Last year I went on an antidepressant. This year I’ve come off it. I’ve done this before, but I learned new things this time. Here are some of them.

background and facts

Prior experience: Prozac (fluoxetine) 20mg 2014-2019. This year:

• Feb-Apr 2023: Lexapro (escitalopram) 5mg then 10mg (I think)
• May-Jun 2023: Wellbutrin (bupropion) 150mg
• Jul 2023-Feb 2024: Effexor (venlafaxine) 75mg

they’re supposed to noticeably do something

SSRIs/SNRIs do something! They’re supposed to be noticeable! If they’re not noticeable, don’t bother!

I took Prozac for 5 years despite it basically doing nothing for me. If I squinted and ignored the placebo effect, I’d say, I don’t know, maybe it took me from a 3/10 to 4/10. Lexapro and Wellbutrin had the same effect. Nobody wants to promise you the moon, so I figured, well, it’s probably low-level working, maybe this is the best you can get.

But luckily, I kept trying. Effexor did something! It almost did too much; the first couple days I felt jittery, like I’d had too much coffee. But man, then it gave me a boost of like 3 points, from 3/10 to 6/10. Enough energy that I could get through each day. A little blunting - I felt a little like a robot - but better than ragedespairing.

“spin the wheel” is state of the art

I joke about the “wheel of antidepressants.” Spin the wheel, try whichever one it lands on. This is the best we’ve got.¹ I guess Lexapro/escitalopram is a common first choice because it doesn’t tend to have bad side effects. Wellbutrin goes in another direction (it works on dopamine and norepinephrine instead of serotonin) so that’s why it’s often tried next. Prozac has a longer half-life than Lexapro. Effexor is an SNRI (norepinephrine and serotonin, not just serotonin) so that might be different too. But then, I know people for whom Lexapro doesn’t work but Zoloft/sertraline does, and they’re both “just SSRIs”. So who knows.

natural remedies might work instead of SSRIs or they might not

If you talk to hippie California types, they’ll say “you’re considering SSRIs? why not microdose mushrooms, or take kanna instead?” Well I… have a close friend who tried those, and they didn’t work. By all means give them a shot, but as with the previous point, who knows.

getting off is difficult!

Nobody told me this before I started, but Effexor is among the more difficult antidepressants to taper off of! Took me a while, anyway. I kinda wish I’d known that beforehand!

why are you snickering? oh yeah, well… that’s true too. not terribly, but noticeably :-/

you can split the pills

My psychiatrist said “well, when you’re at 37.5mg, that’s the smallest pill they make, so the next step is just to stop taking them.” That was hard for me. But the pills are little capsules, you can just open them and subdivide them with a milligram scale and some pill capsules. You can make 18mg or 9mg pills. I wish she had told me that too.

I eventually did 37mg for a couple weeks, then 18mg for a couple weeks, 9mg for a couple weeks, then 0. Going to 37 and 18 was effortless, going to 9 was kinda hard, going to 0 was kinda hard. A new feeling was “brain zaps” - not actually that bad but a little weird!

your psychiatrist might not share your goals

I wanted to get on an antidepressant for a period of months, to get me through the hardest time of baby raising. (My reasons aren’t the kind of thing I want to blog about, ask me sometime. But they’re not the dumb macho “I want to do it myself.") My goal doesn’t have to be your goal, and you should probably stay open to all possibilities regardless of your goal.

My psychiatrist didn’t see things that way; she saw no reason for me to get off. In fact, she wanted me to try a higher dose to see if it helped more. It is good to remember that your psychiatrist is looking at your case through a proverbial keyhole; you inhabit this brain 720 hours a month, they see you for maybe 0.5.

Your psychiatrist also probably doesn’t want you experimenting at all (e.g. reducing your dose before talking with them). So… not saying you should, but if you do, maybe don’t tell them; just present yourself as a very good rule follower.

(Hopefully it goes without saying to tread with care, though. Like, make sure you have other people checking on you who can tell if you’re going off the rails one way or another; you can’t always tell from the inside.)

this might mess up your life insurance

I was trying to apply for life insurance in the middle of this, and got denied. Weird; I have basically no other health concerns. Snooping around r/lifeinsurance, some people suggested that multiple prescriptions for depression meds might raise red flags. So, I don’t know, feeling ok is more important than life insurance, but just FYI.