It took Laura five months to withdraw from five drugs, a process that coincided with a burgeoning doubt about a diagnosis that had become a kind of career. When her aunt Sara updated the rest of the family about Laura, the news was the same: they joked that she had become part of the couch. Her family, Laura said, learned to vacuum around her. Others in her situation might have lost their job and, without income, ended up homeless.
It took six months before she felt capable of working part time. Laura had always assumed that depression was caused by a precisely defined chemical imbalance, which her medications were designed to recalibrate. She began reading about the history of psychiatry and realized that this theory, promoted heavily by pharmaceutical companies, is not clearly supported by evidence. Genetics plays a role in mental disorder, as do environmental influences, but the drugs do not have the specificity to target the causes of an illness.
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Wayne Goodman, a former chair of the F. Few studies follow patients who take the medications for more than a year. A decade after the invention of antidepressants, randomized clinical studies emerged as the most trusted form of medical knowledge, supplanting the authority of individual case studies. For adolescents who go on medications when they are still trying to define themselves, they may never know if they have a baseline, or what it is.
Antidepressants are now taken by roughly one in eight adults and adolescents in the U. Industry money often determines the questions posed by pharmacological studies, and research about stopping drugs has never been a priority. Barbiturates, a class of sedatives that helped hundreds of thousands of people to feel calmer, were among the first popular psychiatric drugs.
Although leading medical journals asserted that barbiturate addiction was rare, within a few years it was evident that people withdrawing from barbiturates could become more anxious than they were before they began taking the drugs. They could also hallucinate, have convulsions, and even die. Valium and other benzodiazepines were introduced in the early sixties, as a safer option.
By the seventies, one in ten Americans was taking Valium. Selective serotonin reuptake inhibitors, or S. There had been other drugs used as antidepressants, but they had often been prescribed cautiously, because of concerns about their side effects. Concerns about withdrawal symptoms emerged shortly after S. A third of the patients said they felt suicidal, and four were admitted to a hospital. One had an abortion, because she no longer felt capable of going through with the pregnancy.
Internal records of pharmaceutical manufacturers show that the companies have been aware of the withdrawal problem. At a panel discussion in , Eli Lilly invited seven experts to develop a definition of antidepressant withdrawal. Guy Chouinard, a retired professor of psychiatry at McGill and at the University of Montreal, who served as a consultant for Eli Lilly for ten years and did one of the first clinical trials of Prozac, told me that when S.
Chouinard is considered one of the founders of psychopharmacology in Canada. When he reinstated their medication, their symptoms began to resolve, usually within two days. Most people who discontinue antidepressants do not suffer from withdrawal symptoms that last longer than a few days. Some experience none at all. Giovanni Fava, a professor of psychiatry at the University of Buffalo, has devoted much of his career to studying withdrawal and has followed patients suffering from withdrawal symptoms a year after stopping antidepressants.
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A paper published last month in a journal he edits, Psychotherapy and Psychosomatics , reviewed eighty studies and found that in nearly two-thirds of them patients were taken off their medications in less than two weeks. To some degree, that makes sense: no one wants to deter people from taking drugs that may save their life or lift them out of disability. In a paper published last month in Lancet Psychiatry , he and a co-author reviewed brain imaging and case studies on withdrawal and argued that patients should taper off antidepressants over the course of months , rather than two to four weeks, as current guidelines advise.
Such guidelines are based on a faulty assumption that, if a dose is reduced by half, it will simply reduce the effect in the brain by half. Three months after Laura stopped all her medications, she was walking down the street in Boston and felt a flicker of sexual desire. The sensation began to occur at random times of day, often in public and in the absence of an object of attraction. When she was thirty-one, she began a long-distance relationship with Rob Wipond, a Canadian journalist.
Everything was new to her. It felt synthetic. I did it! She felt fortunate that her sexuality had returned in a way that eluded other people who were withdrawing from drugs. Although it is believed that people return to their sexual baseline, enduring sexual detachment is a recurring theme in online withdrawal forums.
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Audrey Bahrick, a psychologist at the University of Iowa Counseling Service, who has published papers on the way that S. There was this assumption that the symptoms would resolve once you stop the medication. I just kept thinking, Where is the data? Where is the data? Laura felt as if she were learning the contours of her adult self for the first time.
