Everything You Ever Wanted To Know About Antidepressants and Lots of Things You Probably Didn’t

This is sort of my personal guidebook of “things I wish I had known immediately before starting to take antidepressants.” Or “things that were handy but I was unable to find all in one place.” Or “things that came to mind first when I started writing about my own experiences about antidepressants and the things I had wanted to know about them or had learned over time and which I have bothered to write down so far.” Take your pick, really.

I precursor all of this by saying that this is representative only of my personal experiences and opinions, and the information I have come across, making it an inherently biased perspective. It is also not a reference guide. It is a guide of MY experiences with stuff, which will in all likelihood be different from yours. I wish that I had found something like this when I was starting my own journey, though, so maybe something in here can be helpful to someone else. I encourage you to do your own research as well, but maybe this can be a starting point. I am not a medical doctor. Don’t take me too seriously.  I am also not going to even try to reference this properly.  If you really want to know how I learned something, you are welcome to ask and I will try to tell you, but with everything I’ve consulted so far I can’t guarantee that I’ll have a solid answer for you.

At any rate, here’s the story of me and medications-as-they-relate-to-me.  My family doctor was handling my medications when I was first diagnosed.  Not the best route, I think, if it can be avoided.  Not their fault, but I just don’t think a general practitioner can keep themselves fully informed on every topic.  It took forever for me to get in to see a psychiatrist, though, and at the time I didn’t really know any better anyway.

Jump to:

Pros and Cons of Antidepressant Medications
What to Expect When Starting Antidepressants
Neurotransmitters
Types of Antidepressant Medications
When to Take Antidepressants (if you’re taking them)
Antidepressants and Alcohol
Side Effects of Beginning Treatment With Antidepressants
When to Discontinue a Medication
Antidepressant Withdrawal
Minimizing the Withdrawal Effects of Stopping Antidepressants

Pros and Cons of Antidepressant Medications

There are a number of different types of antidepressants that work by affecting various brain chemicals.  The medical community as a whole seems to have yet to figure out concretely exactly what causes depression, and even they acknowledge that it can be different for different people.  There are some theories out there, but nothing that’s allowed them to really refine medications or testing, or to accurately predict which meds will work for which people.  Some antidepressant medications were originally created to do something completely different, when they happened to notice that some people got less depressed on them.  So now they’re called antidepressants.  Seriously.

Along that vein, I yoinked the following from helpguide.org.

While antidepressant drugs such as Prozac increase serotonin levels in the brain, this doesn’t mean that depression is caused by a serotonin shortage. After all, aspirin may cure a headache, but it doesn’t mean that headaches are caused by an aspirin deficiency. Furthermore, many studies contradict the chemical imbalance theory of depression. Experiments have shown that lowering people’s serotonin levels doesn’t always lower mood, nor does it worsen symptoms in people who are already depressed. And while antidepressants raise serotonin levels within hours, it takes weeks before medication kicks in to relieve depression. If depression were due to low serotonin, there wouldn’t be an antidepressant medication lag.

Plus, since the serotonin system in the brain is so tightly regulated by the body, increasing the levels in the synapses (as antidepressants do) should trigger the body to lower how much gets synthesized in the first place to compensate. So…no overall change (see here).

That said, it seems well accepted now that there are distinct physical differences in the brains of people who are or are not depressed. I’ve also come across some interesting info suggesting that at least some of those differences are still present even when the person isn’t suffering from symptoms (i.e. are in remission). Doctors have also noted that people who’ve had heart problems that cut down blood supply to certain parts of the brain often develop depression as a result. So there are definitely some physical links here.

I have the feeling if they could figure out what actually causes depression, the treatments might be a little more effective and a whole lot less unpleasant. Get on it, science.

There are a lot of different studies out there about how effective antidepressants really are. From my research and experiences, I would say that they definitely do work, and definitely do produce a much more significant immediate result than other options…BUT (and that’s a capital but) only if the right person is combined with the right one. Which means two things: One, that it seems to take a bit of trial and error for most people to find their big winner, and Two, that most of the studies tracking the effectiveness of one particular antidepressant on a random group of people are useless.

