The Simple ABC’s of Antidepressant Withdrawal

 

Antidepressant withdrawal is both complicated and simple. It was complicated when I first started in holistic psychiatry and didn’t know some of the nuances of antidepressant withdrawal, but now that I have gathered enough information to know the most important aspects of antidepressant withdrawal, it has become more straightforward. Well, as straightforward as a complicated process can be, that is. My learning curve, however, was a gradual one, and it stretched over many years. This article is not a comprehensive review of everything about antidepressant withdrawal. The purpose of this article is to alert individuals to key aspects of antidepressant withdrawal that everyone should know, before starting out on their journey. If you don’t, then withdrawal symptoms may become an ongoing source of suffering that can exact a large toll over many years. A successful withdrawal, defined by me, is one in which a person will be able to get off an antidepressant smoothly and stay off, even when under stress.

A. Content & Process

Antidepressant withdrawal can be divided into two aspects: content and process. The content of withdrawal includes what kinds of supplements, diet, or techniques are necessary to support or incorporate during withdrawal. The process, however, which has to do with the how, when, and what, is often poorly understood. In my practice, the process is facilitated by information and feedback learned through the field of energy medicine. In addition, it is supported by having years of clinical experience, working with complex patients and learning from them.

Lacking an overarching method for guiding the process of antidepressant withdrawal is often the main reason why people’s attempts at antidepressant withdrawal fail. Because of this, I would recommend antidepressant withdrawal only with the aid of someone who has had success in helping others through withdrawal. I have had patients who came to me after being taken off antidepressants, by those who lack experience with antidepressant withdrawal.  They were told to lower the medication dosages “slowly.” Without true healing, such an approach often lead to a relapse, within a few months of stopping the medication.

Having said that, however, it is important to withdraw slowly (occasionally, energy healing allows a more rapid reduction). Compounding pharmacies are often necessary to help create liquid suspensions of medications that allow for gradual dosage reductions that are much smaller than available dosage forms. Typically, the time for lowering the medication is when the “functional dosage”—the way the medication dosage supports mental function– is being experienced as being slightly higher than needed. This mental state is usually accompanied by early and mild side effects from the medication, i.e. increased vivid dreams, increased gastric activity, or apathy. Lowering the medication at such a point will lead to a normalization of function, rather than a state of deficiency. The faster the healing process, the faster the pace of antidepressant withdrawal that may be required.

B. Underlying Illness & Medication Dependency

Even the most successful medication withdrawal, however, will only treat half the problem: medication dependency. Quite often, the forgotten half of withdrawal is the underlying illness. Only treatment that simultaneously heals both the underlying illness that led to depression and anxiety, as well as medication dependency, will lead to stable mental health after cessation of medications. Therefore, even with successful medication withdrawal, one may be left with the initial condition that led to medication use, plus the intervening years of progressive worsening of unhealed underlying causes. In short, just tweaking a few neurotransmitters will not accomplish the job.

When addressing psychological traumas and negative mental habits that led to the initial symptoms of depression and anxiety, it is imperative that patients heal their psychological issues at the subconscious level. To do so, they first need to gain insight into what those issues were, and then apply energy medicine techniques to help heal those problems. Emotional Freedom Technique, (EFT www.EFTuniverse.com), and other acupressure techniques are a quick and effective way to heal traumas.

To heal the underlying physiological imbalances that had led to the initial symptoms, a general blend of supportive nutritional supplements are critical. The diet may need to be cleared of foods that cause hypersensitivity reactions. General nutritional areas that often need to be supported through orthomolecular means are: vitamins, minerals, essential fatty acids, amino acids, antioxidants, gastrointestinal support, and detoxification. The higher the absorbability of the supplement, the less one will need to get the job done. So, absorption is the key to choosing high quality nutritional supplements, rather than dosage. If underlying infections such as Epstein Barr Virus, Staph or Strep, H. Pylori, viral hepatitis, Lyme or its co-infections are undermining one’s health, they need to be treated.

