Weaning from an antidepressant.
November 1, 2004 5:45 PM   Subscribe

Has anyone suffering from the kind of low-level endogenous depression from which, apparently, I suffer, aka "dysthymia," ever successfully weened themselves from an anti-depressant? [mi]

I've been told that people, successfully do this, but given my knowledge of the biochemistry involved, I find it hard to believe.
posted by ParisParamus to Health & Fitness (32 answers total) 1 user marked this as a favorite
I did, but was only on it (Zoloft) for a month or two.
posted by IshmaelGraves at 5:53 PM on November 1, 2004

Response by poster: Ishmael, I don't think you have what I do, which is something long-term. Actually, I think I've already answered my question; what I have, I think is sort of like seasonal affective disorder (SAD), except it ain't that seasonal....(too bad I hate Florida...)
posted by ParisParamus at 6:02 PM on November 1, 2004

The several times I've tried to wean myself off my antidepressant, I've regretted it.

I also find it hard to believe that it can be done.
posted by five fresh fish at 6:18 PM on November 1, 2004 [1 favorite]

However, I have found several things do help with dysthymia/SAD/etc: light therapy, Griffonia simplicifolia, and raw, shelled hempseed, each of which made a mild difference.

They might well be enough for someone suffering mild dysthymia or depression; they are certainly not adequate for me.
posted by five fresh fish at 6:26 PM on November 1, 2004

Why would you have to? If you're having problems with side effects, try a different medication.

Having said that, I often go off anti-depressants for years at a time (and I have had a textbook case of clinical depression since I was three, and I'm now forty).

I was on Norpramine from 1990-1992, 1994-5, and 1998-2000. I've been on Effexor since 2002. I generally try to taper off after two years or so, and if it works, I stay off until I start having nightmares/not being able to sleep/bursting into tears in the middle of the day (usually the nightmares are enough to inspire me to make a call to a psychiatrist, though).
posted by Sidhedevil at 6:35 PM on November 1, 2004

Having been on loads of antidepressants and their friends in the past, I've found SAMe, 5-HTP, lots of hard-core regular exercise, and a very, very understanding husband extremely helpful. Have been off psychopharms for about 5 years now, and am doing surprisingly well! But it's a real individual thing, so great care and a positive environment are required.
posted by airgirl at 7:17 PM on November 1, 2004

I have been clinically diagnosed with disthymia more than once, and have been on a bunch of different medications. "Wean off" in terms of antidepressants for a person who is chronically depressed is a bit of a linguistic puzzle. 'Wean' seems to suggest some sort of progressive, healing vector, which is not necessarily what is happening if you are gradually reducing the medicine used to make you feel better in spite of a permanent condition.

I'm not on any medication at this point, because that's what I want for myself right now. And I believe that I have 'learned' how to deal with my moods better as a result of some of the drugs I've been on...if only because I now have memories of being able to blow off negative thoughts not worth dwelling on, and sometimes I can now muster the 'strength' to do it even without the help of the drug. But that's a relative thing. For a person with a truly chronic problem, antidepressants do not move you gradually to a point where you no longer need them; they help you while you're using them, and when you stop taking them, their effectiveness goes away as well.
posted by bingo at 7:47 PM on November 1, 2004

Dsythymia is a chronic mild depression. It has a slightly cyclical nature just like all other mood disorders. First of all, you need to make sure this is what you have and its not clincal depression or SAD or something else -- that will go a long way in answering your question.

Basically, you won't know what happens until you try going off your medication. You may want to see if you can take a lower dosage (depending on the medication), or switch medications, or try a different kind of therapy if stopping completely doesn't work for you. There's no hard and fast rule that says you have to take a drug treatment for dysthymia. Like the others have mentioned, it's just whatever works best for you.
posted by somethingotherthan at 7:58 PM on November 1, 2004

I think antidepressants used to be thought of as curative - that one would take them for a while, the depression goes away, then stop taking them. I think that's changed and now (except perhaps for those who are suffering a "reactive" kind of depression) antidepressants are thought of as maintenance drugs (like insulin for diabetics) and the assumption is that one will stay on them indefinitely.