Medication Cons:

  • trial and error in search of the right one can be long and frustrating for some people
  • until the right combination is found, side effects can make life a lot more unpleasant
  • if you haven’t got quite the right one, feeling moods that aren’t entirely your own can be a little disturbing (but then again…what is depression if not moods that aren’t entirely your own?)
  • these are not medications to be taken lightly. They are invasive, and they do effect more than just what’s causing the depression (for example, around 80% of your body’s serotonin is used in your gut…not your brain)
  • focusing on medication-related options may prevent some people from working as hard at the other (and many would argue, more important) areas of treatment
  • in the long term (i.e. over many years of continuous use), some people find that their body becomes “accustomed” to their antidepressant, and it begins to lose its effectiveness
  • unless you are EXTREMELY gradual in reducing the dosage (and in my opinion, way more gradual than most doctors will suggest), getting off of an antidepressant can come with very, very unpleasant symptoms of its own

Medication Pros:

  • if you can find the right one for your particular chemistry and condition, AND it happens to have side effects that you can live with, you should feel better. A lot better.
  • in the short term, an effective antidepressant can restore some of the hope and energy needed to explore other long term alternative treatments (therapy, etc.).
  • everything I’ve personally encountered leads me to firmly believe that depression is at its heart a physical problem (though perhaps partially resulting from mental stress), so it makes sense that physical remedies may be necessary to help some cases make real progress.

My thoughts on to medicate or not to medicate are here. I have heard from a number of people who found their medication that they dearly wish they had begun looking sooner. I would say that whatever treatment approach you take, take one. I think one of the most insidious effects of this disease is that it makes it seem so unlikely that there is really a better reality out there for us. There is. Don’t stop looking. Hear that, me? Put down the damned remote and go do some yoga.

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What to Expect When Starting Antidepressants

Everybody’s experience is a little different, but in general I would say

1) That it may have side effects, maybe intense ones, particularly for the first couple of weeks.

2) That sometimes the side effects of the transition include feeling more weepy, sad, etc., but that the extra should go away once your dosage has been stable for a while.

3) That it will take at least a couple of weeks to make any positive difference, and more likely somewhere in the range of 4 – 6 weeks, so you will need to take it consistently for at least that long before you can tell at all if it’s right for you.

4) That even if it does make a difference during that time, the dosage will likely need to be increased several times to get to a level where it is really having its full effect.

5) That the first antidepressant you try is not actually all that likely to even work for you at all. So be hopeful, but also prepared to have to try another (and maybe another, and maybe another). I know that I got my hopes up really badly when I was given my first prescription.

6) That the subtle changes it does make in your behaviour may not be as obvious to you as they are to the people around you. It doesn’t change things – it just changes your perception of them (so you may not even always pick up that what’s happening is something that would previously have freaked you out or sent you into a funk).

7) That if it is REALLY helping you, you will notice. If you can’t tell if it’s helping any because you’re still crying, and still worrying, and still melting down all the time, and how would you know if it was working anyway because the changes are all so subtle,…then it’s probably not working.

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Neurotransmitters

No one seems to be conclusively sure that messing with neurotransmitters in the brain is actually what helps improve depression symptoms, but it seems to be the best they have to go on at the moment. Here are the big three, and some of their primary functions that relate to depression (note: that doesn’t necessarily mean that what they do will relate directly to what type of medication will be most effective for you. …But extra info can’t hurt).

Serotonin – affects the perception of your available resources and social status, appetite, sleep, and mood

Norepinephrine – reacts to stress and provides the “fight or flight” response, affects attention levels and physically prepares you for action

Dopamine – involved in motivation, mood, sleep, sexual gratification, attention levels, and memory. Also reinforces things as “rewarding.”

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Types of Antidepressant Medications

As mentioned, there are a number of different types of antidepressants, generally targeting one or more neurotransmitters. The ones I’ve come in contact with are listed below, but the list is not exhaustive.

SSRI’s – selective serotonin reuptake inhibitors

These are the “primary” type of antidepressant these days, and likely what a person will have prescribed to them first. Many of them can make you a little sleepy. They affect brain levels of serotonin, and in my house are distinguished by their potential to negatively affect one’s libido and/or orgasm

SNRI’s – serotonin-norepinephrine reuptake inhibitors

These target two different neurotransmitters instead of just the one. This is known in my house as the one that was FREAKING HARD TO GET OFF OF.

NDRI’s – norepinephrine-dopamine reuptake inhibitors

Sometimes these are added to boost the effectiveness of other antidepressant medications, and are sometimes used on their own. They tend to give a bit of an energy boost. I mostly liked the results of the one that I took. My body unfortunately didn’t.

Tricyclic Antidepressants

These are older, but still used sometimes when they can’t find anything else that’s working out. Supposedly have more side effects. My psychiatrist keeps mentioning these as a possibility, but I’m sensitive enough to side effects to make me wait on this one until I’ve gone through more other possibilities.

MAOI’s – monoamine oxidase inhibitors

These work a bit differently, and are generally only used now when other options have failed. They involved some health risks, as when combined with certain foods they can have serious or fatal interactions. One psychiatrist said he refused to prescribe them unless the patient was willing to take a blood pressure cuff with them. I won’t lie – these scare me a little. …Okay, a lot. I’m glad they’re out there, and I’m sure they’ve helped a lot of people, but I’m just not ready to go there yet.