C. Antidepressant Psychopharmacology & Biochemical Support

To address medication dependency, the first thing to do is: know your medicationIt is important to know how the medication helps and how it hurts the person, when trying to withdraw from it. Open up a PDR or look online to really know the medication’s psychopharmacology and its unique functions in the body. Two important areas to know for navigating withdrawal are: 1) which receptors are blocked or activated by this medication? And 2) which nutrients are affected by this medication?  When withdrawing from a medication, everything that the medication suppresses will become elevated, and everything that it elevates will become depressed—unless you do something to ameliorate that condition beforehand.

To prevent the imbalance that will ensue upon lowering an antidepressant medication, one must anticipate what will happen during the taper process. There are different types of antidepressants. The most commonly used ones are SSRIs (Selective Serotonin Reuptake Inhibitors) such as Prozac, Zoloft, Celexa, Paxil, and Lexapro and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) such as Effexor and Cymbalta. Tricyclics are seldom used nowadays. For those that elevate specific neurotransmitters, it is helpful to use supplements that facilitate the production of these neurotransmitters, beforeattempting to lower them. If the medication is first lowered and the person has low levels of the corresponding neurotransmitters, adding supplements after a taper has already taken place may not allow for normal levels to be restored quickly enough, and withdrawal will ensue upon lowering the medication. There are companies devoted to the nutritional support of creating neurotransmitters such as Sanesco and Neuroscience.  They have combined amino acids with other co-factors in a simple capsule to help patients build neurotransmitters naturally, which allows withdrawal to occur with much greater ease.

Beyond neurotransmitter support, there is a need for immune and hormone system support. For, antidepressants have an effect on hormones and the immune system. All medications are like two sided coins. They have a beneficial side and a toxic side. Antidepressant medications are beneficial, because they have, among their many side effects, some side effects that help lessen depression and anxiety. They are toxic, because they have been patented by a pharmaceutical company, which means they are unique molecules that are no longer a food item that the body will recognize. If the body does not recognize it as food, it is a foreign object, a xenobiotic and perceived by the body as foreign, treated as a toxin, and therefore, must be eliminated—both through detoxification pathways and through inflammatory pathways. (This is why, if a person’s body is already overwhelmed by too many foreign products, i.e. heavy metals, herbicides, or pesticides, the toxic aspect of medications will be poorly managed, and more side effects will ensue upon taking the medication. If a person has a healthy detoxification system, then the toxic aspects of a medication can be handled easily and effortlessly.

As medication levels get lower, its beneficial and helpful side effects diminish in a linear fashion, based on the dosage, but its allergenic effects–stress for the body–does not diminish proportionally. Compare this to what we know about vaccines. Vaccines contain small amounts of stimulus, antigens, but they can produce a powerful immune cascade. In a similar way, even a small amount of medication can cause a strong immune response—not the kind that causes hives, but like the kind that occurs with a kidney transplant. As withdrawal progresses, the imbalance between benefits and the inflammatory reaction will make the withdrawal gradually more difficult, unless you anticipate it and treat it. I have found Opsin II (Professional and Complementary Health Formulas) to be helpful in reducing the histamine response generated by medications, allowing for an easier withdrawal process.

With regard to hormonal support, I differ from other orthomolecular physicians in that I often use pineal gland support. My clinical experience has shown that pineal gland (Deseret Biologicals) eases withdrawal significantly. Patients tend to have better sleep, appetite, and lower stress levels when given this hormonal support.

Conclusion

At this point, you may have read more than you ever wished to know about antidepressant withdrawal, or you may feel like this article is more like an appetizer than the main course you had hoped it would be. You may also have the distinct impression that it may not be safe for you to attempt to do this on your own. However, by reading this article, you have the advantage of knowing more than I ever did, when I began my journey as a holistic psychiatrist. Through ten years of psychiatric training, the only useful piece of advice I remember receiving from my psychiatry mentors about medication withdrawal was to “do it slowly.” Three words on a topic that meant everything to my patients. Unfortunately, these three words may still encompass what many traditional psychiatrists know about antidepressant withdrawal, since their goal has not been to take patients off medications, but to put them on one. May these clinical pearls help you towards achieving a safe journey through your withdrawal process. 

Alice W. Lee, MD, ABIHM