Coming Off Antidepressants - The Long And The Short Of It

What I am currently discovering is that it is a lot easier to start taking antidepressants than it is to stop them. This in itself is more than a little depressing. How ironic.

I have now been off my antidepressants for four weeks, but I have to say, the road has been rocky. There doesn't seem to be a lot of knowledge or support of the process available in the NHS. My GP initially told me I could just stop taking my antidepressant (sertraline), but online research suggested that this wasn't the best idea, especially given I'd had a nasty withdrawal episode in the past when I forgot to pickup my prescription before the weekend. I was only on 50mg a day (one tablet, so the lowest dose), so she then suggested cutting down to half a tablet a day, which is what I tried, initially, but I became anxious and panicky, so had to alternate a whole tablet with half a tablet to begin with. This left me a low level of anxiety that I felt I could cope with and manage with the help of exercise to give me a mental boost. Sure enough, the symptoms settled down within a week or two, and I was ready to reduce down again.

I didn't really feel the effects of this second reduction, which perhaps gave me the (false) impression that I was taking this coming-off-antidepressants-malarkey in my stride. I was fine on half a tablet a day. Trying to reduce this further was when the real fun began. The logical approach was to alternate half a tablet a day with nothing a day, but in hindsight, maybe this was too big a jump. Thing is, these tablets are really tiny - maybe a third of the size of a paracetamol capsule, so cutting them any smaller than in half was always going to be tricky at best. So we went with "the logical approach" and I started to feel really odd. It didn't help that I put my neck out a day or two after the reduction, so when I started feeling light-headed, I thought it was down to that. At a couple of points, everything went a bit dark and I felt like I was going to pass out. This was pretty scary, and I was convinced I must have some kind of blood clot or something. Hell, I'm not a doctor. I felt reassured when NHS Direct seemed more concerned about me blacking out while on my own with a two-year-old than that I had anything serious wrong with me. However, when I started to feel like the room was spinning even when I was sat down, I decided it was time to get checked out.

The out-of-hours doctor checked me over thoroughly. She examined my neck, looked in my eyes, my ears, my mouth. She looked at my nails, listened to my chest, listened to my heart. Checked my pulse on the pulse monitor thingy, and my blood pressure while sitting and standing. She even checked my blood sugar. The thing she seemed most concerned about was the dizziness and my feeling of impending doom. She offered to admit me to hospital for this, but I didn't feel that the doom was impending quite that quickly! I had really hoped that she would come up with an answer, but she seemed puzzled, which was more worrying in itself. Eventually I suggested that it could be withdrawal from my antidepressants, and she agreed it could be that, but she seemed more concerned that I could be anaemic. From my obsessive Googling on the topic of withdrawal from antidepressants though, it would seem I was experiencing classic SSRI withdrawal, and I can't see why she didn't come to this conclusion, unless GPs are just not that clued up about this.

Withdrawal continued to be pretty damn nasty. I quickly decided that I should just cut the antidepressants completely and just power through, knowing that initially it would make me worse, but that ultimately I would be clear of the symptoms faster. I now wonder if the spinning sensation would have subsided after a couple of weeks, but I felt dangerous driving, and a third GP I had recently seen for a review had told me I could "just stop whenever", so I knew they would have nothing helpful to offer, so I didn't bother contacting them and concentrated on trying to get through the withdrawal, which inevitably got worse in the absence of any medication whatsoever. I had difficulty concentrating at work, and felt like my brain was trying to wade through mud to understand the simplest of concepts. I felt like the room was spinning, and sometimes like I was having a slight out-of-body experience when walking. I also started having brain zaps, which are like a little electric shock sensation in your brain, kind of like goosebumps, but inside your head. Not pleasant. I decided I wasn't safe to drive, and The Husband had to drop me off at work and collect me. I worked short days and didn't tell anyone what was going on. I probably would have told my manager because it was affecting my work, but he was on holiday, and I didn't really fancy bringing up the subject of depression with his manager, or one of the other managers, particularly since I had never mentioned my postnatal depression at work, as it hadn't seemed relevant.

It took about two weeks for these symptoms to subside, but now I'm having to contend with mood swings, irritability, low mood, feeling angry/tearful a lot of the time. I tried exercising and just felt a failure that I was finding the moves on the exercise DVD so difficult, and I kept panicking and having to stop. It's very tempting to just go back on the antidepressants. Especially given there isn't a lot of information online about life without antidepressants in the long-term. I found that my GP had little to no knowledge of withdrawal, but at least the internet could fill me in on what was "normal" in the short-term (I hate that word). I've just had a quick Google on the topic of feeling depressed four weeks after coming off antidepressants, and the results weren't terribly encouraging. There wasn't much that was specific to the long-term.

The first link was to an article on PsychCentral.com entitled "When Should I Come Off My Antidepressant? 6 Things to Consider" by Therese J. Borchard, apparently an associate editor (not sure what qualification that gives her, if any). #6 advises:

"Be realistic. According to Sheldon, about 80 percent of patients discontinue their antidepressants in actual practice settings. But most of these patients relapse, and half restart their medications."