Stimulants

These affect dopamine and norepinephrine, triggering a wave of happy hyper neurotransmitters. This is another of those “nothing else seems to be working” options, but since they produce elevated moods even in people who aren’t depressed, it’s not surprising that they can sometimes help people who are. Did have some pleasant side effects for once. Fun.

There is a bit of controversy about using these to treat depression, as among other potential complications, they often come with a “crash” period to balance out the high, and can become addictive (inhibiting dopamine reuptake is what cocaine does). Sigh. In my world, these are the pills that help me Get Things Done. …For an hour or so.

Other Options

In addition, there are some other types of meds (anticonvulsants, etc.) where one or more happen to also seem to function as antidepressants. Again, this is where my p-doc is going now that we’ve been through a number of the more typical options without success.

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When to Take Antidepressants (if you’re taking them)

Some antidepressants are prone to making people sleepy, so your doctor or pharmacist will often initially suggest taking them at bedtime. Taking pills before bed can also me useful if they come with side effects like nausea, so you’ll hopefully be past the worst of it by the time you wake up. Conversely, some pills are prone to making people jittery, so they will often suggest the morning. Neither of these is any more than a guideline in most cases, so if you find it’s having the opposite effect, it’s worth discussing with your doctor. Generally switching the time of day is not a big deal.

Pay attention to the notes that come with your particular medication. Some doses MUST be taken at different times of day, some need to be taken with food, and some come with unexpected food restrictions (like no grapefruit!). These matter, and really do make a difference. Best not to mess with them.

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Antidepressants and Alcohol

When I got my first antidepressant prescription, it had a nice big sticker on the side saying that “alcohol should be avoided while taking this medication.” I’m not exactly on my way to A.A., but I do enjoy the occasional glass of wine with dinner or mild drinking binge with friends. …And I KNOW that I’ve had friends and acquaintances who “weren’t supposed to have alcohol” with their antidepressant meds, but did anyway. So I asked my pharmacist. “So…exactly what happens if I DO have a glass of wine? Is this like a I-might-be-nauseous-and-things-would-be-unpleasant kind of “avoid alcohol,” or more the one-sip-of-wine-and-my-heart-could-stop kind of “avoid alcohol”? She hummed and ha’d a bit, and then said something to the effect of “just don’t drink it.” …While looking at me like a total alchie. It matters, though. This was one of the things I really wanted to know when I started taking these things.

I did not take alcohol for the first couple of months or so. Alcohol can make you more depressed (it is, after all, a “depressant.” Duh.), and I wanted to get a clear perspective on whether or not the meds were helping me. Didn’t want to muddy the waters, so to speak.

In having been through a number of different antidepressants now, and moved progressively further towards convenient daily living than untarnished scientific experimentation, I can say that the effects of mixing alcohol and meds seems to vary a lot from person to person and med to med. …Not that I’m suggesting ignoring your doctor’s cautions and consuming alcohol while taking antidepressants. You hear that, impressionable internet? Internet with lawyers? DO NOT MIX ALCOHOL AND ANTIDEPRESSANTS. It’s bad. Santa won’t like you.

That said, if you were going to take a drink or two anyway, here’s what I’ve discovered…

First off, I would strongly recommend not tempting fate by getting totally sloshed. I read a lot of accounts of terrible, terrible effects of doing this (sometimes lasting for weeks after!) including nasty physical side effects and dramatically increased depression. Also keep in mind that your poor liver is processing a lot of extra chemicals while you’re taking these things, and pouring alcohol on top of that…well,…it just doesn’t seem like a good idea. I mean, heck, slightly fudging the dose limitations of a bottle of Tylenol is enough to kill someone. Maybe that’s just me, but I wouldn’t go there. Plus, as mentioned below, there’s likely no need to drink that much to get the same effect anyway.

As for side effects of drinking small amounts of booze (i.e. one or two glasses max), combining my experiences (which were totally different on different medications, by the way) and the experiences of people who have mentioned it to me, the ones I’ve heard about commonly are:

  • falling immediately asleep
  • nausea
  • headache
  • general intense hangover-type characteristics, but without the “fun” part (this was me on prozac. Didn’t touch booze again during those months)
  • er…disproportionate inebriation (i.e. getting totally sloshed off of a couple sips of anything containing alcohol. Seriously. I ate a gin-soaked olive once and got a buzz.) I spent a lot of time sniffing my husband’s wine during this period

In general, all of the meds I took seemed to make me much more sensitive to the effects of alcohol, to varying degrees. One medication got me totally drunk on two glasses, two others on one glass, one on half a glass, and the other when within fifty feet of someone who was thinking about alcohol. My general rule of thumb is to take it REALLY slowly (like, one-sip-at-a-time slowly) until I have a good idea how I’m reacting. Then, I try not to push the limits of what I need to feel intoxicated. …Even if that happens to be three sips of wine.

