Considering Getting Off Antidepressants? Here's How To Do It Safely
If you’re feeling sad or blue, or suffering from mild to moderate depression, dysthymia, seasonal affective disorder, premenstrual dysphoric disorder, bipolar II, or anxiety, Dr. Ellen Vora has the tips & tools you need to help manage your symptoms and feel vibrantly healthy. Check out her newest mbg class, Managing Depression: A Mind, Body & Spirit Approach, to learn how you can start healing your depression today.
I'm a holistic psychiatrist practicing in New York City, and I often find myself with a line out the door of patients who are struggling to get off of psychiatric medications. While you should absolutely do what's right for you in your health journey, it's worth noting that doctors rarely disclose how difficult it can be to taper off medications like Lexapro, Zoloft, Effexor, Klonopin, Xanax, Lithium, Abilify, Adderall, and Vyvanse.
While some people experience few if any side effects when tapering off these medications, for others it can lead to a persistent state of anxiety, low mood, dread, hopelessness, and despair for months. It can even lead to impulsivity and suicidal thoughts and behaviors. The medication withdrawal state is a difficult and potentially dangerous state. With millions of people on psychiatric medications, and almost nonexistent support from psychiatrists or primary care doctors, patients are left to negotiate this harrowing process by themselves. So I'm left wondering: Why aren’t we having a public conversation about this?
Having a public conversation about the pros and cons of psychiatric medication.
Having this conversation would allow people to make more informed decisions about whether to go on these medications in the first place and would help them feel less alone while dealing with the throes of withdrawal. When my patients find themselves in withdrawal mode, they nearly all have the same thought: "Why is this so hard for me?" My patients often think they’re the only ones struggling with this process, when in fact it’s a common experience. There should be more awareness about this so people don’t need to feel ashamed, alienated, or alone in their struggle.
We also need to start talking about just how long these withdrawal symptoms can last. My patients are often fixated on ideas like: It’s been two weeks since I got off X medication, shouldn’t it be out of my system by now? The fact is, "out of your system" is only one step of a many-step process of your body withdrawing, healing, and rebuilding after such a significant neurochemical change. A person can be in a chronic, subacute phase of withdrawal for months.
Paying attention to the word "relapse."
When someone feels bad after getting off psychiatric medications, everyone jumps to the conclusion that this is a "relapse" or that this is "the depression coming back," or that "the medication must have really been working." While on medication, many people have the thought, Is this medication even doing anything? I don’t feel good.
Then, when the withdrawal hits them, they begin to believe that the medication must have been doing something, because being off of it feels awful. People blame themselves in this moment, failing to recognize that their body was just thrown into a severe withdrawal. This experience convinces people that the medication "must have really been working" if this is how they feel off it.
Of course, sometimes relapses do occur, and sometimes medications really were working, but what you feel like in the first few weeks after getting off a medication tells us little about what the drug was doing, whether your depression will come back, or what your new baseline will feel like. In those first few weeks, you are in chemical withdrawal, plain and simple.
How to best support your brain and body during the healing process.
In my decade of medical school and psychiatric residency training, I’m not sure I learned anything about how to support patients withdrawing from psychiatric medications. You mainly focus on ideas like how to encourage patients to be "compliant" or "adherent" with their medication. When someone goes off their medication on their own, there’s a dismissive attitude toward that behavior.
Nowhere did I see examples of doctors considering it reasonable to stop medication or brainstorming ways to support their patients should they want to try. I’m not sure I blame my colleagues because we’re also never taught many alternatives to medication for managing our patients' mental health. So why would someone go off medications if there's no other way to treat depression? The fallacy here, of course, is that there are other ways to treat depression.
How to get off psychiatric medication safely.
In my own practice, I’ve been on an autodidactic journey of experimentation in terms of learning what helps people most. I’ve learned a lot from my colleague Kelly Brogan, M.D., who has a thoughtful and effective approach to supporting this process. What I’ve learned is that getting off psych medications as safely and smoothly as possible requires the following: eating a nutrient-dense, anti-inflammatory diet (I usually encourage patients to follow a Whole30 diet for the duration of their taper, encouraging home cooking and a focus on sourcing real food from farmers markets); prioritizing sleep, getting to bed early and getting sufficient quantity and quality of sleep; having some form of meditation practice, be it Kundalini, Transcendental Meditation, journaling, morning pages, or lots of good yoga; and moving the body at least some amount most days. Vital Mind Reset.
There is also a role for supporting the body’s natural detoxification mechanisms with practices like dry skin brushing and even coffee enemas. Extra credit for spending time in nature and surrounding yourself with a positive, supportive community. It is also essential to have a well-versed practitioner be your jungle guide on this journey, and it’s often necessary to work with a compounding pharmacy to do a more gradual taper than is possible with commercially available doses. This is the best way I know to support a safe withdrawal.
And for anyone out there weighing the pros and cons of medication treatment, I want you to know that depression is more than just a "Lexapro-deficiency disorder." The root cause of mental health issues is part physical imbalance (e.g., chronic inflammation, thyroid dysfunction, autoimmunity, hormone imbalance, blood sugar dysregulation, chronic sleep deprivation), and part psychospiritual (e.g., history of trauma, cognitive distortions, social isolation, chronic stress, living out of alignment with the way human beings evolved to thrive—eating real food, moving their bodies, sleeping in darkness, breathing fresh air, drinking clean water, seeing the sun, connected to nature, and deeply rooted in community). When you start to recognize the real causes of your mood symptoms, you may be able to address those at the root and heal your depression.
My hope is that this can become a more public conversation so that people struggling with withdrawal don’t feel ashamed or alone and can learn from the experiences of others. Know that while antidepressants can be life-saving, it can be tricky and even dangerous to quit them. If you do decide to begin a taper, focus on supporting your body with food, rest, meditation, exercise, and detox, and work closely with a practitioner familiar with this process.
Want more advice from Ellen Vora? Check out her class here.