{"id":895341,"date":"2026-03-29T07:23:32","date_gmt":"2026-03-29T12:23:32","guid":{"rendered":"https:\/\/newsycanuse.com\/index.php\/2026\/03\/29\/the-honest-conversation-about-antidepressants-i-wish-my-psychiatrist-had-with-me\/"},"modified":"2026-03-29T07:23:32","modified_gmt":"2026-03-29T12:23:32","slug":"the-honest-conversation-about-antidepressants-i-wish-my-psychiatrist-had-with-me","status":"publish","type":"post","link":"https:\/\/newsycanuse.com\/index.php\/2026\/03\/29\/the-honest-conversation-about-antidepressants-i-wish-my-psychiatrist-had-with-me\/","title":{"rendered":"The honest conversation about antidepressants I wish my psychiatrist had with me"},"content":{"rendered":"
\n

If you\u2019ve been taking antidepressants or anti-anxiety medications for years, you might have certain questions. Do you still need the medication? How would you know if you didn\u2019t? Does it make sense to stay on it indefinitely, or do you owe it to yourself to see what life would be like without the medication?<\/p>\n

I don\u2019t believe any of us has one true self, so I don\u2019t think you can \u201cowe\u201d it to a central self to act in this way or that. Instead, I offered an alternative way of approaching this dilemma in a recent installment of my Your Mileage May Vary advice column<\/a>.<\/p>\n

But beyond the philosophical question of what you do or don\u2019t owe yourself, there are medical questions that might still gnaw at you. Some people worry, for instance, about the withdrawal symptoms<\/a> they might experience should they try to taper off selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed type of antidepressant. Others worry that perhaps they\u2019ve become dependent on a drug and are not sure how to feel about that.<\/p>\n

Since I have no medical training, I can\u2019t give medical or psychiatric advice. But one of the most interesting voices tackling these questions is Awais Aftab, a psychiatry professor at Case Western Reserve University School of Medicine. I came across him through his insightful newsletter, Psychiatry at the Margins<\/a>, and a piece he wrote for the New York Times calling for psychiatry to engage honestly<\/a> and transparently with patients\u2019 concerns about antidepressants, rather than ceding that conversation to those \u2014 like RFK Jr. and the MAHA movement<\/a> \u2014 who would exploit it for political ends.<\/p>\n

Aftab is critical of the psychiatric establishment\u2019s failings, but he doesn\u2019t throw the baby out with the bathwater; he is very aware that for some people, antidepressants can be lifesaving. I reached out to him because I knew he\u2019d have a nuanced take on all these questions \u2014 some of which have niggled at me as someone who\u2019s been taking an anti-anxiety medication for years. Our conversation, edited for length and clarity, follows.<\/p>\n

Why are so many people unsure how to think about the meaning of taking antidepressants, especially long-term? Are most psychiatrists failing us in some way? Or is ambivalence just an unavoidable feature of living at a time when medical progress keeps handing us choices that come loaded with tradeoffs?<\/strong><\/p>\n

I think it\u2019s both, honestly. Let me start with the deeper issue. Medical progress keeps giving us more and more control over aspects of our lives, such as our moods, our anxiety, our emotional reactivity, but that control is imperfect and comes with genuine tradeoffs. [The philosopher] Bill Fulford<\/a> has articulated the idea that scientific progress creates new technologies which create new choices for us, and this increasingly brings the full diversity of human values into play. More choices mean more uncertainty, more ambivalence. That\u2019s just the moral cost of living in a world where these options exist.<\/p>\n

\n

\u201cWe can choose to take antidepressants or not, continue them or stop them, but we can\u2019t choose not to have the choice. And the uncertainty is genuine.\u201d<\/p>\n<\/div>\n

We can choose to take antidepressants or not, continue them or stop them, but we can\u2019t choose not to have the choice. And the uncertainty is genuine. \u201cAre the drugs helping?\u201d \u201cDo I still need them?\u201d aren\u2019t always easy questions to answer for any specific person.<\/p>\n

That said, too few clinicians are attuned to any of this. Most psychiatrists aren\u2019t trained to explore the meaning and emotions patients assign to their medications. Patients can feel relieved by symptom improvement and simultaneously detest feeling dependent on a pill. They may credit the drug with saving their life and still wonder who they\u2019d be without it. When clinicians don\u2019t anticipate and directly address that ambivalence, patients are left to navigate it alone.<\/p>\n

The goal should neither be to nudge people toward staying on medications or encourage them to discontinue, but to support them in making decisions that align with their own priorities. That requires a kind of clinical attention most people just aren\u2019t getting.<\/p>\n

If someone says to you, \u201cLook, I\u2019ve been on these meds for years, and at this point I honestly can\u2019t tell whether they\u2019re still necessary\u201d \u2014 what would you advise them to do?<\/strong><\/p>\n