As a side note, the antidepressants that I found reacted most strongly to alcohol also gave me a bad reaction to caffeine. …Again, sort of like having a really bad hangover. I couldn’t touch coffee for months, and even green tea was too much for me. Not fun to give up, but not in any way worth the consequences of continuing to have them (I will admit that I caved a couple of times, “just to see.” …No. Still not worth it.)

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Side Effects of Beginning Treatment With Antidepressants

My body chemistry is particularly sensitive. I have ample evidence of this now, despite the knowingly skeptical looks my current psychiatrist gives me when I try to explain it to him. I have heard many stories of people who have started taking antidepressants and had barely any noticeable side effects. This is not me. I am the person who will have difficulty standing up off the floor after inadvertently taking something that “may cause drowsiness.” I do not make a habit of operating heavy machinery, but if I did, let’s just say I would be pretty screwed.

The first couple of weeks after starting my first SSRI were pretty crazy to say the least. I started out on the smallest possible dosage, cut in half. If you know yourself to be a chemically sensitive person, I would strongly suggest making your first antidepressant one that can be cut into smaller pieces (some are caplets, and some extended release pills, both of which are much more difficult to deal with this way). Statistically speaking, the first antidepressant tried isn’t necessarily likely to be the big winner anyway, so you might as well make the transition as painless as possible. Get yourself a good pill cutter (which costs about $2), and arrange yourself some progressively larger scraps until you get to the dosage you’re aiming for. My doctor recommended that I be taking the full pill after a few days. I would give it at least a week or two to work up to that – more if you have to be doing…pretty much anything during this time. Don’t be afraid to speak up about what you need. Doctors will tend to assume that you are average and unremarkable unless you tell them otherwise.

I was pretty out of it for those first two weeks. I started on 5mg of Cipralex for four days, then went up to 10mg. The first week or so, I was in another world completely. A sleepy, hazy world, where I could fall unconscious at any time of day on a moment’s notice. When we would attempt to do things together during this time, if my husband left the room for so much as a minute to use the bathroom, or get a drink of water, or anything else, nice times out of ten he would return to find me asleep. I was lucky and was on vacation for this week, so I didn’t have work to worry about. Thank goodness. I wasn’t prepared for things to be so bad, but I honestly don’t think there’s any way I could have functioned at my job. Daytime T.V. was enough of a challenge. In addition to the fatigue, there were some other fun tidbits like digestion issues, mild to moderate nausea, and “surprise” sweating. Good times.

The second week, I did have to go in to work. There was no way that I was in any way able to operate a vehicle, so my husband had to drive me up to work and pick me up after in addition to his own commute. I was pretty useless at my job this week. Putting together coherent sentences was sometimes challenging.

The severity of many of these effects did wear off after several weeks, as they were supposed to. Some of the odd ones just went away completely. As I understand it, you kind of have to just bear with whatever happens for the first couple of weeks, and then make the real judgments on what’s going on after that point.

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When to Discontinue a Medication

First off, DO NOT UNDER ANY CIRCUMSTANCES stop taking these things suddenly. Pretty much anything you read will tell you this, and having experienced the withdrawal effects first hand (though not for that reason), I can tell you that this is really, really, really, really, really (really) not something you want to do. These are medications that your body gets accustomed to having there, and if you stop taking them without doing so gradually, your body will FREAK RIGHT OUT. In just about the most unpleasant ways you can imagine.

If you take an antidepressant for a few weeks, and your depression is getting significantly worse, talk to your doctor. If more than a month goes by and it’s still getting worse, make your doctor listen and start the process of getting off that stuff right away. Likewise if at any point you’re feeling significantly more suicidal or likely to harm yourself than you were when you weren’t taking the medication. That is a risk with these things. Don’t assume that your doctor will catch the problem. They may not (mine just kept increasing the dosage of a medication that made me want to stab pears in my eye. …Don’t ask.).

I’ve been told that if a particular side effect lasts longer than two or three weeks that it will probably be around for good. I wasted a LOT of time letting doctors increase my dosage on things with unlivable side effects before I found this out. If you can’t live with what it’s doing to you, make sure you’re vivid and specific when you describe the problem to your doctor, and try something else. It’s not much good being happy if you’re asleep twenty hours a day.

There also seems to be a lot of evidence out there that if what you’re taking only partially relieves your symptoms, you are much more likely to have a relapse of the depression in all it’s nasty glory.  Better to keep up the search and find something that genuinely makes you feel well.

