My general practitioner asked what Sucralfate was after I’d finished rattling off my prescriptive party mix during our first appointment. I was 22 and a recent Manhattan transplant. I had an apartment in Murray Hill and a job waiting tables at a local Italian restaurant.
“It’s for something called bile reflux disease,” I said. “I used to randomly puke up bile all the time.”
“Huh. Never heard of it.” He ripped off a completed prescription slip and scribbled across the new blank page.
“You should really get the prescription for antidepressants from a psychiatrist, but I’ll give it to you along with all the rest since you’ve been on it for so long. And whenever you come back, maybe we should do a physical.”
At the time, it never occurred to me that my medication needed monitoring or that perhaps my doctor should do a physical before sending me to the pharmacy. Not only was this five-minute exchange routine, but at no point during my years in the American mental health system did a psychiatrist, psychologist, doctor or pharmacist suggest that I consider reevaluating the decision to take antidepressants. Therefore, I believed that my only choices were to cope with depression or cope with antidepressants, and that depression would always thump inside me with the regularity of my own pulse.
At age 30, I found myself hanging halfway out my Manhattan high-rise window, calculating the time it would take to hit the ground. Still depressed despite my antidepressants — possibly caused by the possible decrease in antidepressants’ efficacy over time or because I’d never properly dealt with loss and trauma — I regularly considered suicide. As I looked for breaks in the pedestrian traffic patterns, a thought dawned on me: I’ve spent half my life — and my entire adult life — on antidepressants. Who might I be without them?
The suicidal gears in my mind came to a screeching halt.
I pulled myself back inside my apartment, scheduled an appointment with a new psychiatrist and made the decision to get off all the drugs before deciding whether to take my life. I needed to figure out my true baseline. If I didn’t like what I found, well, the window was always open.
Flash forward to today, 3½ years since I took my last antidepressant. I’m all right. Deeply, honestly, joyfully, all right.
I followed my psychiatrist’s advice and went off one drug at a time, beginning with Effexor XR. I was on the lowest dose available — just 37.5 mg per day — so I had no choice but to stop taking the Effexor, cold turkey. Within 24 hours of missing my usual dose, flulike symptoms set in and my emotions went into overdrive; so in between the sweats and the shakes, I resisted the urge to saw off my skin with a box cutter just to get away from myself.
After six days without the drug in my system, my mind began to flood with bloody, homicidal visions. I was too scared to tell my psychiatrist what was flashing through my mind because I feared that she would deem me a danger to myself or others and put me on an involuntary, psychiatric hold.
I called an old family friend, a psychologist who lived across the country. She assured me that I wasn’t going to hurt anyone, but I still didn’t trust myself not to snap. So I locked myself in my apartment for a week.
The visions eventually lifted and were replaced by an intolerable sensitivity to light and sound. I tore the clothes off my back when shirts I’d worn for years suddenly became unbearably itchy. Then, I bent a metal ironing board in half out of rage.
I am not alone in this experience. In one New Zealand study of 180 long-term antidepressant users, 73 percent of participants reported withdrawal effects, with 33 percent reporting their effects as severe. Even several clinical trials aimed at discontinuing long-term antidepressant prescriptions “failed to successfully withdraw a majority of patients from the drugs despite slow and gradual tapers,” according to a 2019 article on antidepressant withdrawal published in Epidemiology and Psychiatric Sciences.
For many people, antidepressants can be literal lifesavers. But not everyone wants to stay on them indefinitely, and herein lies the problem: There are few accounts about what it’s like to get off and stay off these drugs. For good.
The American Psychological Association reports that 12.7 percent of the American population is on antidepressants. One analysis found that nearly 15.5 million people have taken antidepressants for more than five years.
The conversation is beginning to shift about the efficacy of long-term antidepressant use, with articles in the Wall Street Journal and New York Times discussing questions that have long been neglected. But I think an important aspect of the issue remains overlooked: the importance of hope and role models.
I’ve spent the past 3½ unmedicated years wandering back through time, trying to untangle the decisions that led me to calculating the rate of a falling object from my windowsill. I began speaking publicly on the topic in an effort to organize my thoughts and break the shame I felt for letting my 20s slip away into a depressed, robotic haze.
When audience members approached me and told me that I gave them hope for their sons, their daughters, for themselves, I initially brushed these declarations off as niceties given to anyone who stands onstage and bares part of their soul. But as I reach a broader audience, my inbox is filled with messages from strangers specifically asking how I got off antidepressants.
This strikes me as odd. I’m not a medical professional. My bachelor’s degree is in history. I spent most of my career making $7.25 an hour in sweaty Manhattan kitchens, and there’s little I can offer others than to wish them well and send them links to a few books that helped me.
And the people who tend to contact me are not without other resources.
Among the strangers who have reached out to me in the past year: a Google executive, an American Airlines pilot, an audiologist, a physician assistant, a wealthy software developer and more than a few veterans.
They tell me that they’ve taken the drugs, talked to the doctors, practiced yoga, changed their diet and filled out the gratitude journals. And yet, they’re still depressed. What are they missing?
“Objectivity is what makes therapists so effective,” says J.P. Crum, a Reno, Nev., psychologist, “but it also comes with a loss of power. When patients can talk with other people who have had the same experience, who know what it’s like, that can sometimes be even more powerful and effective than what a psychologist or psychiatrist can do.”
The people who reach out to me are looking for hope. Hope that they can escape what’s been presented to them as a choice between depression or antidepressants. They want to rewrite their own personal stories, they want role models for how to do that, and few are available.
“The lack of research into patients who have recovered from depression is a great puzzle to me,” says Jonathan Rottenberg, professor of psychology at the University of South Florida. “The fields of psychology, psychiatry, epidemiology, and public health focus on the causes of people doing poorly — having more depression and more symptoms — rather than the causes of people doing well. We need to flip that paradigm.”
But hope, much like depression itself, can’t be measured in a lab. So what role does it play in the brain?
“Neurotransmitters are activated by more than just medicine,” Crum says. “If you eat something you like, chocolate for example, dopamine spikes. It’s a pleasurable activity that has nothing to do with medication. Having hope, being inspired, being encouraged — that’s a pleasurable state. There’s a chemical change because you feel different.”
Fidel Vila-Rodriguez, a clinician-scientist at the University of British Columbia, says he observes the effects of hope in his research on the neurobiology of mental disorders.
“Before the clinical trial begins,” he says, “patients report all these symptoms. Three days later, when they’ve officially entered the clinical trial but we haven’t begun any treatment, they tell us that they’re doing better. It’s because they have hope. We [as researchers] have done nothing. There are variables — nonmedication and nontreatment factors — that contribute to people feeling better. Hope is one of them.”
Had I been shown a role model for hope and a life without antidepressants early on, would I have spent so many years struggling to cope? I can’t ever know the answer. That’s part of what was taken from me.
But what I do know is that we rarely speak about depression as a temporary human experience.
So let me introduce myself:
My name is Brooke Siem. I am 33 years old. I spent nearly 15 years on antidepressants. As of today, it’s been 1,368 days without them.
And I’m all right.