Therapy Helps With The Emotional Side Of Getting Off Antidepressants or Anti-anxiety Medications
In our NYC therapy practice, patients sometimes come to us who are considering getting off antidepressants or anti-anxiety medications, or have decided to stop taking medication. We’re not psychiatrists, medical doctors or otherwise psychopharmacologists. If you want to take antidepressants or anti-anxiety medications, or make changes with these meds, including getting off of them, that process must be done in consultation with a qualified medical doctor. We work with a few, and we would be happy to work with yours. What we do offer, however, is the emotional and developmental side of the process, alongside assisting with decision-making.
The Controversial History Of Psychiatric Medications Often Leaves Patients Concerned and Confused
Psychiatric medications have a long and controversial history. Many didn’t work, while others worked but at such a detriment to a patient’s quality of life as to be harmful. Others came with side effects that were seen to be a necessary evil given how few options existed to manage what were often dangerous or debilitating psychiatric symptoms. Prozac wasn’t the first antidepressant, but it was the first seen to be broadly effective and the first in a class of broadly marketed antidepressants that include Zoloft, Lexapro, Paxil and many more SSRI’s. More recently, newer classes of meds have emerged. SSRI’s and some of the newer medications are frontline treatments for depression, but also anxiety (therefore the label “antidepressant” is a bit of a misnomer). These medications have become so common that they are almost ubiquitous and are often prescribed not by psychiatrists, but by primary care doctors. This also reflects the general (though not universal) sense of how safe they are.
It’s important to not understate the degree of controversy about both these meds’ efficacy and their safety. Serious people on both sides of the issue have raised serious concerns. Some believe psychiatric medications are clearly effective, while others see little evidence. Mainstream psychiatry and much of mainstream medicine believe these drugs are both safe and helpful, but a number of studies have questioned both.
This leaves many individuals concerned and confused–both about taking these medications to begin with, as well as the question of how long to remain on them. Patients regularly speak to us about concerns about long-term use, including side effects and a sense that their personality or way of relating to the world has changed, blunted or muted. It is, of course, a challenging problem.
When Deciding Whether To Get Off Antidepressants, We Support Patients Through Their Concerns Rather Than Impose Our Opinions
Our position on medications isn’t simple and we believe it shouldn’t be. We do believe strongly that at least some of the time medication is helpful–often very helpful–and at times, essential. We also feel its efficacy is often overstated. We are certainly concerned about the safety of medications and are skeptical that they are as safe as their manufacturers and the doctors who prescribe them often insist they are.
We also believe our place isn’t to impose a given point of view about whether psychiatric medications are good or bad, or whether they’re right or wrong for a given patient. What we do–and what we do best with any issue–is get to know the patient’s point of view. Then, we help articulate a process of investigation, of empirical discovery, and to look, perhaps, philosophically at their experiences, fears and concerns.
Decided To Get Off Antidepressants Or Anti-anxiety Meds? You May Need Help In Your Relationship With The Prescriber
After the decision has been made to get off antidepressants or anti-anxiety medications, you may need help in your relationship with the prescriber. There may be resistance from the provider, often intense, to making the change. Doctors see a benefit from the medication and don’t want patients to make a change that might cause them to suffer.
We help our patients have empowered conversations with their doctor (as we do in many parts of their lives). There’s a delicate balance to strike here: respecting the doctor’s concerns and recognizing that, in many cases, those concerns are part of their job, while helping patients take charge and see themselves as the ultimate decision makers in their medical care. In some instances, we hit an impasse–a provider is uncooperative with making a change. In those cases, we need to find another provider who can manage the process. We don’t want anyone to go it alone in trying to get off meds and we aren’t qualified to manage the medical aspects of making this change.
In Therapy, We Focus On Practical Emotional Skills With An Eye On Symptoms To Help Patients Feel Good Without Meds
Of course, the biggest issue for patients is the question: what tools, skills, resolve in my emotional burdens, and growth do I need in order to be strong and feel good without meds? That’s therapy–that’s what we do. Here’s the great news: Much of the time that we support someone getting off meds, we’ve worked with them for some time and it turns out they’re further along than they realized. Often it can be hard to see our own growth. Part of our job as therapists is to help with just that. We also help patients think about what sorts of objectives they may want to meet before scaling back, whether getting out of a bad relationship, job or friendship, having that long overdue conversation with a sister, paying down debt or getting savings to a better place.
There are some special considerations in therapy with those who are considering getting off meds. In particular, there may need to be a focus on some practical emotional skills and an extra eye kept on symptoms so we can spot them if they creep in. Starting with the latter, if a patient has a history of depression, for example, we think back and ask: What kinds of behaviors can lead to a move into a dark place? What are some early signs that is happening? We, then, consider what sorts of practical skills we can focus on, add or iterate to help if those symptoms do come back. At times, as well, we’ll look at what additional things we may want to add in a period of cutting back and stopping a medication. Do we want to double up on the therapy? Double down on meditation? Add or increase exercise, recovery or groups?
