I’m Taking So Many Meds! What Can I Stop? Part One: Antidepressants

Although many new patients arrive at WholeHealth Chicago with chronic symptoms and a history of no help elsewhere (“You’re my 12th doctor.”). Others pour out a bagful of medications with a mournful, “I’ve got to get off of some of these!”.

Going off a bevy of psych meds is a popular request, especially when the patient has perceived a side effect like weight gain or personality change. The antidepressants (Prozac, Celexa, Lexapro, many others) are currently being used by approximately 10% of the American population with 60% of these being on them 2 years or more. These numbers are about the same throughout Europe, especially in the North.

When you go to your health care provider with symptoms of depression, she may begin by referring you to a mental health counselor for cognitive behavioral therapy (CBT) or CBT plus an antidepressant. These act by changing brain chemistry, especially serotonin, helping you deal with your episode of depression. If your depression is serious, then you’ll hopefully find yourself under the care of a good psychiatrist.

If that episode of depression was mild, and you’re now feeling pretty good and can look back on your period of sadness having learned something, there’s usually no reason to stay on your medication for long-term treatment.

There’s a big “however” here and no time for sweeping generalities. Some people are biochemically depression-prone and weeks to months after stopping their antidepressant medication actually feel the dark cloud of depression returning. Sometimes they’ll recall feeling this way as a teenager and self-treated by binge-eating or cutting themselves or in their 20’s when they needed a few months of Prozac. These patients likely need a maintenance antidepressant.

Antidepressant use skyrocketed during the pandemic which caused all sorts of stuff to resurface and now 332 million antidepressant prescriptions are filled annually, from childhood to the elderly.

So the problem is this:

In most cases of mild depression, Cognitive Behavioral Therapy (or CBT + St. John’s Wort (SJW) works as well as an antidepressant, especially if you add sunlight, exercise and the right vitamins. Patients are usually a bit skittish about starting an antidepressant but once antidepressants take effect (a month or so) patients are equally reluctant to stop them, fearful their depression might return.

Primary care physicians are equally skittish about stopping antidepressants, fearful about triggering a major depressive episode (MDE). This rarely happens if the med is tapered. Insurance companies love you to be on antidepressants and would be perfectly happy if you renewed your prescription for the rest of your incarnation. One year of sertraline (the #1 antidepressant) is $56, much less expensive than weekly visits to a therapist.

Another problem that occurs in that bagful of meds I referred to at the beginning is that psych meds are “stacked”. This means two or more antidepressants, two or more anti-anxiety meds, something for drowsiness (a side effect), something for sleep. And then: the patient moves to another city and can’t find anyone to renew her meds OR her psychiatrist retires OR her insurance companies drop coverage for meds that have worked and insist she use other meds she knows haven’t worked. All sorts of unpleasant possibilities.

One day you might announce to yourself, “I have been feeling emotionally good for a long time but also stressing out about these meds for a long time. I’m not sure exactly what my personality is, but I do know I’ve gained ten pounds a year on these meds.

For those patients motivated to reduce their medications, I would suggest an appointment with any of our practitioners and at the same time alerting whoever is your medication prescriber that you’d like to try a trimming of your psych meds. If you have a history of severe depression (hospitalization, suicide attempts), I do not at all recommend a program to lower your meds without the blessing of your psychiatrist.

We’ll measure levels of vitamins, minerals, amino acids, essential fatty acids and determine how well you are digesting and absorbing food. You’ll work with our team including Nurse Practitioners, Physician Assistants, Nutritionists, Counselors, as well as our Naturopaths. If your meds have made you seriously overweight, we’ll consider semaglutides (Trulicity, Ozempic, generics, etc.) and hormones (thyroid, bioidentical sex hormones) to work on this as well.

Be well,
David Edelberg, MD