If you suffer from anxiety or depression and have tried multiple ways to manage your symptoms to no avail, your doctor might prescribe you an antidepressant to boost your mood.
With rates of mental illness skyrocketing, antidepressant use has only increased during the pandemic. Medical providers use antidepressants to treat a wide range of mental illnesses including depression, a variety of anxiety disorders, chronic pain and post-traumatic stress disorder. Despite somewhat of a negative cultural stigma surrounding them, per a major Lancet study, most of the top antidepressants are more effective than placebo pills at treating symptoms of major depression. Other patients, with conditions like bipolar disorder, are more likely to benefit from other medications like mood stabilizers or antipsychotics.
Selective serotonin reuptake inhibitors (SSRIs) are perhaps the most popular antidepressants on the market; these include Zoloft, Prozac, Lexapro and others. Put simply, SSRIs increase the amount of serotonin, a hormone that stabilizes your mood, in the brain. SSRIs are very similar to serotonin and norepinephrine reuptake inhibitors (SNRIs). Along with serotonin, SNRIs increase the brain’s levels of norepinephrine, which can help with focus.
However, not every antidepressant will work for everyone. A lot of its efficacy depends on the patient’s own biology. Antidepressants are also not a cure-all for mental illness — they’re simply part of someone’s treatment plan.
When patients start taking an antidepressant, they usually go through a period of intense side effects as their bodies adjust. These usually disappear with time. But for some, various side effects, like low sex drive or weight gain, may not. At some point, if a patient starts to feel like they can manage their condition without an antidepressant or if side effects of the medication start to outweigh the benefits, they might talk with their doctor about stopping treatment.
Tyler Rickers, a psychiatrist at Rogers Behavioral Health in Oconomowoc, Wisconsin, says stopping cold turkey is never a good idea, even if you start to feel better. Many antidepressants come with withdrawal side effects, which can be alarming if you aren’t aware of them. Plus, Rickers says, it’s relatively common for people to start feeling depressed or anxious again a month or two after they stop without medical guidance. “Your doctor can help you decide whether you should go off medication and provide you with guidance on how to do it gradually and safely,” he says.
(Originally, antidepressants were thought to serve as short-term treatment for episodic problems, but more and more doctors are prescribing them to patients for the long term. More research needs to be done in this area.)
Unfortunately, Rickers says even with a doctor’s help, tapering off an antidepressant can be notoriously difficult and come with a cocktail of bothersome side effects, like fatigue, brain fog and more. Below, five people describe their own experiences.
Alyssa, 34, Illinois
For most of her life, Alyssa took hormonal birth control to manage her polycystic ovary syndrome (PCOS) symptoms. While it helped with her periods, after getting on the pill, she noticed she began experiencing more symptoms of depression. So a psychiatrist prescribed her a low dose of Effexor, an SNRI. While it helped, after three years, she decided she didn’t think she needed the medication anymore for her mood. Her psychiatrist warned her that tapering off Effexor was difficult, but Alyssa says she wasn’t prepared for what “difficult” meant.
“Every time I lowered my dose, I felt like I had the flu,” she says. At night, she had vivid nightmares. She was too dizzy to drive her car. Every few weeks she’d find an equilibrium — just in time to taper again and start it all over. Because she didn’t have insurance at the time, she couldn’t afford extra doctor visits for more support.
It took five months to taper off Effexor completely. During that time, Alyssa lost a job because of her withdrawal symptoms. “Coping with withdrawal was its own full-time job,” she says.
Alyssa’s been off both Effexor and birth control for several years — she quit the pill four years after she stopped taking Effexor. While she experiences depression before her period, a symptom of premenstrual dysmorphic disorder (PMDD), it’s been less debilitating.
She has no plans to take Effexor, or any SSRI, either. Instead, she manages symptoms by seeing a therapist and practicing self-care through yoga, reading and going on walks.
My experience tapering off was so harrowing that I still have nightmares about it, and I would be reluctant to accept a prescription for another antidepressant unless I were in dire straits,” she says.
Richard, 39, Illinois, director at audio production company
Richard was on a low dose of Zoloft, an SSRI, for three years to manage panic attacks and social anxiety. “I remember thinking that my anxiety was definitely impeding my normal life, most obviously after my improv shows, but also that it was spilling over into my family life,” he says.
After a few years, Richard noticed his anxiety had disappeared, but side effects from his medication had not. He noticed Zoloft gave him brain fog that made it hard for him to think clearly. And he didn’t want to deal with it anymore.