When she felt dread or despair, she tried to accept the sensation without interpreting it as a sign that she was defective and would remain that way forever, until she committed suicide or took a new pill. Laura tried to find language to describe her emotions and moods, rather than automatically calling them symptoms.
She wrote several letters to Dr.
The Challenge of Going Off Psychiatric Drugs
Roth, her favorite psychiatrist, requesting her medical records, because she wanted to understand how the doctor had made sense of her numbness and years of deterioration. After a year, Dr. Roth agreed to a meeting. Laura prepared for hours. How do you make sense of that? Roth opened the front door.
She had always loved Dr. By the time Dr. Roth walked into the waiting room, Laura was crying. They hugged and then took their usual positions in Dr. But Laura said that Dr.
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It was only when Laura left that she realized she had never asked her questions. Laura started a blog, in which she described how, in the course of her illness, she had lost the sense that she had agency. People began contacting her to ask for advice about getting off multiple psychiatric medications.
Some had been trying to withdraw for years. They had developed painstaking methods for tapering their medications, like using grass-seed counters to dole out the beads in the capsules. Laura, who had a part-time job as a research assistant but who still got financial help from her parents, began spending four or five hours a day talking with people on Skype. I needed to know that someone else had gone through it and survived.
I know that I would lay down my life for her. Laura realized that she was spending her entire workday on these conversations.
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Because she needed to become financially self-reliant, she began charging seventy-five dollars an hour on a sliding scale to talk to people. Few psychiatrists are deeply engaged with these questions, so a chaotic field of consultants has filled the void. The groups offer instructions for slowly getting off medications—they typically recommend that people reduce their doses by less than ten per cent each month—and a place to communicate about emotional experiences that do not have names.
For many people on the forums, it was impossible to separate the biochemical repercussions from the social ones. The medicines worked on their bodies, but they also changed the way people understood their relationships and their social roles and the control they had over elements of their lives. It has not worked. I am not an angry person—I am gentle, I am affectionate, I am open—but in withdrawal I found that these qualities were less clear.
I was more irritable. We are trained to understand the evidence base as paramount—it is the primary basis for mental-health prescriptions around the world, and I fully subscribe to it—but this evidence base can never be complete without listening to the wider story. There were few precedents. In the late nineties, Heather Ashton, a British psychopharmacologist who had run a benzodiazepine-withdrawal clinic in Newcastle, had drafted a set of guidelines known as the Ashton Manual, which has circulated widely among patients and includes individual tapering schedules for various benzodiazepines, along with a glossary of disorienting symptoms.
She and Rob whom she was no longer dating created it with a grant from a small foundation, which gave her enough money to pay herself a salary, to hire others who had consulted with people withdrawing from medications, and to cull relevant insights about tapering strategies.
The Web site helps people withdrawing from medications find others in the same city; it also offers information on computing the percentage of the dosage to drop, converting a pill into a liquid mixture by using a mortar and pestle, or using a special syringe to measure dosage reductions. Swapnil Gupta, an assistant professor at the Yale School of Medicine, told me that she is troubled that doctors have largely left this dilemma to patients to resolve.
They routinely encounter patients who, like Laura, are on unnecessary combinations of psychiatric medications, but for different reasons: Laura saw her therapists as gurus who would solve her problems, whereas poor or marginalized patients may be overtreated as they cycle in and out of emergency rooms. It is a loss of identity, a different way of living. Suddenly, everything that you are doing is yours—and not necessarily your medication. Put me back on my meds.
Now they had just returned from spending the holiday with her family in Maine. He asked if a number of different household items were safe for the dishwasher, before saying he had one last question and pulling an engagement ring out of his pocket. Laura had met Cooper, who works at an agency that supports people with psychiatric and addiction histories, two years earlier, at a mental-health conference in Connecticut.
Cooper had been given Adderall for attention-deficit hyperactivity disorder at seventeen and had become addicted. I need tweaking, I need adjusting. His work made him unusually welcoming of the fact that people in various states of emotional crisis often want to be near Laura. A few months after they were engaged, Bianca Gutman, a twenty-three-year-old from Montreal, flew to Hartford to spend the weekend with Laura. Susan paid Laura for Skype conversations, until Laura told her to stop.