Delaying The Inevitable
Behind The Counter | 01 | Building The Community
Last month, I had a very enlightening conversation with an individual who endured a 10-year, deprescribing journey. For the sake of this post, I’ll refer to her as “Jane Doe.”
JD had been prescribed antidepressants as an adolescent — an unfortunate trend that is becoming more prevalent. She continued on the medicine for several years.
After listening to JD’s story, dealing with antidepressants and her trials and tribulations coming off of them, I wanted to unpack some of the issues with antidepressants and share a key takeaway she taught me from her experience.
No Biological Free Lunch
Human despair is a universal trait; life is suffering according to the Buddhists. The hard part for most, is seeking help. Many suffer in silence, not just from physical ailments, but especially from mental illness. However, seeking help can be a liberating process.
For those struggling with mental health, a diagnosis can bring comfort to your crisis. Although I believe our current system relies too heavily on the DSM and prescription pads, medications can offer hope for many. Pharmaceuticals can be an effective option in certain situations and contexts. But, it’s important to remember they are not a panacea, and their (over)use in primary care needs to be reconsidered.
More and more clinicians in psychiatry are questioning current guidelines and practices with antidepressants. The chemical imbalance theory of depression and anxiety faces intense scrutiny. Physicians and pharmacists have known since the discovery of these medicines, that their mechanisms are not fully understood. Yet we continue to prescribe and dispense antidepressants without considering the potential harm these agents may cause, especially for the people who have to endure intense suffering and withdrawal when they come off these medicines.
In the end, I’ve realized there is no biological free lunch, especially with psychiatric medicines. With continued use of antidepressants, the neuroplasticity of the brain does its part to maintain homeostasis and adapt a chemically altered environment. Eventually, receptors that interact with psychotropics can become desensitized and down-regulated.
To add fuel to this dumpster fire, the medical guidelines healthcare practitioners follow recommend linear tapers as the only method to stop antidepressants, which can prove very difficult, especially for those who have been on these medicines long-term.
I’ve seen it over and over in my practice. An antidepressant is initiated. When it’s time to stop, the patient and their GP decide to use a linear taper, cutting the dose in half for 2-4 weeks before stopping the medicine completely. Within three months, they’re back in the doctor’s office, misdiagnosed with a relapse or rebound of their initial depression and anxiety. Back on the medicine they go, reinforcing the false narrative that they’ll need this medicine for the rest of their lives.
Surely, there must be a better way.
Walking The Path
One thing is for certain, if you’ve ever been prescribed an antidepressant, eventually, you will come to a point where you may consider coming off of it.
If you’re fortunate to have an open-minded physician or pharmacist by your side, you’ll likely have discussions on your goals of therapy and a sound care plan with a reasonable duration of therapy.
Navigating the perils of antidepressant withdrawal can be a unique challenge. For our friend, JD, when she decided to discontinue her antidepressant, she traded one problem for another. However, her experience coming off the medicine led her on a new journey, one of self-discovery, healing and overcoming adversity. As she mentioned during our interview:
“You realize, you have no control over your withdrawal symptoms.
This teaches you to let go.
It teaches you mindfulness of pain. It teaches you radical acceptance.
All of these lessons were an essential component of improving my mental health.”
— JD
Listening to the wise words from our friend, JD, it’s important to realize what we can and cannot control. In the context of stopping your antidepressant, there’s a high chance you may face intense withdrawal and uncertainty. The symptoms may appear in waves, providing peaks and valleys of hope and despair. But ultimately, it is an inevitable path you must walk.
Using radical acceptance, mindfulness and other stoic techniques like reframing, gratitude journaling or misogi, it’s possible to build a mental health toolkit that will equip you with the right resources to overcome the burdens and struggles of antidepressant withdrawal.
With JD, she realized that letting go of what was out of her control, and accepting the responsibility of doing the hard work, wasn’t only necessary to get her back on track towards better mental health, it was an inevitable step she had to face.
In my own battles with anxiety and stress, I’ve realized the things you work on, work on you. Dedicating time, effort and practice into developing your own mental health toolkit will always compound and produce a healthy return on investment.
So instead of denying the road ahead, take on the challenge of stopping your antidepressant as an opportunity. A chance for you to grow, reflect, experiment and try new modalities or methods to help overcome your obstacles with mental health.
All it takes are the right tools, support and mindset. What you might discover is that the power to heal, the power to transcend and the power to transform were always inside of you. You just have to tap into them.
So I invite you stop delaying the inevitable. Always remember, you’re not alone on this path. This community at B.U.D.S will always be here to support you on your way. More power to you.
Much love.
SG
“When we are no longer able to change a situation, we are challenged to change ourselves.”
— Viktor Frankl. Man’s Search For Meaning
Behind The Counter is dedicated to all my patients and colleagues. These stories are true anecdotes and experiences from my time behind the counter: short tales, random encounters, and heart-to-heart patient counseling sessions. BTC is meant to give readers a glimpse into the world of my patients. Their struggles with their health, navigating our complex sick-care system and my attempt to offer humor and hope to an ever-growing epidemic of chronic disease and mental health. These stories are not meant to offend anyone. If you enjoy these stories or support my mission, please subscribe. Peace and Love. SG.
Build. Understand. Discipline. Stillness. “B.U.D.S” is written by me, Dr. Shawn Gill - I’m a pharmacist and Father of two boys. During the day, I work as a deprescribing pharmacist, helping patients get off drugs, safely and effectively. At night, I write this newsletter. B.U.D.S is a community that's focused on inspiring individuals to take account of their health and wellness, as well as reverse mental health and chronic disease. If you’d like to support this mission, please subscribe below. Much love. SG