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Antidepressant Withdrawal

I will precursor this by saying that apparently many, many, many people stop taking their antidepressants and notice minimal if any withdrawal symptoms (provided that they do so in the medically suggested way). As mentioned, my system does not appear to be precisely “average,” so this was a lot harder on me. I had physical withdrawal symptoms on a gradual reduction of Luvox.  In the words of my psychiatrist, no one ever has withdrawal symptoms from Luvox.  Except me.  Hey there.  That said, I have now done it three separate times, and have learned a lot about how to prevent my body from hating me in the process, though I have not perfectly mastered it yet.  If you do happen to be the type of person who encounters this type of thing, or if you’re trying to get off of one of the ones that’s particularly well known for being nasty about this (*cough* Effexor or Paxil *cough*) maybe something I’ve learned can be of use.

There are lots of sites out there that with a quick search will provide you with the full list of possible complications of suddenly discontinuing usage of an antidepressant drug. They do not officially call this collection of symptoms “withdrawal.” They call it “discontinuation syndrome.” Because most antidepressant meds are not “addictive.” …Meaning that you don’t crave the drug, and want the drug, and NEED to take the drug. Please note, though, that “not addictive” doesn’t mean that your body won’t get very dependent on having them there, and that taking the pills away won’t leave it reeling from the adjustments. I went through a particularly bad spell of discontinuation syndrome, so I have looked into this a lot. I can tell you that it certainly feels a lot like any other drug withdrawal. It’s just that with addictive drugs, the withdrawal effects wreak havoc on your body, and you take another pill because you really, really want to. With antidepressants, the withdrawal effects wreak havoc on your body, and you take another pill to stop them even though you really, really don’t want to.

The specific withdrawal effects I’ve encountered have varied a little between different medications. The most common and noticeable ones for me fall into two categories:

Emotional/Mental Effects:

I get really, really extra moody when I lower my dosage even slightly. This one sucks a little, because since it’s an emotional thing, I find it more difficult to pinpoint at first that it’s due to the pills (or absence of them) and not me. I can recognize it a little more quickly now that I’ve been through it multiple times, but at the time of writing this even the most recent time around I was a real mess before I clued in for sure. On one of the meds, I also got a little…er…irritable. Ahem. For me, these mental symptoms start showing up significantly earlier than the physical ones, and take a much less dramatic change to trigger. Going from a high dose to a moderate one is enough to make me really extra depressed, but not enough for the additional physical symptoms.

I often wonder if this is at least partially responsible for the large number of people who try to go off their antidepressant and make it on their own, only to realize that their depression is still crazy bad and immediately start taking them again. I’m not suggesting anyone try to tough it out if they still need the medication to be functional/happy, but I would guess that at least some of those people might not actually need the meds once their body recovered from the aftereffects. It doesn’t seem well publicized that a wave of extra depression is a common side effect of the discontinuation process, and if you didn’t know to expect it and consider it in that light, I can see how it would be easy to misinterpret its significance. Just an observation.

Physical Effects:

Any time I reduce the dosage on one of these, I seem to get really intense food cravings for anything sweet or otherwise loaded with carbs.  Not as debilitating as the other symptoms, but definitely annoying (these are sometimes not ignorable cravings).  Getting off the Luvox I was dizzy, but in general the first hardcore thing I notice is mild nausea. If I don’t do something to counter the effects, that is followed by more severe nausea, and by the feeling that my head has shrunk three sizes. …Which is not the same thing as having a headache – it’s a very distinctive and familiar sensation to me now, but I’m not quite sure how to accurately describe it. It’s not pleasant. Let’s leave it at that.

If things continue to progress from there, we get into the actual-potential-to-vomit stage, and add in what seems to be commonly referred to as “brain zaps.”  If I had not experienced these myself, I’m not sure that I would have believed they were possible. When one gets triggered somehow (I think it may be connected to blinking, and sometimes sudden movements), I hear this little metallic clicking noise and get a little jolt down my body, followed by a split second where I cease to exist in space or time. Upon arriving back in this reality, there’s a moment of visual disorientation (since I must have moved ever so slightly and things do not appear to be QUITE where they were when I left them) with an accompanying stomach lurch. Mega weird, and MEGA unpleasant.

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Minimizing the Withdrawal Effects of Stopping Antidepressants

Reminder:  I am just a person who’s been there and is trying to share whatever advice I can that might help somebody else going through the same thing.  But I am not a medical doctor, or any kind of licensed natural health practitioner, and as such officially you shouldn’t listen to anything I say.  Nothing here should legally be considered medical advice.

The first thing I would say here is that if you begin to experience anything at or past the “mild nausea, head too small” stage, take steps to stop it. From what I’ve read, there’s some suggestion that you don’t actually do any good or speed up the process by trying to be a hero anyway. And beyond that, the full-blown withdrawal symptoms, if they get there, are Hell. Absolute Hell. There are class action law suits against some of these drug companies because getting off the drugs was such absolute Hell. And we’re not talking Hell for a couple of days. I had that mentality at first. That if I could just ride it out for a few days more, than surely it would all be over, and I’d be off the meds, and I could get up off the bathroom floor again. As it turns out, some people get trapped in this Hell for MONTHS. …Which I will tell you is WAY too long to cope with this stuff. Don’t do it!

