[mwfunk]

I had similar experiences. Going off the antidepressants didn't have an effect initially, if anything I felt more alert and energetic for the first few weeks. After about 6 months I felt like my terrible old self and had to start taking them again. I've been through this 3 times over the past 20 years.

Some people will no doubt chime in that they are sure that my brain developed a dependency on the drugs and the return of my symptoms was simply that dependency asserting itself. Maybe, but probably not? That's the most anyone can really say about situations like this one, based on how well these things are currently understood. All I know is that antidepressants saved my freaking life when I first started taking them 20 years ago.

[a3n]

Everyone's depression is their own, and one experience does not necessarily relate to another's experience. Go ahead and read what you like, but listen to yourself and your doctor.

Counter to the "takes a long time" statements: I was suicidal, and down 24/7. I started taking an SSRI on an afternoon, and that night noticed a difference. It took me awhile to get used to it and get past the side effects, but the depression changed literally overnight.

But that's me, that's my personal depression. I got lucky. Resist changing your routine just because someone has a well told story, no matter how smart they are.

[striking]

Antidepressants take a while to take effect and take a while to go away. The people talking about dependencies are almost certainly horribly wrong.

That being said, if you feel that decreasing your dose makes you more alert and energetic, take it up with your psychiatrist. You may end up being advised to try a lower dose. (IANA psychiatrist, etc. etc.)

[ajarmst]

Withdrawal symptoms with SSRIs/SNRIs (often called a "Discontinuation Syndrome" to avoid a semantic argument about what "withdrawal" means) are quite well documented. The symptoms are exacerbated by long term use and especially by sudden discontinuation. Medical professionals will invariably recommend a slow tapering of dosage before attempting to discontinue treatment.

[serge2k]

> Some people will no doubt chime in that they are sure that my brain developed a dependency on the drugs and the return of my symptoms was simply that dependency asserting itself. Maybe, but probably not?

Even if it is, does it matter? If the drugs aren't hurting you in other ways then why not stay on them? Especially if you can get off for a while without becoming ill immediately.

[drumdance]

That's my feeling as well. No one seems too concerned that diabetics depend on insulin shots.

[DanBC]

Some of the anti-depressants have pretty unpleasant side effects.

[pc2g4d]

I went through this, too---I felt there were good reasons to get off my antidepressants, so I began tapering off of them at what I thought was a reasonable rate, something like 10% of the original dose per month (I was at 250mg so that was 25mg per month).

Things proceeded smoothly for a long time---getting down to 100mg I felt great. But the closer I got to zero the more sensitive I was to the dose changes, and things started to fall apart for me emotionally. I had terrible withdrawal effects, becoming severely depressed and even developing OCD-like symptoms that I had never experienced before. My anxiety was also through the roof. And so I concluded that I did, indeed, need the antidepressants, and I went back on them at nearly my original doses, and things seemed to go back to normal. (Which wasn't great, but at least wasn't hell either.)

But after learning more about other people's successful attempts at antidepressant withdrawal I decided a few years later to try it again. I'm currently in the midst of that tapering process, taking things much more slowly. The important thing seems to be that as you approach a dose of zero your rate of tapering should also diminish. So going from 200mg down to 100mg I did it in 25mg/month increments. From 100mg to 50mg I did it in 10mg/month increments. And now going from 50mg to 25mg I'm doing it in 5mg/month increments. I'm right at the point where things fell apart last time, but so far things are going great.

The dose->blood serum concentration response curves for this medication are non-linear, suggesting that something other than constant incremental tapering is needed in order to keep the rate of change to brain chemistry constant. The rate of taper must be decreased as the dose comes down.

Of course, in theory you'd have to live infinitely long in order for such an approach to get you to zero. So at some low dose like 12.5mg or 6.25mg I'll just have to cold-turkey it and drop down to zero.

I think people underestimate the degree to which their brain chemistry has adapted to the presence of the drugs. When they fail to do well emotionally when off the drugs, they blame it on their native brain chemistry being broken---it's seen as proof that the original "illness" was real and the drugs were needed. But my belief now is that this is an artifact of the brain being given insufficient time to adapt to the absence of the drugs. Slow, slow tapering is the way to go.

Regarding antidepressants saving lives, I also believed that mine saved mine in my darkest hours. And perhaps they did, but I now consider that to be only due to the placebo effect. The physical symptoms such as dry mouth made it feel like the drugs were really doing something. But ultimately I think their power was only that which I gave them by believing they were a miracle cure.

[aaronem]

This happens because the receptors to which the drug binds are saturated at a concentration lower than that produced by the dose you're taking. So basically everything over 100mg/d is just going straight out via your kidneys, and you can taper down from whatever dosage to there in more or less whatever fashion you please because none of it has a meaningful effect on your brain chemistry in any case.

[pc2g4d]

Interesting possibility. Is there a technical term for this effect so I can find further documentation?

[matthewbauer]

Its really interesting how the tapering works. I went from like 200mg to 100mg without a problem and then from 100mg to 50mg with no problem then going down to 0 I got terrible headaches. I ended up doing the slow tapering like you're supposed going to 25mg and waiting for a while then 0 but I still got negative side effects. Anyway, things slowly seemed to build up and eventually I was just as bad as before the medication so I had to go back up to 300mg over time.

(Just realized that different SSRIs have different treatment sizes so maybe it doesn't compare)

[pc2g4d]

What sort of time period did you do the taper over? I've been working on this taper for over two years, I think.

[chris_wot]

Did you consult with a doctor or psychiatrist? Curious.

[pc2g4d]

I began the taper on my own and only discussed it with my doctor when it came time to drop from a 100mg to 50mg prescription. He wanted me to meet with him monthly to report my status but I thought that was ridiculous. I just meet with him when I need a refill.

This is a general practitioner, not a psychiatrist. I've met with many a psychiatrist before and find they are generally so invested in the biomedical disease model that I don't expect them to be particularly helpful. They're the group of people who got me into the emergency room from over-aggressive onboarding of an off-label drug (geodon for depression? It was insane) and also who advised me to get electro-convulsive therapy when I had "treatment resistent" depression (i.e. the psych meds weren't helping me to feel happy.) Fortunately I declined that frightful procedure.

[anfedorov]

Did to taper off or stop cold-turkey? I imagine taking several years to decrease dosage could be significantly more manageable than going off them right away.