I went on Zoloft in the mid '90s and it was a revelation. I discovered, in retrospect, that I had been, like Sidhedevil, depressed my entire life; I'd have recurrent episodes of major depression superimposed on a background of chronic "minor" depression (aka dysthymia). Until Zoloft I had no idea what the world looked like to other people; I thought everyone lived everyday with a sense of dread and hopelessness.

I was never comfortable with the idea of being dependent on a drug forever, so I'd go off the Zoloft for a spell. It became apparent pretty readily that in fact I did need to be on medication indefinitely so back on the Zoloft I'd go. Once medication released me from my personal hell there was no way that I could ever choose to go back.

Unfortunately, after several years, the Zoloft stopped working, which apparently is not unusual for the SSRI drugs . Since then I've tried everything (various therapies, other drugs, lifestyle changes, ECT, etc.) to find relief without, so far, any success.

So, to answer your question, yes, it is possible to wean oneself from an antidepressant (don't do it cold turkey, though). You may find that you'll need to go back on. I hope that if you do discover that you need to continue with the medication that it continues to work for you. Good luck.
posted by TimeFactor at 7:59 PM on November 1, 2004

I'd tell you how I did it, but I'd thereafter miss your posts in MeFi...
posted by Fupped Duck at 8:10 PM on November 1, 2004

Response by poster: Fupped: no danger: I'll probably be back "on" Mefi, which is sort of a drug, soon (went off cold turkey, at least for things political, about a month ago). I don't think my political outlook changes with serotonin levels--although I did first try an SSRI just after 9/11...

More seriously, wow, what openness about depression. The reason I would like to go "off" is, as someone mentioned, a lack of comfort with the idea of being dependent on some substance that isn't a food. On the other hand, the SSRI does make me "even better" in the sack than I was previously, so...

I guess the other question I should have posed is whether anyone seemed to be worse than before, once off the medication--that sounds kind of scary to think about, but I guess it's too late now...
posted by ParisParamus at 8:24 PM on November 1, 2004

My depression is of a different sort, but getting out into the sunlight really does help. Also exercise. It is worth getting a fitness membership and putting the time in. A good B vitamin complex tablet may also help you out, along with the suggestions everyone else has.

What I would give to get back on Zoloft, though. I had six of the happiest months of my life on that stuff.
posted by konolia at 8:48 PM on November 1, 2004

It also depends on the medication. Weaning yourself off Effexxxor is extremely unpleasant.
posted by mookieproof at 8:55 PM on November 1, 2004

Response by poster: mookieproof, just to clarify, I wasn't talking about "withdrawal" issues but the concept of somehow being cured of depression and not needing the drug. (That makes sense when the depression is linked to some external, transcient event, but when it's largely internal, the idea seems implausible.)
posted by ParisParamus at 9:05 PM on November 1, 2004

the concept of somehow being cured of depression and not needing the drug

If you have dysthymia, that is probably a false hope. It's chronic. TimeFactor probably got the closest to an answer that you're looking for.
posted by somethingotherthan at 9:16 PM on November 1, 2004

Agreed with somethingotherthan and TimeFactor. It's not something that's going to 'go away'.

If you're going off of meds because you're in Side Effect Hell, that's a different story altogether.
posted by Electric Elf at 11:18 PM on November 1, 2004

How often do the SSRIs 'run out'? Is this a common occurance?
posted by daver at 11:51 PM on November 1, 2004

Just a quick Google search revealed this:

Some patients will run into so-called "Poop-out"; the medications simply stop working after a while. There are no official data on the antidepressant poop-out rate, but experts estimate it at about 20%. According to Klein, poop-out is highly unlikely to occur before three or four months of treatment; after that, there is no saying whether or when it wilt. "Poop-out is not uncommon, but it's not the expectation" says Goodwin.

The whole article is good, as it discusses drug therapy in the long term for the spectrum of unipolar depression.