One of the most frustrating things about all of this is that much of the medical world discounts it entirely. Very few doctors have even ever heard of this before (particularly the stranger symptoms), and even fewer seem to care. The most sympathetic thing I heard from a doctor when I managed to drag myself into their office was “Oh. That’s weird.” No potential treatments. No suggestions of help. No offer to investigate. Nothing. Anything I found to help alleviate my symptoms, I found on my own.  If you can get a doctor to support you in trying to minimize your suffering, having an expert opinion or medical advice from someone who knows what they’re talking about could be a great help.  Psychiatrists will generally recognize that Effexor and Paxil are brutal to get off of, and may have some suggestions to help you.  In my experience, regular family doctors often aren’t even aware of the reputation they have (or the many, many law suits against them).

The good news is that there are ways to minimize the suffering. First off, the more gradual the weaning process, the better. For some people, the suggested timeline their doctor gives (generally two weeks, it seems) works just fine for them. And that’s great. Again, the key is to be aware of the physical warning signs and to pay attention to them when they appear (these are not things you are going to be “unsure” about. If you’re not certain that you’re actually nauseous, just wait a while and see. If you really are, you’ll know. Trust me.). If you’re seeing symptoms, things might be progressing too rapidly for your body to keep up with the change.

If you are taking a medication that comes in “caplet” form, making a gradual transition can be difficult. I have read a lot of cases of people breaking open the caplets and removing some of the “beads” each day to create progressively smaller doses. With some antidepressants that are especially well-known for severe withdrawal effects (Effexor is one of the worst), people have gone so far as to count out how many individual beads they are removing, and reduce it by one individual bead each day. Apparently this works quite well.

My first experience with this stuff came with one of these “caplet” meds, so I brought up this method with a pharmacist (so as not to accidentally overdose myself or something by messing with the “extended release” effect). She did not seem to know for certain whether there would be poor consequences, so advised me not to mess with it. So I will formally advise you not to mess with it. I, however, eventually got desperate enough to do it anyway. I’m not sure if it’s better to keep the little balls in a caplet or if they could be swallowed on their own. I ended up doing a bit of both along the way. I think maybe the caplet was a significantly better way to go.

I attempted to taper off my dosage by pouring some of the beads out of caplets until I had a gradual progression over about two weeks. It was not gradual enough. Not nearly. I probably should have taken the advice of the “one ball a day” crowd, but that seemed crazy extreme at the time.

If you are running into significant difficulties with a “known to be difficult” medication, or one that comes inconveniently in caplet form, you may want to consider the option of switching over to a different (and more reduction-friendly) medication first and then weaning off that one instead. This is something that I dearly wish I had discovered sooner. In particular, Prozac is known to have a comparatively long half life in the body, meaning that it takes a long time to get out of your system. That means that getting off of Prozac is for many people much easier than other antidepressants, since the body gets rid of it more gradually naturally. Apparently taking even one 5mg or 10mg Prozac for one or two days while experiencing withdrawal can be enough to eliminate the symptoms for some people (though it wasn’t for me). If I had it to do over again, I think I would definitely have switched to something that could be chopped up into smaller pieces. My Prozac came in caplet form, but if you could find it in regular pill form, that would be perfect. If not, I would go with some other choppable pill.  Of course, some people have difficulties getting off of Prozac smoothly too.  There are other options, though, like Luvox or Cipralex or one of the others that is a pill you can cut up but isn’t known for its withdrawal symptoms.

If the antidepressant you’re trying to wean off of is a pill that can be cut, life is comparatively easy. There are two different strategies I would suggest.  The first is that rather than just cutting some of the pills in half, as most doctors will recommend to you, consider chopping them up into more gradually shrinking pieces instead. I would suggest laying out at least two weeks worth of pills or more (or pill pieces), with the first one just missing the tiniest bit (i.e. sort of more “shaved” than “cut”), and the last one consisting of a sliver so tiny it seems like it almost shouldn’t count. If you can salvage the various pieces of the pills you cut, you can use them all for different stages. The more unnoticeable you can make the changes, the less likely you are to suffer. Keep in mind that this is potent medication, and that every particle counts. If it’s easy to tell which pill is bigger, the difference likely may not be subtle enough. I cut up all of mine, and then squint at the pieces for a long time trying to gauge which order they should be placed in. Some of the decisions are tough.  The down side of cutting the pills is that the actual medication is not always evenly distributed throughout a single pill, so you may randomly get more or less medicine in each piece.  That means if you’re unlucky, you may still end up with side effects on some days.  If you’re super-unlucky and hyper sensitive to changes like I am, you may need more than a two week period, even when you’re weaning down from the smallest pill.  It ended up taking me months to successfully get off of the Luvox I was taking.  But in the end, I was able to do it successfully and without triggering many physical side effects.