Richard’s therapist fully supported his decision to taper off Zoloft. His family doctor gave him instructions on how to do it safely. “I think because I had a pretty terrible first two weeks of getting on Zoloft, I assumed the two week wind-down would be similar,” Richard says.
Turns out, it was easier than expected. Some days, he’d wake up feeling jittery or sad, but he persisted. “It seemed like I would have these really bad days, and then the next day would be this beautiful revelation, a glimpse of what could be if I could ride it out,” he says.
Throughout the process, he says he realized he might need to go back on antidepressant medication. However, since Richard reached zero milligrams, he’s adjusted well; although he still experiences depression, he considers it “situational.” “Ultimately, I found that I ‘just knew’ when I was done with the meds,” he says.
Brett, 39, Indianapolis, engineer
Brett had been on antidepressants for depression since college two decades ago. When he became a dad 10 years ago, his depression shifted into anxiety, so his primary care doctor prescribed him a new medication: a high dose of Effexor. Unfortunately, while the medication helped with his anxiety, it gave him unwanted side effects — daily headaches, lightheadedness and fatigue.
After about two years, he talked to his doctor about stopping the medication. He decided to go through with it, and his withdrawal symptoms were worse than expected. As he finally reached the lowest dose, his constant headaches, confusion and dizziness made it tough to function.
After stopping Effexor, Brett had another child, which triggered more anxiety. He was prescribed a new antidepressant, and plans to stay clear of Effexor. “I might have avoided some of the anxiety struggles if I had remained on an antidepressant, but Effexor wasn’t the right one,” he says.
Lorren, Georgia, 33, piano teacher, freelance writer and editor
Lorren started taking Prozac, an SSRI, to help ease postpartum depression in 2015, after her second son was born. When she found out she was expecting a third baby in 2018, she tapered off Prozac. To her dismay, she found it hard to get through the long, dreary Pacific Northwest winter without its mood-boosting effects. Her ob-gyn recommended she switch to another SSRI, Lexapro.
By April 2021, Lorren decided the side effects of the antidepressant outweighed the benefits — she had gained 100 pounds since 2015, which she thinks may have been due to antidepressants. She couldn’t seem to lose weight no matter what she tried. “I was in a good place mentally with no planned pregnancies, and it was summertime, so it seemed like an ideal time to stop taking the medication.”
Lorren had a hard time getting in touch with her medical provider, so she took matters into her own hands. She researched common protocol and used the most conservative approach, reducing her 20 milligram dose by 25 percent for four weeks. (Disclaimer: This isn’t recommended. If you’re considering stopping a mental health medication, talk to a clinician.)
In the first few weeks, she experienced some gut issues, but didn’t notice an increase in depressive symptoms. “It felt like I was able to feel my feelings more deeply instead of having them muffled,” she says. However, she adds, “When I hit 5 milligrams, I was hit by depression like a truck.” Her low mood and fatigue lasted a few more weeks.
Since April 2021, Lorren has been completely med-free. While she’s generally happy and is inching towards her weight loss goal, she still experiences bouts of severe depression.
“I hoped that I would be able to feel mentally healthy without antidepressants, because it had been so long since I’d had an episode, but I’m doubting that now,” Lorren says. “I should have been more mindful about getting support. I may finally try to set up a therapy appointment.”
Maira, 30, Indianapolis, registered nurse
Maira had always struggled with seasonal depression and general anxiety, but she never really thought about taking medication for either until recently. Three years ago, her mental health hit an all-time low: Her new husband lost his job the week they returned from their honeymoon. At the same time, she was returning to school to become a nurse. “It was a lot of change in a very short amount of time,” Maira says. “The longer I waited, the darker my thoughts got and the harder it seemed to get out of.”
Maira’s nurse practitioner recommended Celexa, an SSRI, to manage her depression symptoms. However, a year later, Maira’s depression symptoms worsened, even after doubling her dose. Her nurse practitioner switched her to Pristiq, an SNRI, and Maira finally felt normal.
By summer 2021, Maira’s life had stabilized, so she decided to wean off the medication. To curb side effects, she worked with her doctor to taper off as slowly as she could. As she went through the process, on top of dizziness and occasional headaches, Maira felt forgetful and irritable. But by the time she had come to a full stop, she felt confident she’d made the right decision.
While she’s not currently taking an antidepressant, she knows the medication was necessary for her to be safe and function well — and she’s open to taking medication again in the future if needed. “I’m able to look back on that time of my life and see it much clearer now,” she says. “I believe that medication was truly necessary for me to be safe and function well.”