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Let's Call It What It Really Is: Withdrawal

The potential horrors of stopping an antidepressant

For the last several months, I've been either wildly feverish, chilled to the bone, throwing up blood, or lying inert in a fetal position—all because I've been trying to get off an antidepressant I take for my bipolar disorder. Even though I've been working very closely with my doctors, it's been a hellish journey.

Who's to blame? Me, the doctors, the drugs, the drug companies, or all of the above? This seems like an important question, if only because I don't ever want to go through this again. I don't want to be a helpless victim; nothing's less appealing than victimhood. And I'm positive that I'm not the only person who's affected by this problem. In 2007, the Center for Disease Control and Prevention announced that antidepressants were the most frequently prescribed drugs in America, trouncing the runner-up, high blood pressure medication, by five million prescriptions.

So all of you out there, blithely taking your Paxil or your Zoloft or whatever, let me ask you: do you know how hard it may be to go off it, should you want to? Did your doctor explain the risks when he dashed off the prescription, on his way to his next patient? Did you even think to ask?

I've always thought I'm an informed consumer. As a lawyer, I'm naturally suspicious of all new developments, so every time a doctor prescribes a new drug for me I whip out my legal pad and start taking notes. I ask what I can expect to feel, the possible side effects, interactions with food and other drugs, etc. I don't stop the interrogation until I feel that I'm satisfied. Then I go home and God help me, I google, which may or may not be such a good idea. But at least I tell myself I've done my homework before I pop that next pill.

I never think about what might happen if I someday want to stop taking it. I'm too eager to be fixed, to be cosseted and soothed by the mighty magic that lives in that tiny capsule—that symbol of hope and transformation. It's like starting out in a new relationship: you don't even think about the possibilities of divorce.

You should. Divorce is a messy business.

I started feeling sick less than two days after I reduced the dosage of my antidepressant. I'd only gone down a little bit, because I know that you're never supposed to stop any drug abruptly. Ideally, you should slowly taper off the medication in compliance with your doctor's directions, to give your body a chance to adjust to the change. Which is exactly what I did. Nonetheless, I felt woozy and nauseated, and when I tried to get out of bed, I briefly passed out. Then the chills started, followed by a fever, then more chills, then copious sweating. The most I could do was get out of bed to throw up.

Definitely the flu, I thought, and I continued to go down on the drug. But every day I got sicker, until finally I couldn't keep anything down, not even water. I vomited so often I must have ruptured something in my throat, because pretty soon I was throwing up blood. I lost ten pounds I can't afford to lose. And still, it never occurred to me that going off the antidepressant might be the culprit. But when I found myself getting severely depressed, I finally called my psychopharmacologist.

He told me that the fancy term for what I was going through was "serotonin discontinuation syndrome." As pretty much everyone on the planet knows by now, serotonin is a chemical in the brain that may be implicated in depression. Antidepressants, many of which are called selective serotonin re-uptake inhibitors or SSRI's, seek to increase the amount of serotonin available to you. So when you go off an SSRI, the amount of serotonin in your brain diminishes, and this can cause all sorts of possible nastiness.

According to the Journal of Clinical Psychiatry, "Physical symptoms include problems with balance, gastrointestinal and flu-like symptoms, and sensory and sleep disturbances. Psychological symptoms include anxiety and/or agitation, crying spells, irritability and aggressiveness." Other studies report "zapping" or shock-like sensations in the brain; headache; fatigue; tremor; and visual disturbances, among other things.

I looked up the patient information leaflet that came with my medication. Despite a long listing of side effects, there was no mention of "serotonin discontinuation syndrome," or of any of the problems inherent in reducing or stopping the dose. Getting angry at the drug company helped me a little—I was less angry with myself, at any rate, for not having asked the right questions of my doctor; and for my naive belief that prescription drugs aren't every bit as dangerous, potentially, as street drugs.

But shifting the blame didn't lighten my symptoms. No matter how slowly I tapered off, I just continued to get worse. After weeks and weeks spent shivering in bed, unable to write, unable to eat, unable to meet any of my social commitments, I finally had to admit I was licked. My doctor prescribed a different antidepressant to get me through the worst of the discontinuation syndrome, and gradually I started to feel more like myself. I still continue to take the new drug, although I'd much rather not. I'm horrified to realize that I'm physically dependent on this antidepressant, and can't get off it without extreme suffering.

I've had a lot of down time to reflect on this experience, and I think in the end what's upset me the most is the soft and fuzzy terminology being used to mask a severe and significant problem. While I was retching and shaking and passing out, I felt very much like one of those poor pathetic characters in a grainy 1950s film about heroin addicts kicking their habit. The squeaky clean clinical term "serotonin discontinuation syndrome" did nothing to capture the shame and degradation I was feeling. I hate it when words don't work.

So it was some small comfort to discover in my reading that "serotonin discontinuation syndrome" is a relatively recent term. Get this: it was coined after a pharmaceutical convention in 1996. Before that, the term for what I've been going through was simply this: "withdrawal."

Since others are fudging, let me be perfectly clear: I believe in medication. I can see the positive impact drugs have made on my life across the years. For me, it's the difference between being relatively functional and completely incapacitated. So this isn't a rant against pharmacology. It isn't an exhortation to get off your drugs. By all means, take them if you need them. But stop for a moment before you do, and ask yourself: do I really know what I'm doing? And will I be able to stop?

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