If the gradual reduction is still producing physical discontinuation symptoms, you may want to consider going a step farther and taking little bits of the medication over the course of the day. Think of them sort of like Tylenol. If you don’t have a headache, you don’t take any. When the headache appears, you do. When I notice my stomach starting to churn, I cut off a small piece of the day’s allotted dosage and take it then. Sometimes this will happen multiple times during the day, but I always wait a number of hours (around 5, maybe?) after taking a dose to give it time to kick in. At the end of the day, at my usual dosing time, I take whatever is left. If you find that you are in need of more medication than you have set aside for each day, I would suggest either taking smaller pieces of the day’s allotment at a time, or if you STILL run out, making the overall reduction more gradual. If it’s measured out well, you shouldn’t end up needing to take more medication than you did the day before. That said, if it comes down to it, I think you would be better off taking what you need to ward off the side effects and then starting over with the reduction process with that new amount as your starting point.

The second option here is a bit more of a hassle, but will get you a more reliable dose of the medication.  This was recommended to me by a psychiatrist, and supported by some testimonials online.  Personally, it ended up making me crazy nauseous so I guess it’s not for everybody.  I think it’s the “official” recommended method, though.  Crush a pill well and disolve it in juice or water (make sure you get all the particles mixed in well, and that the pill you’re using is not an “extended release” or “sustained release” or one of the other types that comes with cautions not to crush it).  The first day, drink almost all of the mixture.  The next day, do the same thing, except drink slightly less.  Repeat each day so that you are getting less and less medication every time.  The crushing makes sure that you don’t randomly end up getting proportionately more “filler” or medication on any day, like you can when just chopping up the pills.  As with the chopping, if you’re careful about keeping track of how much you need to drink in a day, you could spread it out over the day if you needed to.

As I understand it, whichever method you’re using, the last 25% is the hardest.  I would agree with that from personal experience.  Maybe it’s just that it’s tough to chop up tiny fragments as accurately.  Maybe I just get a little over-eager once the pieces get really small, but when I’ve run into pronounced physical symptoms again, it’s usually in what I had intended to be the final stages of my withdrawal.  However, if when this happens you hold the dose steady until they disappear and then begin gradually reducing again, eventually you’ll get there.

In addition to strategies that are directly pill-related, I try to keep my blood sugar from dropping, and keep a little food in my stomach whenever possible (I’m sometimes not actually great about this, but it definitely does help). That seems to keep the nausea from rearing up too badly in the first place. I also add a few supplements to my diet for the time that I’m reducing my dosage. I’m not sure how much they actually do, to be honest, but they’re reported to make a difference and I’ll take any potential help I can get. As a note, please be careful if you take supplements. Too much of a good thing is not still a good thing. It is a bad thing. And it could hurt you. Severely. And I don’t want you to sue. Here’s what I take:

  • Magnesium Malate – Didn’t hear about this when I was gong through my withdrawal, but apparently lots of people are now finding it helpful.
  • Lecithin (1200 mg) – There are some theories that many of the withdrawal symptoms could be caused by a shortage of acetylcholine. Lecithin is a building block to make more.
  • Omega-3 (700 mg) – Some people think this helps. I take an omega-3 most of the time anyway, so I just make sure to be consistent about it during this time.
  • B 100 Complex – They say that 25 – 50 mg of B6 in particular is helpful, but that many of the other B vitamins can contribute to reducing these symptoms as well. I take the complex to cover my bases. This I only take when I’m noticing persistent physical symptoms, and if I’m taking one of these in a day I will sometimes skip my multivitamin (which also has B’s in it). Too much of some of these can be fatal. No thanks.  B6 itself isn’t too likely to harm you in doses like these, if you want to just go with that instead (it’s water soluable, although it can have bad effects at high doses over a prolonged period of time).
  • Many people mention positive results from taking a Benadryl as well.  I have done this too, when the nastiness was at its worst, but as it tends to knock me out I can’t say whether my symptoms continued.  On the plus side, I can’t say whether my symptoms continued.

In general, if I know that I’m going to be going off of a medication (and am feeling wise), I will try not to schedule too much for myself during that time period just in case I’m feeling kind of shitty. Any appointments, social gatherings, etc. that can be postponed are usually better off left for another time when my physical and emotional state will be more predictable.

I think that’s it, outside of learning to be more sympathetic with myself when I’m dealing with this crap. …And avoiding it at all cost where possible. If they need to try “something else” in the same family of drugs, I will now make a gradual switch from one to the next, without any time between. If needed, I would rather take a drug that wasn’t working for an extra few weeks to allow for that to happen (i.e. if I have to wait for an upcoming psychiatrist appointment or something).

