In his book The Antidepressant Solution, Harvard physician Joseph Glenmullen, MD, uncovers the problem of antidepressant withdrawal that’s not discussed in most doctors’ offices.
“Research has shown,” he writes, “that when patients stop antidepressants cold turkey, they can have high rates of withdrawal reactions, which vary depending on the particular drug.”
For example, he says, 66 percent of patients stopping Paxil (paroxetine), 60 percent stopping Zoloft (sertraline), and 78 percent stopping Effexor (venlafaxine) have withdrawal reactions, according to some studies. “Unfortunately, most doctors and patients have not been adequately informed about the problem of antidepressant withdrawal reactions,” Dr. Glenmullen explains. Too many people are caught in what he calls the antidepressant catch-22: restarting antidepressants or upping the dose, thinking they’re treating depression when, in fact, they’ve become dependent on the drugs to suppress withdrawal reactions.
Even when folks do slowly taper off of a drug, I’ve found that there are often withdrawal problems. A while ago, I asked my online depression communities,Project Beyond Blue and Group Beyond Blue, for input on medication withdrawal. I was surprised that two-thirds of the members said, even with careful tapering over an extended period of time, it took them three months on average to regain stability. As I mentioned in my piece differentiating withdrawal from relapse, it can be especially confusing when the withdrawal is a delayed reaction, happening two months after the last dose is taken — when everything has cleared your system.
While antidepressants aren’t addictive in the sense that cocaine and other street drugs are, they do cause dependence, meaning the brain has to substantially reorganize when you stop taking them. The period of withdrawal can be brutal and downright dangerous, causing impulsive behavior, intense suicidal thoughts, insomnia, crying spells, severe anxiety, mania, and even hallucinations.
Stopping antidepressant medication is a serious step, and you should never stop taking antidepressants without first discussing it with your doctor.
I’m in the midst of withdrawal right now, and I can say it’s one of the most difficult things I’ve ever done in my life.Like any challenging endeavor, this one requires preparation. Here are some techniques that have helped me through the last few weeks and aided others I know who have persevered through withdrawal to the other side.
Aerobic exercise can be very effective at relieving some withdrawal symptoms. First, cardiovascular workouts stimulate brain chemicals that foster growth of nerve cells. Second, exercise increases the activity of serotonin and/or norepinephrine. Third, a raised heart rate releases endorphins and a hormone known as ANP (atrial natriuretic hormone), which reduces pain, induces euphoria, and helps control the brain’s response to stress and anxiety. Exercise also improves sleep patterns, which are usually affected by withdrawal.
2. Hot Yoga
In a TEDx talk, yoga instructor Sara Curry explains how yoga can decrease the length and intensity of post-acute withdrawal symptoms in addicts, which include anxiety, irritability, depression, and sleeplessness. In the last few months, I’ve benefitted immensely from hot yoga. The 105-degree room is important for sweating out the toxins that are stored in fat cells beneath your skin, and the combination of postures and rest redistribute blood flow to all organs and glands, increasing oxygen delivery. Regular practice also destroys and metabolizes stress hormones.
3. Saunas or Steam Rooms
In the same way that hot yoga can promote detoxification through sweating, saunas and steam rooms may help cleanse your system. According to one small Finnish study published in 2013 in the Journal of Human Kinetics, saunas may also help create a stronger immune system by producing white blood cells. Our arsenal against infections and ailments, white blood cells can help us heal faster.
The blog Mental Health Daily, written by someone who’s had experience with withdrawal, offers a great list of supplements for antidepressant withdrawal. Among the suggestions are omega-3 fatty acids (I find a higher ratio of EPA/DHA is best, like this one by OmegaBrite), glutathione, magnesium, 5-HTP or L-tryptophan, vitamin B complex, L-tyrosine or L-phenylalanine, Himalayan salt, gamma aminobutyric acid (GABA), and S-adenosylmethionine (SAMe). Amino acids, especially L-theanine, and lots of vitamin C have also helped me. Other supplements that have taken the edge off for friends of mine are LifeExtension’s Natural Stress Relief, and Calm PRT by Neuroscience. Finally, I have been taking a multivitamin by Truehope, EmpowerPlus, designed to help people taper off meds.
