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How to wean antidepressants that release themselves from SSRIs in the long term

It started five years ago . My boys were two and four years old, my wife was a stranger, and my professional life felt like an avalanche of insecurity and stress. In the morning the air smelled of ashes; In the evening the sun looked like blood. When people opened their mouths, I stared at them blankly. I could only hear the orcs howling.

More than half of men who have depression symptoms and may benefit from antidepressants do not seek professional help. I'm not one of those guys. My family doctor distributed the sweets: 150 mg bupropion, a starter dose. I whined and she doubled it.

Life became less jagged. I discovered a newly discovered emotional resilience. Spouses no longer resulted in isolation in bunkers. A wind chime replaced the ringing of doom.

  Bottle of Pills


Life today feels almost Brady Bunch normal. Every morning I wake up humming like an idiot. Feed the children, water the plants, take the pill. I could do that forever. A lot of people do it. According to the CDC, 8.6 percent of men over 12 years of age in the United States are taking antidepressants – down from 5.1 percent in 2002 – and about a fifth of them have been taking them for ten years or more.

There are a lot that we don't know about antidepressants and how and why they interact with the brain, mainly because we don't understand most of the how and why of the brain itself. What we do know is that recent research suggests that some antidepressants – including the class known as SSRIs (selective serotonin reuptake inhibitors) – can increase the risk of heart attacks, seizures, and dementia, among others. Admittedly, the data remains rather mushy – more correlation than causality. And nobody has done long-term research on antidepressants for a period of time that has been nearly as long – in some cases 25 years.

But it is enough to wonder whether the mental health subscription model – $ 20 a month or whatever Tier 1 membership in the Sane and Functional Club – is all that matters.

It's a tough call, especially now that the stigma of depression is finally subsiding and we're starting to take care of our heads as we take care of our bodies. Depression is still associated with liabilities that are at least as bad as the medication used to treat it – substance abuse, cognitive impairment, increased risk of heart disease, more than 20 times the risk of suicide – and much better founded. Stopping antidepressants carries its own risks: especially relapses. Then there are all possible withdrawal symptoms – fatigue, headache, pain, sweating, insomnia, nausea, dizziness, anxiety, irritability – that can sometimes last for months or even years.

According to Dr. Peter Kramer, the pinnacle of modern psychiatry and author of Listening to Prozac (among half a dozen other books), can always use a guide for people considering stopping their medication. Principle: "In general, it’s better to refrain from medicine if you don’t have to be on it. "

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To justify Dr. Quotes Kramer something that an old mentor once said to him during his training in child psychiatry: “I never had to go back to a mother and say, 'Do you remember that we had your child? You have done some studies and it turns out that it makes children smarter! “

  Man in glasses and jacket

Peter Kramer, M.D.

With the kind permission of Peter Kramer

On the contrary. If anything, the news always seems bad. (Do you remember Fen-Phen? Vioxx? Darvon?) This doesn't mean that everyone should take their medication like last year and make a promise of purity. A calculation has to be considered. "The main thing is that you want someone to be really good for nine months without recurring," says Dr. Chandler.

And – to be very clear – this assumes that there have been no suicide bombings, hospitalizations or several long episodes in the past, as there is a difference between a single attack of mild depression and the recurring, more severe variant. You don't mess with the latter. But even if your depression is not acute, it still makes sense to give the medication at least a year to do its thing. "Medicines work by changing the brain," says Drew Ramsey, M.D., assistant professor of psychiatry at Columbia University, "and the brain is complicated."

It may take months to understand how your medication has changed your brain. "Depression sets your life in a pattern that requires focus and intent to undo," says Dr. Ramsey. "It's not like, Oh, wow, my symptoms are gone, great. You have to fix things with people and you have to fix things with yourself."

Timing is another factor. Perhaps your dog has just died or you have just been divorced or you are on a romantic getaway – probably not the best time to stop taking the medication. The time of year can also affect the decision. Winter can be pretty rough after all. Why not waiting for the birds to come back?

There are also your loved ones to consider, if you don't have one, the decision is much easier – if things go badly, only you will suffer The woman and I get on well and I've been doing pretty well for at least a year.

So, okay, what now?

It's tempting to have a cold Tru to get thahn. Then I could at least turn my back with a show of bravery and regain some self-esteem.

But no.

"Halve the dose for a week and see how you are doing," says my family doctor.

I like my family doctor. It is empathetic. She works hard. And she's a family doctor, God bless you. It is not there for the money.

But even she is wrong about this. "We are now rejuvenating very slowly," says Dr. Ramsey. "Much slower than before."

  Doctor writing a prescription

Jose Luis Pelaez Inc Getty Images

According to a recent Lancet study, ideally you should be on the ramp for months. (To be fair to my family doctor, there is no reason why she would know, because even the guidelines of the American Psychiatric Association still say “at least a few weeks.”)

The Lancet Study also suggests that if you carefully lower your dose, your risk of withdrawal will be significantly reduced. Instead of a "look, ma" jump from a 300 mg cliff, it gets better if you cut it in half – 300 to 150, 150 to 75 and so on.

It all depends, of course, on the details – the medicine you are taking, how long you have been taking it and the size of the dose. That's why it's really important to talk to a doctor about it.

"I try to anticipate the side effects you will have and then I try to anticipate the options," says Dr. Ramsey. “I want to learn about your mental health game plan. Do you eat well, exercise, do you get a lot of omega-3 fatty acids, zinc and vitamin E? "

It could even contain whole herbs and prescribe St. John's wort – as effective in treating depression as SSRIs, as studies suggest. Even the herbs can have side effects and interact with other medications – another reason to resist the urge to use them Consider this the first test to return to a non-medical life. If you can do it right, you may be really ready to do it alone.

I am. I think there are only two Weeks have passed, so it's hard to say.

One more thing Dr. Ramsey said, "There is a period of two months when you wonder if you have stopped taking your medication no matter what."

I can live with the lack of clarity because even though the drugs are gone, they left something important: a better sense of what works in life. A clearer picture of it, what it looks like That was the present. Now I just have to hold on to it.

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