"Poop-out" probably has something to do with the fact that the drugs have not been studied for long-term effect. They are only supposed to be given for 6-12 months at a time.
posted by somethingotherthan at 12:16 AM on November 2, 2004 [1 favorite]

If you know how to read psychological research literature, here's more info about this effect, scientifically known as "antidepressant tachyphylaxis."
posted by somethingotherthan at 12:26 AM on November 2, 2004

Some people with chronic endogenous depression can find ways of managing their depression without medication, just as some people with diabetes can find ways of managing their diabetes without medication. But it's highly individual.

In any case, does that represent a "cure"? I wouldn't say so. However, I would love to be able to manage my depression without medication, just because I worry about very subtle long-term side effects. I would also love to be able to manage my serious allergies without medication, because I worry about very subtle long-term side effects, and sometimes I can go several months without any antihistamines. Etc., etc.

The thing that troubles me, though, is when people think of needing medication to manage depression as a "defeat". I think it's less likely that people would think of needing insulin to manage diabetes as a "defeat".
posted by Sidhedevil at 3:45 AM on November 2, 2004

Also, medication plus talk therapy has been shown in numerous studies to work MUCH better than medication alone.
posted by Sidhedevil at 3:46 AM on November 2, 2004

skallas, where do you get the datapoint that antidepressants are 20% effective? I'm not challenging it, I've just never heard it before.
posted by Sidhedevil at 4:00 AM on November 2, 2004

Response by poster: "Some people with chronic endogenous depression can find ways of managing their depression without medication, just as some people with diabetes can find ways of managing their diabetes without medication. "

I decided to go try My SSRI in the winter, just after 9/11, and when my short, controling marriage deprived me of the road cycling I had been doing for most of the last 20 years. I can definitely imagine a lifestyle that would allow me to do enough exercize to not take happy pills, but not today, or this month. The sadness which brought me to take happy pills is almost instantly erased by a 10 or 20 mile bike ride.
posted by ParisParamus at 4:47 AM on November 2, 2004

Response by poster: (and Kerry losing still won't do it...)
posted by ParisParamus at 4:49 AM on November 2, 2004

Well, mine will be one voice of dissent, then.

I was chronically depressed, not in reaction to anything, and ever since I could remember feeling anything. I don't know if it was dysthymia or something more major, but it certainly wasn't "reactive" or in response to any events. I took medication (Zoloft followed by Prozac) for around four years, and I stopped around four years ago.

And I would consider myself cured. I can't attribute it directly to the drugs, because there are always tons of other factors influencing things at the same time, but I can say that they helped a lot. My feeling is that the drugs let me see things from a different perspective (like TimeFactor), and I was able to hold on to that. I still have shades of depression, but I can recognize it clearly and work through it if I need to.

So while my case seems to be far from the norm, it definitely is possible. And really, with the possibility there, if the side effects and cost are manageable, it's certainly worth trying.
posted by whatnotever at 9:22 AM on November 2, 2004 [1 favorite]

Sidhedevil, you might want to do some research on Effexor. There are recent studies that indicate it causes permanent changes in brain wiring, and not for the better.

PP: if your condition is genetic, treat as you would diabetes. Insulin isn't a food, but it ameliorates a deficient body chemical problem; ditto anti-depressants in those with not-to-spec brain chemistry.
posted by five fresh fish at 9:48 AM on November 2, 2004

whatnotever, a) congratulations! and b) I totally agree that it's worth trying, because nobody knows whether or not they'll be the rare person who can manage /illness/ without resorting to standard medications unless they try. You are a lucky, lucky person.

Although, if you're like me, you might need the meds again someday, which wouldn't be so terrible. I see myself going on and off for the rest of my life in an attempt to balance out the costs and benefits of both strategies.

Thanks, fff, I've done a lot of research on Effexor. Did you have a specific study in mind that I might have missed? Again, not saying this to be challenging (though it was kind of prick-y of you to say "you might want to do some research" as though you somehow knew I'd never done any) but because I honestly don't know what you're talking about and I would be interested to read and attempt to evaluate this data for myself.