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Good luck to all of you out there who would have reason to be reading this page.  Let me know if any of this makes a difference or if there’s something you’ve discovered that I might want to add.  …Or if there’s anything I might be able to help with.  There are a lot of us going through this stuff, and I figure it would be a lot easier if we all went through it together.

If You’d Like To Explore My Own Experiences:

If it helps to read about my own explorations, frustrations, and attempts to get clear of antidepressants, the relevant posts are in this category.   The relevant parts of my whole messy journey are there.  Or if you like, you can feel free to start from the beginning, where you can watch me go from sickeningly boringly hopeful and perhaps a little smug to blathering mess of weepy nausea, one post at a time.

If you’re looking more for the lighter side of things, this is where I tend to put that kind of stuff.  If you’d prefer to vicariously watch me cry until internal organs come out my nose, those posts are here.  You’re welcome to anything positive it can do for somebody else.

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8 Responses to “Everything You Ever Wanted To Know About Antidepressants and Lots of Things You Probably Didn’t”

  1. Mia says:

    I also do not understand the apparent lack of awareness by GPs of the side effects of coming off anti-depressants. It took me 6months to wean myself off a paxil range pill, after numerous stubborn cold-turkey attempts. All one has to do is google ‘paxil and brain zaps’ and a gazillion forums come up with people describing their unfortunate experience of that unsettling electrical sensation. Why the medical profession is unaware of this issue is totally beyond me.

  2. Curiosity says:

    I TOTALLY agree with you. It’s a really sad thing that doctors aren’t more aware of these things. My doctor pretty much thought I was nuts when I mentioned it (and couldn’t help). It’s extra sad because I’m sure sometimes they choose paxil or effexor for people sometimes when a different antidepressant would be just as good (or at least just as worthy of a try). And if people are going to try one of them, they should know in advance how hard it might be to get off of so that they can make an informed choice. Makes me want to head up…something.

    Anyway, thanks for leaving your comment, and I’m sorry you had to go through that.

  3. Amy says:

    Dear Curiosity,
    This is a truly awesome post. I wish I had found your blog 4 months ago. I prophylactically started weaning myself off of bupropion and citalopram in January because I had just moved, no health insurance, and was having a hard time finding a job. From previous experience with lack-of-meds side effects (being to lazy/depressed/scared to get refills), I knew I would experience acute dizziness and a “dropping” sensation. I was not prepared for the nausea/vomiting, or the emotional side effects. I haven’t taken my meds since March 31, and the physical symptoms have pretty much subsided, but the emotional side effects remain. The best part is I am a health care professional, a RN, and not only do they not ever mention or teach much of this in school or in training, but I know MDs/PAs will pay little attention to depression or, worse, treat it as annoying or a sign of weakness. THANK YOU SO MUCH FOR EXISTING! You are giving me a lot of support right now. I need to stop writing before I start crying or run out of space (if that’s possible?).

  4. Curiosity says:

    Hello Amy. Thank you for the comment. I’m so glad you ended up here if it’s helping at all.

    I’m so sorry to hear that you’re going through this. It’s crazy how extreme the symptoms can be coming off of these pills, and how little awareness there is about it. It’s sad to know that even people in the medical profession still sometimes don’t “get” how bad depression can be, and how much of it can’t be controlled through force of will. Good luck to you with the struggle. You’re welcome here anytime.

  5. Amy says:

    After reading my post 20 times, I realized I mistakenly wrote “not treat it as a weakness”. I was trying to decide between “treat it as a weakness”, or “not real” and ended up with an accidental crash between the two. Very different meaning, my apologies.

  6. Curiosity says:

    No need for apology. I completely got your meaning. You expressed yourself well. I’ve now removed the “not” from your comment, so it should say what you intended it to. Hope that’s okay.

    It really is sad how pervasive that mentality is. Unless they’ve been through it, many people just really don’t understand that the worst day of a healthy person is so much better than the best day of someone going through this stuff.

  7. Victoria Dominguez says:

    Hi,

    Thank you so much for this post. I’m currently on my first week back on antidepressants (I went off them 3 years ago but thankfully I made the decision to stop only 3 months in, so the withdrawal wasn’t so bad). The problem I face is that I’m very sensitive to the side effects. I know from my first experience that I just have to endure and let my body adjust but that doesn’t change the fact that I feel so sick right now.
    Again thank you for putting this together. It is a great help!

  8. Curiosity says:

    Thank you so much for letting me know.

    I’m super sensitive to the side effects too. With some medications they went away with time. Some stuck around for months and months until I finally changed medications. I know it can be pretty awful. Sorry to hear you’re dealing with that.

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