I recently stopped taking the anti-depressant medication sertraline – not for the first time, but hopefully for the last. A few people were interested in how and why I did this, and suggested that I shared my experiences in a blog post. This is not something that I could do in one blog post. It seemed like a good idea for a writing project.
This will be the ‘hub’ post for this project. Below I will provide an overview of the (currently) six sub-topics I intend to write more on in due course. It will be updated with links to these posts as they are published.
Reasons to quit
If you’re currently taking SSRIs, and have been for months or years, the chances are you’ve wondered about coming off them. Anti-depressant medications are an easy target for these sorts of musings. Whether you feel better, the same, or worse than you did before you started taking them, there’s an argument you can make for quitting.
I think there are probably some bad reasons for quitting. The problem with suggesting any is that the mental health journeys we go on are of such variety, that to state a reason is bad (meaning bad for everyone) at best makes me look imperious, at worst risks damaging another person. With that said, I’ve got one good reason that I think has a shot at applying universally: you can try moving on from the medication when you feel ready to take full responsibility for your mental health.
It’s an oft-used trope that mental health is not like a broken leg. Therefore, coming off the medication is not equivalent to throwing away crutches. ‘Preparing the way’ for yourself, with support mechanisms up and running whilst you’re coming off – and with a view to continuing these indefinitely – is key. If you’re ready to do this, you might be ready to quit medication.
Involving the doctor
I can only speak of my experiences here in the UK. Perhaps it goes without saying that you should involve a doctor with your decision to quit your medication. The ideal scenario is that you have a doctor that you are able to reliably see on a regular basis. You trust this person to listen and offer you a range of advice and care, from which you can both make the decisions and monitor outcomes together.
For many of us this seems like the impossible dream, and in most cases its impossibility is not down to any individual’s fault. Personally, I’ve had one doctor with whom my experience helped me to write that description of the ideal. I’ve also spent a lot of time with other doctors who all miss that (not, I think, unreasonable) mark.
If you don’t have health professionals you can rely on it’s not game over. I quit sertraline without ongoing external support, but I doubt I would have been able to do so without the professional help I had received in the years prior. In particular, CBT was hugely valuable to me. Its techniques and vocabulary have stuck with me. You might have already noticed that.
The one thing I feel all my doctors got wrong was dosage reduction. I still need to do some research into the reasons behind this. The suggestion has been put to me (and is restated in that article from Mind I just linked to) that knowing the half-life of the particular compound used for your medication is key to working out a plan for coming off. For sertraline, this knowledge certainly seems to render illogical the advice I’d had: to do things like skip days when coming off. However, I’m nothing of a chemist, and the nature of all this is more complex I’m sure.
The kind of gradual reduction that I calculated and followed did not make the process easy. It only made it easier than my previous attempts. It took me 134 days to go from 150mg of sertraline a day to zero, and with hindsight I’d suggest that perhaps this was too fast.
I put together a spreadsheet prior to beginning this process, which you can take a look at here. This shows my withdrawal plan. There’s quite a bit to unpack, and not a lot of space here to do it. For now, let me note that the 12.5mg increments I’ve used were a kind of hard lower limit for me. The lowest single pill dosage of sertraline available was 50mg, and cutting these tablets into quarters was just about (roughly) doable.
I’m unsure whether lower increments would offer any benefit to the process. At 12.5mg I believe I’m already well below the level at which I’m supposed to notice the difference. Yet I definitely did feel each drop, albeit with varying degrees of unpleasantness. Having come off this same medication with larger increments (25mg) in the past, let me restate that this time round was better.
Putting together that spreadsheet gave me a sense of the timescale I was to engage with. It was a bit scary. Because I didn’t feel I could rely on my local NHS services at all, I did spend some time looking into finding a private (paid for) therapist. I figured I’d see them once a week as a way of helping me keep track of how I was doing. It’s not a bad plan. As I mentioned above, getting professional help throughout the withdrawal is probably a solid idea.
In the end I just couldn’t find anyone I liked. So I brought the therapy ‘in-house’ with a rehabilitation journal. This was likely the best move I made throughout. It was, perhaps, even more important the shallow gradient I used in cutting back the medication. I still write every day, answering the same questions I initially set out for myself. Part of this involves tracking the overall sense I have of my mood each day, on a -3/+3 scale, and plotting this on a graph. For me this is a pen and paper job, but it could all be done electronically.
Journalling is my number one top tip to anyone looking to move on from anti-depressants. If you give it a try and hate it, no sweat. Some days it’s a nuisance for sure. For me though, overall, it’s a winner.
It still feels as though the literature out there is pretty weak on anti-depressant withdrawal. I’m happy to describe my experience. I’ve not spent much time candidly discussing this topic with other former users of SSRIs, but it seems there are common kinds of experience beyond just feeling a bit down sometimes. I’ve had great difficulty explaining my main symptom over the years – because it’s not quite like any other experience I’ve had.
It blends a few of the symptoms mentioned here, but ‘ghosting’ is a term I’ve sometimes used. Unfortunately that has two meanings, and the only relevant one is inadequate: secondary images on a display screen. My primary symptom (with a particular shout-out to my first week on 0mg) was the feeling that I was leaving my head me behind when I moved, whilst it was simultaneously flung out ahead of that movement.
This particular kind of feeling is similar to the one you get when you flinch or are startled. It tends to be triggered by sudden movement of the eyes or head, but it’ll quite happily happen even when you’re being careful. Sometimes this feeling comes with a sense that you’re falling. Sometimes it brings overwhelming waves of emotion. It’s always horrid and I hate it – but it does get better with time.
It seems important to end with a bit about what comes next. As we’re not ‘throwing away the crutches’ there’s still a lot of things to do once the medication is out of the way. Life, for example. As noted, I found journalling so helpful that there was no doubt I would continue to do this. Aside from this there are some fundamentals I picked up along the way that are perhaps worth sharing.
Chiefly, cultivating a more detached (but kind) perspective of your self and life seems not only key to getting through the withdrawal process, but of huge importance to how you carry things from now on. Giving yourself opportunities to think about the things you experience, as well as your thoughts and feelings, away from the moments that bring them is great – but no good if what you’re actually doing is beating yourself up.
It’s taken me over a decade to figure out that I don’t need to beat myself up, as well as how not to. Nowadays I’m ruthless about it. I’ve come to see the whole thing in terms of the practical pursuit of living contentedly. Therefore if a particular experience, thought, or feeling causes me any kind of discomfort – experiential, mental, or emotional – I question its practicality to death. If I can find a positive justification to its continuance (perhaps I feel guilty for having said something that I think might have upset someone, but I’ll take that guilt as a nudge not to say that thing again) then we’re good and I’ll leave it at that. Otherwise it’s out.
This doesn’t work all the time, every time. I still struggle with things and will continue to do so – but I’ve accepted that. One of my favourite articles of 2017 suggests that “if at any point, Life runs out of problems to give us, then as players, we will unconsciously invent problems for ourselves. Problems are what keep us occupied and give our lives meaning.”
The point is that I no longer struggle with these problems as much as I did, and I feel equipped with the tools I need to continue in this fashion. Life is a much more pleasant place to be today than it ever has been before – and that’s the goal, right there. That’s everything.