So that's reassuring. Not. Sheldon (referred to earlier in the article as Dr. Richard Shelton, professor of psychiatry at Vanderbilt University, so I'm not sure what his actual surname is) suggests that most people go back on the damn antidepressants. You have to wonder though, how much support people get in the slightly longer term. My experience via my GP was that antidepressants are the answer - "Here, have a prescription. Take forever, if necessary." Coming off them - "Sure, just stop. It'll be fine. Withdrawal is very rare." My guess is that if I go back to my GP now, she'll say I should go back on them. But given they tell you to give the antidepressants six weeks to work, shouldn't I also give them six weeks to completely clear my system? I'm concerned that what I'm experiencing now is not so much depression, but what I'm tentatively calling "Face Wash Syndrome". No, I'm not necessarily crazy. Hear me out.

You start using face wash because you have bad skin, and you keep using it because you continue to have bad skin. What you don't immediately realise is that the face wash is drying out your skin and causing the spots. Any time you stop using the face wash it gets worse, so you tell yourself that you just have bad skin and need to keep using the face wash. Until one day you stop using it because you aren’t convinced any more, and after you get over your skin being initially worse, you realise that you and your skin are better off without the face wash. So I’m currently wondering if I just need to get through this stage, and that ultimately I will be better off without the chemicals. I hope that is the case. I realise I need to be prepared to consider the possibility that I just need antidepressants the way a diabetic needs insulin. That it is an illness, and not something I can change with my willpower. Maybe the GPs are right. But I’m not ready to accept that just yet.

The Reorganised Mother

So, you may be thinking, why have I called this blog 'The Reorganised Mother'? To explain, I really have to go into a bit of my background. I was diagnosed with postnatal depression (PND) in February 2012, though as far as I can see, the only reason it was diagnosed as PND rather than just depression was because I had had a baby within the previous 12 months. After seeing one GP who was very helpful and suggested many different ways I could try and help myself without resorting to antidepressants, my gran then died and I went to pieces, resulting in another GP convincing me that antidepressants were the only way out of the dark hole I was in. After initially making me feel worse, they did start to make me feel less depressed, but I wasn't "better". I felt a bit lost, because the antidepressants had really been presented to me as a solution in and of themselves, though increasingly I felt I couldn't get better until I knew what had gone wrong and how to fix it. Eventually, I discovered some counselling at the Women's Centre in my area, available for up to six to eighteen 50-minute sessions for the bargain price of a £10 donation per session. There was a waiting list, but I was able to skip up it by being willing to have a trainee counsellor. 

Having counselling has made a big difference to my life. I thought it would be probably 6 sessions maximum, because I didn't have what I considered to be particularly bad mental health problems that required treatment, and in truth, I felt a bit guilty going along in case I was taking a counselling spot away from someone who really needed it. What I discovered though was that I really needed it myself, and there probably aren't that many people who wouldn't benefit from counselling. I ended up having the full eighteen sessions. The purpose wasn't for my counsellor to tell me what the problem was and how to feel better - with her guidance, I discovered this for myself, which was far more useful. We mainly just talked about what was going on in my life, but I discovered that all these little things and how I reacted to them were connected to the big things, and in some instances, had made the big things so big in the first place. 

I learned that I tended to talk about myself very negatively, that I said "I should" a lot, and that I directed a lot of energy into feeling down about things that I had decided "I should" be doing or should have done. It was illuminating to discover that I was setting these "shoulds" for myself and making myself feel guilty for not achieving them. I learned that I am a perfectionist, that I am hugely self-critical, that I over-analyse pretty much everything, that I have an over-developed sense of fairness and that the approval of others is massively important to me, for reasons unknown even to myself. I also learned that I am a work in progress. No one has the perfect life, no one is doing everything right all the time, everyone else is making mistakes too. That there is no point worrying obsessively about things I have no influence over and which I can't do anything about. That if I am worried about something I can do something about, I should do all I can and then stop worrying about it, because it is out of my hands. I learned that I have to stop worrying about the future and just enjoy the journey, because that is what life is all about. The biggest gift was probably self-awareness though. Now it's like I have a little mini counsellor in my head all the time!

Counselling has set me off in a new direction and helped me find myself again after getting a bit lost in just being a mum. Really, counselling has helped me reorganise my life, and discover what is important to me and for me and that is why this blog is called The Reorganised Mother. I'm a much happier and more positive person now, and I'm in the process of coming off my antidepressants (that will probably require its own separate blog post). I wouldn't say I'm fixed though. I will probably always be susceptible to depression, but I'll be far more adept at seeing the warnings signs and knowing how to get myself out of it. I've learned a lot about myself and how I work, and what I need, which has been invaluable. So I guess the purpose of this blog is to continue the journey and see what more there is to discover. I would love to become a writer one day, and I see this blog as an opportunity to practise. :-)