“I’m almost unmedicated,” the novelist Diana Spechler cheered in the New York Times earlier this year, in a series of candid, beautifully written posts called “Going Off.” “Each morning, I take just 100 milligrams of bupropion. At bedtime, I take a quarter milligram of lorazepam. I’ve eliminated trazodone.”
The Times has long-covered the complexity of anxiety and depression from the perspective of their sufferers. What was different about “Going Off,” Spechler’s series (which ran from February until this week), is that it focused almost entirely on the challenges of ending psychiatric medication—as the newspaper put it, “from both the drugs and the withdrawal in her pursuit of a drug-free life.” The series would thus resemble a high-profile version of the type of encounter with medication documented for instance by PLoS One Database Searching or, even more immediate, David Healy’s RxISK: Making Medicines Safer for Us All.
The Times series impressed me for a number of reasons, not least for its clear-eyed focus on withdrawal syndrome as a medical phenomenon in itself. The consequences of that emphasis should not be underestimated. When, back in 2007, I finished researching a chapter on “Rebound Syndrome: When Drug Treatments Fail” for my book Shyness: How Normal Behavior Became a Sickness, it was common for psychiatrists and general practitioners to dismiss withdrawal or discontinuation syndrome from meds as, broadly, recurrence of the condition diagnosed. Although studies of “emotional blunting” from SSRI antidepressants had begun to filter into psychiatric journals, the difficulty of placing such articles in top-tier journals stemmed from the complexity of funding studies that might draw negative conclusions about a pharmaceutical sponsor’s products. It was far-more common to assert at the time that the original form of anxiety or depression had returned, even intensified—that it was time, accordingly, to raise the dose or cycle through another brand. That a major newspaper would commission and publish a series on medical withdrawal syndrome was, at the time, unthinkable.
Another consequence of Spechler’s emphasis on ending medication as a goal in itself: the problem to be solved—the unapologetic focus of her writing—is the side effects of the drugs themselves; the originary anxiety tends to recede in importance. “I worry about the long-term effects of these drugs,” she writes, “which are still relatively new to consumers. I worry about Big Pharma. My stomach clenches when I read about covered-up studies and the ugliest side effects of the very medications pharmaceutical companies hard-sell to psychiatrists, including to pediatric psychiatrists. I feel great discomfort with my doctor’s Celexa clock.”
She’s advised to see a psychiatrist, who subsequently “told me that with medication, we would aim to get my mood as close to 100 percent as possible, my anxiety as close to 0 percent as possible.” “I’d been on medication a few times before,” Spechler elaborates, “but had always quit because it wasn’t working or I couldn’t write, so I was in no rush to return to it.” In light of this far-from stellar experience, one might wonder at the persuasiveness of any claim that medication could bring her mood to “as close to 100 percent as possible.”
Perhaps predictably, the problems with writing intensify. “My version of screaming is writing,” Spechler wrote back in June, “but for two years, from the time I started taking medication, until recently, the words were stuck inside me. I had to force them out.” Yet the consequences of tapering her doses are far-from straightforward, including as a catalyst to creativity: “When I reduce, my anxiety and depression creep back in; when I increase, my side effects range from grim to unbearable.”
Spechler’s candor about such difficult, personal battles is enormously commendable, not least in bringing a big audience to a still-controversial problem that large numbers of researchers, psychiatrists, and drug companies would still gladly ignore. “You might need to taper more gradually than your doctor thinks,” she wrote last week in her final post, “10 Things I’d Tell My Former (Medicated) Self,” unwittingly drawing attention to large gaps in knowledge about this medical condition, even as tapering must always be done with great care, at slow speed, and always under medical supervision: “Reduce one medication at a time, just a sliver, every couple of weeks at the most. Be gentle…. The time will come when you wake each morning not woozy with dread, but excited that the sun is shining.”
It might be a version of the promise that used to fill psychiatric advertising, before the black-box warnings and long lists of side effects crowded out images of the hopeful and expectant. Except, here, the promise lies firmly in ending medication, not in starting to take it.
The entire "Going Off" series can be read here.
Professor Heather Ashton, a British psychiatrist who runs a renowned clinic on benzo withdrawal, supplies important safety information about recommended tapering here. See also the safety information detailed in my post "The Hidden Dangers of Benzodiazepines."