PP, it seems both easier and healthier to take antidepressants than to go for a 20-mile bike ride every day. The potential downside to liver function, etc., from the a/ds would surely be offset by the dangers of repeated hip and knee replacements.

Also, you are an utter jerk for intruding politics in this thread. Maybe if you didn't insist on acting like a strident, abject asshole, you would be a happier person. (I know that I would be a much happier person if you didn't insist on acting like a strident, abject asshole!)

I hate to be so hostile on AskMeFi, but seriously, PP--going around acting like this is not conducive to your mental health. It just makes life more stressful for everyone around you, and thus for you. Serenity is much, much preferable to whatever satisfaction one gets from constantly stirring the pot and feeling aggrieved.
posted by Sidhedevil at 10:45 AM on November 2, 2004

it was kind of prick-y of you to say "you might want to do some research" as though you somehow knew I'd never done any

Oh get over yourself. You're the one who cares to spin it that way, reading far more into a simple sentence than is warranted.

I can't find a citation. What I remember is a report that many people coming off Effexor have disruptive side-effects that appear to be permanent: "the zaps", visual hallucinations, etc. Much the same as when one first starts up on Effexor.
posted by five fresh fish at 11:55 AM on November 2, 2004

whatnotever tells a pretty good story, which is very similar to my wife's. She was on prozac or 6 months and effexor for about 3 years, and it seemed to serve the purpose of helping her identify her own darker moments, and what she needed to do to get past them. I forget what precipitated it, I think is was that despite the general even-keeledness that drugs finally brought her, she was not happy about the lethargy and drowsiness that they seemed to cause (she's a personal trainer). It took her a year to kick effexor, and she had to put up with dizzy spells during that time. She's been off for about two years now, and never happier. She still is naturally someone who is somewhat shy, but she now knows enough not to let social anxiety get to her in a debilitating way. ("The only thing we have to fear is fear itslef, etc.'"), and she gets through those situations.

I have some pretty dark moments myself, as my many postings in the blue attest, but I would never consider this route for myself. Having a somewhat addictive personality (smoked for 15 years), I am very resistant to sampling meds of any kind.
posted by psmealey at 12:00 PM on November 2, 2004

for what it's worth, a daily "10 or 20 mile cycle" is probably a pretty good thing to do (certainly on the 10 mile side of things). cycling is pretty easy on the body and, for a reasonably fit person, that's less than an hour of exercise a day.
posted by andrew cooke at 1:58 PM on November 2, 2004

Also, you are an utter jerk for intruding politics in this thread. Maybe if you didn't insist on acting like a strident, abject asshole, you would be a happier person.

Wow, people are touchy these days. Doesn't that seem a bit of an extreme reaction to a one-liner? Everybody knows PP's not a Kerry fan; I assumed he was just making a little joke, just as if one of our resident lefties had said "(and Bush losing still won't do it...)." Would you have gotten as upset in the latter case? I don't think so. PP does like to stir the shit, but I don't think he was doing that here -- people are just so upset by Bush they can't deal with even a jokey reference. I sure hope all this abates after today.
posted by languagehat at 2:57 PM on November 2, 2004

The insulin analogy isn't a very good one. Insulin is a peptide that your body produces normally and rapidly as a reaction to food consumption and blood sugar elevation. It is produced in a free state, delivered to the blood stream, and rapidly (30 min-1 hr) degraded.

Injected insulin goes in subcutaneously and is in the form of hexamers. It gets into the bloodstream slowly over time (6-12 hours) whether blood glucose is going up acutely or not. And insulin signals the body to store energy as fat. The injection-insulin-using diabetic's metabolic state is nothing like the healthy state; docs are pleased to spare patients the use of insulin with the *-glitazones, sulfonylureas, and *-formins that are out there, when we can.

I don't have any brilliant pearls to add about the antidepressant discussion; I might throw out a caution about being too quick to assume we know exactly what the 'healthy' state consists of.
posted by ikkyu2 at 10:51 PM on November 2, 2004

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