I had my first panic attack when I was 9 years old. One minute, I was in music class, belting out “Camptown Races.” Then, in less time than it took to sing “all the doo-dah day,” nausea and weakness swept over my body. With sweaty palms and trembling legs, I asked my teacher if I could go to the school nurse. Within 30 minutes, my mom showed up and carted me to the local emergency room, where an ER doctor suggested I see a therapist for anxiety.
It wasn’t a one-time thing. After a few repeat panic episodes, my mom pursued the best solution she knew: medicine. On a spring afternoon in fourth grade, I walked into a child psychiatrist’s office for a consultation and walked out with a prescription for an antidepressant called Luvox.
The little pink pills relieved my anxiety almost immediately. I exchanged my fears of lockjaw and fatal car accidents for more normal grade-school worries about sleepovers and school play auditions. From that point on, varying doses of SSRIs — Zoloft, Paxil, Lexapro, Celexa — were a part of my life.
Then, last year, I decided to wean myself off the medication I’d relied on for two decades. By that point, I’d made a lot of progress in managing my anxiety through therapy and had begun to see antidepressants as more of a burden than an asset. Thanks to my Lexapro, my libido was nonexistent and my extra pregnancy weight wouldn’t go away. And I couldn’t shake the feeling that I wasn’t fully experiencing the joy of mothering my two toddler sons. Something about my way of being just seemed flat. Didn’t my kids deserve to know an unconstrained, unmedicated version of their mother?
But in the process of quitting antidepressants, I realized there was something I needed to abandon more than Lexapro: the belief that being strong means being unmedicated.
As of 2017, 13 percent of Americans take antidepressants. The term “antidepressant” applies to several different classes of drugs, the most popular being SSRIs. Standing for selective serotonin reuptake inhibitors, SSRIs are typically used to treat mood disorders like anxiety and depression. The drugs work by increasing the brain’s supply of serotonin, an emotion-stabilizing neurotransmitter. In one study, 60 percent of people who took an antidepressant noticed improvements in depression symptoms within two months; research also shows SSRIs to be more effective than placebos in treating panic disorder.
As for the fine print, SSRIs also have well-documented side effects, including decreased sexual desire, weight gain, insomnia, headaches and nausea. And it’s debatable how well SSRIs work for anxiety in particular; some experts argue they can do more harm than good.
When I announced my decision to part ways with Lexapro, my soft-spoken, ultra-zen psychiatrist supported me. “I think you can do it, but we’ll need to come up with a plan for a slow taper,” he said, after laying out the risks. Given how long I’d been on SSRIs, we agreed the one thing I shouldn’t do was quit cold turkey.
My psychiatrist switched me to a liquid form of Lexapro and told me to reduce my daily dose of 10 milligrams by one milligram every two weeks.
Discontinuing SSRIs can be an extremely difficult process. Studies on long-term use have shown that the longer someone is taking an SSRI, the harder it is to quit. Some people develop discontinuation syndrome, a real, diagnosable condition that comes with physical symptoms like restlessness, tremors, nausea and vomiting, along with neurological symptoms like dizziness, trouble concentrating and the sensation of “brain zaps.” People can also experience increased feelings of anxiety and depression during discontinuation, but Dr. Anna Lembke, professor of psychiatry and behavioral sciences at Stanford University, says flare-ups generally don’t last more than a few weeks, especially with a gradual taper.
Tapering is something of a hot topic among psychiatrists, and prevailing opinion in the field is changing. For years, it’s been standard for doctors to recommend 2-4 week tapering regimens. But two psychiatric researchers recently published a paper recommending an “extended tapering regimen, reducing [a patient’s] dosage by smaller and smaller increments, down to one-fortieth of the original amount.” This method takes months or even years, but researchers say it accounts for how antidepressants change brain chemistry, while the old way does not.
My psychiatrist switched me to a liquid form of Lexapro and told me to reduce my daily dose of 10 milligrams by one milligram every two weeks. He also prescribed supplements and dietary changes to support serotonin production in my brain.
I followed his instructions to the letter. Every morning, instead of swallowing a pill, I poured unflavored liquid into a syringe and squeezed it into my mouth. And every night I swallowed a handful of vitamins. Each time I cut my dose, I felt out of sorts for about a week, which Lembke says is typical. “At first, we expect people to feel worse, but that may be withdrawal-mediated anxiety and depression,” she said. “Once their brain adapts to the new dose, a person might go back to their original baseline. It’s important to wait until the withdrawal is complete, then reassess.”
Some days, when I felt too anxious and uncomfortable to engage fully with my kids, I parked myself on the couch and let Curious George marathons do the parenting for me.
I couldn’t tell if my anxiety had resurfaced or if I was just experiencing withdrawal symptoms. Either way, I was struggling. In addition to brain zaps and dizziness, I felt like I had the flu. My appetite waned. I was irritable and restless. My whole body felt achy and fatigued. Some days, when I felt too anxious and uncomfortable to engage fully with my kids, I parked myself on the couch and let Curious George marathons do the parenting for me. Then I felt guilty. It was all so overwhelming.
But I didn’t want to undo my progress, so I forged on, reducing my dosage to 5 milligrams over three months. Once I adjusted to this dose, it felt like a comfortable midpoint between panic-stricken and emotionally clogged. Still, I assumed I should continue tapering until I hit zero. There was just something so intriguing about the prospect of living without medication.
But my doctor urged me to stay put for a while. If I wanted, I could resume tapering in a few months, or a few years, or whenever I stopped feeling like myself at my new, reduced dosage. By winter, 5 milligrams no longer felt right — but not in the way I’d hoped. Pummeled by the flu and the oppressive darkness of Minnesota in January, my anxiety came back in full force.
I holed up in my room, terrified I’d never get better. After two months of debilitating anxiety, I did what I swore to myself I wouldn’t: I scheduled an appointment with my psychiatrist and begrudgingly increased my dosage to 10 milligrams. I felt like I was giving up my chance of being an emotionally authentic person, but my doctor wasn’t having it.
“Don’t think of it as a failure,” he said. “You’re doing what you need to take care of yourself.”
I couldn’t appreciate his advice until my anxiety calmed down enough for me to put my tapering experience in perspective.
Originally, I wanted to quit Lexapro, or at least drastically reduce my dosage, to show myself and my kids that I was strong enough to thrive on my own — without pills to keep serotonin coursing through my synapses. But after coming full circle, I was able to see that being strong isn’t about taking (or not taking) medication. It’s about taking care of myself, just as my doctor said.
“Don’t think of it as a failure,” my doctor said. “You’re doing what you need to take care of yourself.”
If I were on medication for epilepsy, diabetes or any chronic illness with more acute physical symptoms, I doubt many people would call me strong or courageous for choosing to manage my disease naturally. The truth is, I’ve summoned plenty of strength and courage since I first went on antidepressants. I’ve spent years learning how to control the anxious thoughts that plagued my 10-year-old self. I’ve worked hard to build and maintain relationships that give me the stability I didn’t have as a kid. I pour myself into writing and parenting, both of which lend an empowering sense of purpose to my daily life. I advocate for my mental health needs whenever I can, and ask for help from friends, family and professionals when I need to.
So many times during my taper, I was motivated by self-discovery. I wondered if a “real version” of me was hiding beneath the medication I’d been taking most of my life. I envisioned the emergence of a resilient, vibrant, does-it-all woman. But I didn’t need to go looking for her. She was there all along.