Antidepressant medications. I work with them every day.
As a social worker (and psychotherapist), I work closely with medical and psychiatric providers to provide the best care to the patients I work with. This means addressing the whole person. In social work, we call this the biopsychosocial approach. Bio meaning physical health and neurochemistry, psycho meaning patterns of thought, trauma, and all things psychotherapy, and social corresponding to environment. It’s nearly impossible to help someone manage their symptoms of trauma when they are facing homelessness and food insecurity.
It all goes together (hopefully) for the good.
In this work, I do my fair share of research and psychoeducation on psychotropic medications for aiding in the management of mental health symptoms. Psychotropic medications refer to a class of medications specifically designed and used to treat mental health concerns. This includes, but is not limited to, mood stabilizers, stimulants, antipsychotics, anxiolytics, and a plethora of antidepressant medications.
I am a firm believer in psychiatry when needed.
I have seen the life-changing difference it has made for individuals who are chronically depressed or suicidal, those struggling with mania and labile moods, those suffering from psychotic symptoms, and the miraculous difference it can make when hormonal shifts occur, as in the case of perinatal and postpartum mood disorders.
I will save you from my soap-box speech on the overuse of psychiatric medications (particularly benzodiazepines), and sole reliance on medications for the management of mental health struggles. Medication can be an excellent tool and has been proven to be most effective in treating mental illness when combined with psychotherapy, exercise, increased social support, and spirituality.
Antidepressants have played a starring role in my life for 15 years.
I first was placed on a selective serotonin reuptake inhibitor (SSRI) when I was 16. This class of medication is the most commonly prescribed for treating anxiety and depression. It includes things like Zoloft, Prozac, Paxil, Lexapro, and a litany of others.
I was on Zoloft throughout college and it seemed to help. I began the medication because I was struggling with significant symptoms of depression and suicidal ideation. The medication seemed to lift my depression and certainly ended the suicidal ideation I was feeling at the time.
Throughout college, I stayed on Zoloft. I simultaneously developed an eating disorder. I kept raising the medication dosage because it was seemingly ineffective. Knowing what I know now, I don’t think it would have mattered the dose or the medication I was on at the time, because the eating disorder would have washed out any benefit of the medication. Psychiatric medications work by binding to protein in the brain. I was mal-nourished and washing out every bit of protein that was entering my system. No wonder it wasn’t working...
After college until age 25, I tried several medications. I was still struggling with depression and still in the throes of bulimia. And then, it changed...
I started seeing an excellent psychiatrist. In our first meeting, he told me about the importance of protein binding for medication to be effective. Essentially, if I wanted any of these medications to work, I was going to have to stop bingeing and purging. This was October 22, 2014. The process of stopping eating disordered behaviors was not easy and was several years in the making through treatment and therapy.
I started taking two medications at that time and finally stopped engaging in bulimic behavior. One was an SSRI, and the other was an SNRI, which works selectively on the neurotransmitter norepinephrine. The SNRI was a game-changer for me. For the first time in a decade, I felt like a “normal” person. I felt the fog of depression and crippling self-loathing lift. There was still an enormous amount of personal work to be done, but it was incredible to experience reprieve for the first time in years.
Over the next six years, I maintained my recovery from the eating disorder. The medication doses changed slightly, but I had found a great combination. I felt free from the shackles of depression, and I got to work. Deep work.
Over the last six years, I have spent a lot of time learning about my body, about the importance of food and nutrition in mental health (mostly making sure we are all eating enough), moving in ways that feel good, going deeper in therapy, and implementing evidence-based practices for improving my mental health daily. These are things like mindfulness, gratitude, use of the senses for grounding and self-soothing, social connection, and use of self-compassion practices.
Internally, I changed a lot. I still, however, held onto a huge fear; depression.
Depression felt like a silent and lonely battle for so much of my adult life. I was terrified of the possibility of becoming depressed again. Medication had been such a game-changer for me that I feared how I would be without it. I knew that if I wanted to find out, I was going to have to be smart, intentional, and open in seeking support.
I started the conversation about getting off of medication with my psychiatrist two years ago. I was also taking a proton pump inhibitor (PPI) for severe GERD from a hiatal hernia and damage from bulimia. PPIs are not ideal for long-term use and often lead to gut issues and mal-absorption of nutrients from our food.
After learning that we have more serotonin receptors in our gut than we do in our brain, I realized the PPI had to go. If I wanted to get as healthy as I could, I was going to have to do some work around repairing my digestive system. I tapered off the PPI around the same time as the SNRI. I felt really good after both were out of my system, and I was content. I was still taking an SSRI and felt great on it.
I knew it was time to continue moving forward. I’m of an “if it ain’t broke, don’t fix it” mentality for most things, but I knew to continue to taper off of medication was the next right step for me. I was still afraid.
I also knew that this process was beyond me. I had to let go of control if this was going to work. I did something that my ego and control issues had prevented me from doing for some time.
I asked God to see me through this process. I began spending time with God more and more than I had in years...maybe ever.
I slowly tapered off of the SSRI. For the first time in 15 years, I was medication-free. I could hardly believe it!
After 15 years of being on antidepressant medications, I had completely weaned off, and it’s been such an experience of grace.
I consider myself fortunate. I also don't believe that mental illness is something we can simply "pray away". Our chemistry is unique and there is no one-size-fits-all solution. Some of us may have the strongest faith in the world and require medication to help our chemistry remain balanced. Medication is a tool and not an indication of weakness or lack of spiritual strength.
Some physiological changes happened; increased appetite (not a bad thing), dizziness, headaches, and fatigue. There was a bit more irritability internally than I was used to, but there was no depression.
To me, it was a miracle.
Medication provided me a life-line at a time when I desperately needed it. It got me out of deep depression and played a major role as I healed from an eating disorder. I don’t think this would have worked as well had I tried it a few years ago. So much of this process came down to timing, where I was in my healing journey, seeking incredible support and being transparent in every step of the way with my partner and family, making sure I was taking care of my movement and eating, and giving up my fears and my desire to control the situation to my higher power.
I am also open. I work with women every week who are struggling with perinatal mood disorders or post-partum issues. Hormonal shifts are real, and I am open to the possibility that there may come a time in life where medication may be needed.
I will cross that bridge when I come to it. For now, I am grateful for this experience and how empowering it has been. It is not right for everyone, nor would I advocate it for everyone.
If you are considering getting off of medication, here are a few things I would highly encourage:
Work closely with your doctor/psychiatrist to TAPER off of medication. Going cold turkey is NEVER a good idea. Our brain does adjust, but the tapering is how it adjusts best.
Tell a partner, a trusted friend, family member, or therapist when you are preparing to taper. Having someone to check in with is incredibly helpful.
Whenever we take something away, we must build something in. Add in some practices to help with your mood. This can be movement, spiritual practices, therapy, writing, music, gratitude, daily check-ins with someone you care about, or a combo of them all.
Be honest with yourself. If you are noticing symptoms re-emerge, it’s okay. It’s okay to stay on the medication, go slower, or hold off on weaning.
Make sure you are eating enough! Our brain needs the equivalent of 3 cups of spaghetti in carbs each day for serotonin (mood neurotransmitter) production. There’s a reason why carbs make us happy...
Limit alcohol intake. It’s a depressant and feels good at the moment, but leaves us feeling more down the next day.
Care for yourself like you would a child. Rest, play, and be gentle.
As always, work with a professional for support. Don’t go it alone. Seeking support from a licensed mental health professional is a sign of strength and courage. It is never a weakness.