You’re going to need support, because most people will think you’re irresponsible for trying to do what you’re doing. You need at least one person — preferably a few — who will be there to remind you of why you are attempting to do this, and to be your cheerleader along the sidelines of this hellish marathon.
I have three people in my life right now who are behind me 100 percent. When I don’t think I can take another night of insomnia followed by a day of crying spells, they tell me that I am Sisyphus pushing a rock of immense weight up a hill, but that my efforts will soon be rewarded. There is an end to this pain, and the pursuit of healing is worth the sweat.
6. Epsom Salts Baths
I mentioned Epsom salts baths in both my piece on panic attacks and in the one on insomnia. Epsom salts are a mineral compound containing magnesium, sulfur, and oxygen. When used in a warm bath, they allow magnesium to be easily absorbed into the skin, which promotes a feeling of calm and relaxation. According to a study published in 2012 in Neuropharmacology, magnesium deficiencies induce anxiety, which is why the mineral is known as the original chill pill.
7. Deep Breathing
Every relaxation technique that mitigates the stress response and halts our “fight or flight” or “I’m-dying-get-the-heck-out-of-my-way” reaction is based in deep breathing. I find it miraculous how something as simple as slow abdominal breathing has the power to calm down my entire nervous system. One way it does this is by stimulating the vagus nerve — our BFF in the middle of a panic — because it releases a variety of anti-stress enzymes and calming hormones, such as acetylcholine, prolactin, vasopressin, and oxytocin. Deep breathing can be very effective at mitigating the panic that’s so often part of withdrawal.
Although some people find that crying makes them feel worse, I’ve always felt much more calm after a sobbing session. In a New York Times piece, reporter Benedict Carey referred to tears as “emotional perspiration.” They remove toxins from the body that build up from stress, like the endorphin leucine-enkephalin, and prolactin, the hormone that causes aggression. Emotional tears — those formed in distress or grief — actually contain more toxic byproducts than tears of irritation (like onion peeling). Crying also lowers manganese levels, which triggers anxiety, nervousness, and aggression. In that way, tears elevate mood.
9. Dry Skin Brushing
In the last two weeks, I have started to brush myself every evening before I go to bed with a dry skin brush. A friend of mine said it helped soothe her father when he was battling a brain tumor. Dry brushing can stimulate the lymphatic system, which is responsible for eliminating cellular waste products. In this way, it helps release toxins and decrease inflammation. It also increases blood circulation to the skin and reduces muscle tension, helping us to calm down and relieving stress.
10. Calming Foods and Teas
Diet is critical to mood, of course, but it’s especially important to pay attention to what you eat and drink when you’re going through withdrawal symptoms. Some ingredients, like white flour and sugar, can aggravate your symptoms, while anti-anxiety foods can help calm you. They include maca root, almonds, dark chocolate, pumpkin seeds, seaweed, blueberries, kefir, turkey, avocados, and teas that contain chamomile, rooibos, lemon balm, passionflower, ashwagandha, valerian, peppermint, and kava.
Massages can be expensive, but if you can afford it, this hands-on therapy can help you relax — priming your parasympathetic system — and can facilitate the elimination of toxins. According to a study published in the International Journal of Neuroscience, women with breast cancer who received massage therapy three times a week reported being less depressed and angry. Other studies have found that massage improved the quality of sleep in women with breast cancer.
12. Incentive and Good Information
When I decided to get sober, I penned pages and pages of my “bottoms”: memories of those times I woke up in a foreign place and didn’t know what had happened, the things that I had lost because of my drinking, and the reasons I had for quitting. In the same way, I consult my mood journals over the last 10 years to remind myself of the risk-benefit ratio and the track record of many of the drugs I was on: how, in the last six years, they failed to improve painful depressive symptoms while contributing more and more significantly to health conditions. I revisit the incentives I have for trying a more holistic path to healing, even if it entails feeling my way through a haunted forest to get there. It’s also helpful to read the research of Glenmullen and others who aren’t afraid to expose the side effects and significant risks of antidepressants, while sharing the success stories of people who have found other paths to recovery.