdrawal has been an opportunity to meet the darkest darkness with that. It feels like descending into a hole and seeing if I can bring a flashlight. That’s what it’s like sometimes.

Siem: What have you learned about yourself through this process that you didn’t know before?

Lee: One of the biggest things is that the part of me that has access to light is always there. That’s been really interesting. But I have to choose it — that’s the caveat.

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