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Queeries: Should I come off my SSRIs?

Our Fagony Aunt guides a reader through a dilemma about medication, and emphasises the importance of slowing down and seeking guidance.

06 Dec 2022

Dear Fagony,

I’ve been on SSRIs for a few years but for the past few weeks I’ve been messy with taking them, – either forgetting, taking them at random points in the day or just not bothering – and just riding the wave of whatever that has looked like. I’m thinking maybe I should stop taking them altogether? I’m in a loving relationship that’s holding me in a way I’ve never experienced before, and I’m smashing it at work. Even in the moments of stress and resulting catastrophizing thoughts that may arise, I seem to be pulling through with my own healing tools (mostly naps). I’m contemplating stopping coz I’ve found myself in a place where I haven’t really been taking them for a week and I’m trying out different ways to cope that aren’t bad. I’ve run with the idea that maybe I could be a person who isn’t dependent on meds and then maybe I’d lose weight and then maybe all these other things would happen. I just don’t want to think, “everything’s great i’m killing it yeeeey don’t need u meds BYE”, and then be on death’s door in a month lol.

Best,

Meddy Steady Cook

Dearest Meddy Steady Cook,

I’m gonna need you to hold your horses, love. Don’t get me wrong, I appreciate you so much for taking us through this particular thought process with you. As a fellow member of the “antidepressant” club, and someone who has in fact used a host of psychiatric medications to manage my own mental health over the last decade (with wildly varying degrees of success), trust me when I say I relate to and deeply respect the questions you’re asking here, and your right to ask them. What I recommend for now though, is try to stay in this state of inquiry without making any sudden movements if you can. 

In an ideal world, everyone who takes meds for mental health stuff has a professional care team around them to generally check in about the experience, any side effects and help them decide when it’s time to start, stop, change dosage, get a blood test or whatever. This can look like a combination of a therapist, psychiatrist and/or GP.  I am Very Passionate about the right and importance of everybody to have a good therapist. A good one will not only support you in your feelings around taking meds, they will also guide you through the journey, and add a layer of safety for you as they check in about how you’re feeling as the weeks pass. 

Now, there are lots of reasons someone might not have a team, or even one trusted health professional available to support them with this kind of thing, and there are lots of reasons why even if someone does, they may prefer to confide in a friend, a stranger in a Facebook group or an advice column. All routes to self-determination are valid; what’s important is that you feel truly heard, cared for, well-informed and empowered. 

“What’s important is that you feel truly heard, cared for, well-informed and empowered”

What’s tricky is that there’s contradicting information out in the world, and two people can have completely different experiences on the same drug. Being on medication is a deeply personal and intense experience, as you clearly know, and so finding at least one health professional you can truly trust to listen to you and offer sound guidance will benefit you in the long run. You can, and should, corroborate the advice they give you with community wisdom and your own knowledge of yourself, but it can help to feel grounded by having someone outside all of that to work with on this. You deserve support of various kinds, from many directions.

One thing that strikes me about your situation are the timescales. You don’t say how long you’ve been on the meds, but it’s clearly significantly longer than the few weeks that you’ve been taking them irregularly. I mention that not as a judgement, but to offer some perspective on the whole thing, because I know when we’re in our own realities they can feel consuming sometimes. There’s a sense of urgency in your message, and it makes me want to say, give it time. Give yourself the stability to enjoy this moment: the romantic bliss, the great job, the new coping skills you have no doubt painstakingly cultivated for yourself. If and when you choose to come off your meds, do it with intention. And try to take your meds at the same time every day while you’re figuring this all out. This timer cap thingy has helped me in the past when my medication schedule has gone awry! 

“There’s a sense of urgency in your message, and it makes me want to say, give it time”

Personally, I am a strong believer that if someone wants to stop taking meds for any reason – be it destructive side effects, or they feel ready and want to give their other coping tools a whirl, or they want to just try and raw-dog life for a while and see how it goes – they should feel empowered and supported in doing that! Going cold turkey is not advised though, as that kind of withdrawal can be really hard on your body and mind. If you do decide to come off the meds, taper off them super slowly and ideally with the support of a mental health professional and loved ones who can hold you extra close through the transition. Reduce your dose bit-by-bit over a few weeks at least. Try to keep track of any changes you notice and remember the meds are there for you if you ever want to try again. Try to do it when other things in your life are relatively stable, i.e. not during moving house or an upsetting life event. This zine, Harm Reduction Guide To Coming Off Psychiatric Drugs is brilliant.

I want to be sure to honour your curiosity around what unmedicated life might look like for you. It’s so real, especially after having been on medication for a while, to question the role they play in your life, your happiness, the effects they’re having on your body, whether you need them anymore and whether your life would be better without them. This year there has also been a lot of important Big Discourse Energy around the overmedication of people with mental health challenges in an attempt to make them essentially more “compliant” for the capitalist hellscape we live in. 

“We all get to decide for ourselves where we fall, and that can change, as it’s potentially changing for you”

Is it true that many people on psychiatric drugs wouldn’t need them if alternative care was available to them and basic human needs were met abundantly? Yes! Is it true that meds and overmedication can have awful effects on people? Yes! Is it true that antidepressants and other drugs can legitimately help people to feel like they can survive and flourish in the world? Yes! More than one thing can be true! And we all get to decide for ourselves where we fall, and that can change, as it’s potentially changing for you.

From what you’ve said, it doesn’t sound like these SSRIs you’ve been on have been harmful to you so far, thank god, and so in that way all the options are yours to choose from. If you’re worried about weight gain or other potential side-effects, you could also think about changing the type of SSRI you’re on or lowering the dose to see if you notice changes after talking things through with a health professional. Side effects are a scary and violating part of experimenting with psychiatric drugs and I really wish I could take that part away – for the 21-year-old past-version of myself muddling through all this, and for you, too. Know that any good healthcare provider will be charting any symptoms you have with you and will help you find alternate medicine, or taper off completely if your side effects are too intense or do not naturally subside after some time. Care without consequences should be the goal.

“Please remember to hold so much compassion for yourself through this all”

Please remember to hold so much compassion for yourself through this all. Shit is rough, and rougher yet for QTIBPOC who are rightfully and understandably distrusting of psychiatric meds and so often low-key devastated we might need to take them. There are so many reasons for this: beliefs embedded by caregivers throughout life that mental health problems are not real, pressure to be immaculately high achievers, messaging that queer and trans people are inherently mentally ill with meds being a confirmation of that, a lack of language to speak with family about what we’re going through thus increasing loneliness, fear and lack of support, terrible experiences with Western medicine and the care system, huge access barriers… The list goes on. Know that whatever you decide to do, you’re actually such a baddie for having made these loving decisions, and continuing to reach into the abyss to find peace for yourself. Trust your gut and handle this with care. You are the only expert of your body and mind. 

Best,

Fagony

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