Psychoactive medication is stigmatized in our culture, but mental illness is slowly coming to the forefront as equivalent in importance to physical illness. It’s now finally being recognized that medication can be necessary for the management of both physical and mental conditions. Recently I’ve been reflecting on my own journey with Cognitive Behavioural Therapy (CBT) and antidepressants, and decided to try coming off of my medication.
Week 1: No noticeable change in mood, no unusual physical sensations.
I was prescribed Venlafaxine four years ago to help minimize symptoms of depression and Borderline Personality Disorder (BPD). My experience with BPD involved unstable relationships, fluctuating emotions and a deep fear of abandonment. I’d be swept in the crest of tidal sadness, anger and anxiety, making impulsive gestures to keep people close to me. I recall, with great shame, incessant calls to loved ones, screams so loud the neighbours could hear, and other public displays of my anxieties. Those tidal waves still come and pass, only now I’ve learned how to ride them out a bit more smoothly.
“I’d be swept in the crest of tidal sadness, anger and anxiety, making impulsive gestures to keep people close to me.”
Over five years of non-linear progress with therapy, the supplemental medication helped stabilize my fluctuating moods. Antidepressants can save lives and are often foundational to recovery — some patients are encouraged to take them consistently as essential lifelong support. It’s not uncommon to stop a prescription and later return to it, or to change the medication/dosage prescribed.
Week 2: Extreme restlessness. Even when exhausted, I have a lot of difficulty falling asleep. Increased anxiety — is this normal?
Venlafaxine is an antidepressant that works by increasing levels of serotonin (a neurotransmitter contributing to feelings of happiness and well-being) in the brain. I know this because Google tells me so.
Unfortunately, I don’t recall the psychiatrist giving me information on how the medication works or its potential side-effects at the time of initial prescription. Only recently was I enlightened by a book that I borrowed from the library. This book, followed by some online research and a chat with my therapist, informed me that many antidepressant medications are extremely difficult to come off of and may increase the risk of suicidal ideation. This seemed altogether counterintuitive and, frankly, it scared me that I hadn’t been made aware of this information prior to taking the prescription.
Week 3: Taking melatonin to help with sleeping. It’s mostly working, but the exhaustion is making me a bit more irritable.
Although Venlafaxine was an integral part of my BPD’s treatment, I’ve been reflecting carefully on what I put into my body and its role in my well-being. Through this, I came to understand that antidepressants helped me during a very dire time of my life, but that I no longer need them since developing resilience and skills through the work I’ve done in therapy.
So, I made the decision to come off of the medication. It wasn’t sudden, I considered it for a while. First, I talked to my therapist, then my doctor, who offered me a strategy: the first week, I was to take a pill every other day, the following week a pill every three days and so on. Worst case? I don’t feel good and can go back to a regular dose.
Week 4: Feeling more energetic and positive. Experiencing lightheadedness. I called the pharmacist, who assured me that all of these symptoms are uncomfortable, but typical of the body’s transition off of Venlafaxine.
I’m currently going into week five and despite the unpleasant physical sensations, I feel driven and happy to be taking steps to care for and challenge myself in a way that feels conducive to my well-being. Simultaneously, I’m using the tools I’ve gained from therapy: recently I took my dog for a walk in Toronto’s first snowfall. Today I’m writing this essay. Tonight I’m volunteering with some coworkers at a Spelling Bee for charity. Tomorrow I’m meeting with my therapist and making glogg for a family dinner (it’s mulled wine but I’m calling it glogg because it’s fun and I love anything Norwegian). These small activities help me feel connected— a tool in CBT called “pleasant events” or “behavioural activation,” which focuses on how behaviours influence emotion. I’ve found that certain simple activities help alleviate depressive flare-ups.
BPD has been a very isolating experience. In the years when mental illness swooped me up with its ugly claws, medication helped regulate my brain’s responses to stressors. There were still intense lows but, over time, I learned to cope. Progress is not fixed or linear; it’s imperfect and it looks different from case to case. I still have a lot of headway to make in my own journey of growth and recovery, but I feel good about taking this step.