I\u2019d say: That uncertainty you\u2019re feeling is completely legitimate, and you\u2019re not alone in it. A lot of people on long-term antidepressants feel this way. What I\u2019d recommend depends on multiple factors. Their mental health history is especially relevant. Someone who\u2019s had multiple severe depressive episodes with hospitalizations has a very different risk calculus than someone who started an SSRI for mild anxiety five years ago and has been stable since. The subjective meaning matters too. Some people are at peace with taking a daily medication; for others, it gnaws at them. Some patients would rather stay on a medication and minimize any chance of relapse or deal with withdrawal; others are determined to find out whether they still need it, even if that means going through some rough patches.<\/p>\n

What I recommend to my patients is the courage to make an informed choice \u2014 to continue or taper, whatever the case may be. A lot of people stay on antidepressants because they\u2019re stuck in a kind of ambivalent inertia. Years pass while they wonder what their life would be like without the drugs, whether they\u2019d feel more brightly, think more creatively, have a more intimate sense of their own resilience.<\/p>\n

If someone wants to stop their meds, it should be done carefully, with clinical help and with a slow taper. If someone has been on SSRIs for years, a cautious taper would take several months at least. But I also want to be honest: A slow, gradual taper is not easy because it often requires using doses that are not available in standard pills available at pharmacies, which means people at times have to use liquid versions of the medications or use expensive compounding pharmacies. There is also no agreement in the psychiatric field right now about the best tapering protocols, and patients will encounter all sorts of guidance online.<\/p>\n

How common is it for people who take antidepressants for years to form either a physical dependence or a psychological dependence on them? What does each kind of dependence look like?<\/strong><\/p>\n

Physical dependence on antidepressants is a well-established phenomenon. Your body adapts to the presence of the drug, and when you stop or reduce the dose, you can experience withdrawal symptoms, like dizziness, nausea, \u201cbrain zaps\u201d (an electric shock-like sensation in the head), vertigo, irritability, insomnia, and sometimes a rebound of anxiety or mood symptoms that can be difficult to distinguish from a relapse of the original problem. Most people who have been on antidepressants for years will experience some degree of withdrawal, although severe withdrawal appears to be less common. Some people have also reported protracted withdrawal online, lasting months or even years, though this remains poorly understood.<\/p>\n

Psychological dependence is more about the anxiety of going without it. Once you\u2019ve internalized the idea that you need the pill to feel okay, it can feel almost impossible to stop. Why run the risk? Why open yourself up to withdrawal, to a possible return of depression or anxiety? This is understandable, but it can keep people on medications for years and decades more out of fear and inertia than any active choice. My view is that such psychological dependence shouldn\u2019t be ignored by clinicians and any distorted worries and fears should be addressed.<\/p>\n

One thing that confuses some people is whether it makes sense to think of this dependence in terms of \u201caddiction.\u201d Some people reason that if they experience withdrawal symptoms when going off the pills, that means they\u2019re addicted to the pills in some way. Is addiction the wrong frame when thinking about antidepressants?<\/strong><\/p>\n

Yes, addiction is the wrong frame. Addiction in the clinical sense involves compulsive use of a substance despite harmful consequences, quickly escalating doses to achieve the same effect (tolerance in the classic sense), craving, and loss of control. Antidepressants don\u2019t produce any of that. People don\u2019t crave antidepressants the way someone addicted to opioids craves opioids.<\/p>\n

What antidepressants can produce is physiological dependence. The body adapts to the drug\u2019s presence and reacts when it\u2019s removed. The confusion with addiction is understandable. If you experience withdrawal symptoms when you stop a substance, the intuitive conclusion is \u201cI must be addicted.\u201d But dependence and addiction are different phenomena medically. Many medications can produce physical dependence without being addictive.<\/p>\n

That said, I\u2019m sympathetic to why people reach for the addiction frame. When you\u2019re experiencing terrible withdrawal and you feel trapped on a medication you want to stop, the language of addiction becomes appealing and powerful. But clinically, it\u2019s not accurate, and using that becomes confusing and stigmatizing.<\/p>\n

My own psychiatrist once told me that my SSRI is not the kind of drug where it makes sense to worry about addiction. She said that instead, I should put it in the mental category of \u201cif you have high blood pressure, you take blood pressure medication.\u201d Is that a more accurate way to think about it? <\/strong><\/p>\n

Your psychiatrist is right about the core point: Antidepressants aren\u2019t addictive in the way that, say, opioids or benzodiazepines can be. Putting them in a different mental category from drugs of abuse is appropriate. But the blood pressure medication analogy is limited in its own way, and I think it can be misleading if taken too far.<\/p>\n

With most blood pressure medications, if you stop taking them, your blood pressure goes back up and possibly may even shoot up higher than what it used to be, but you don\u2019t experience a distinct withdrawal syndrome with symptoms you hadn\u2019t previously experienced. With SSRIs and other antidepressants, stopping can trigger symptoms that are distinct from a return of depression or anxiety. Like dizziness, brain zaps, nausea, electrical sensations, severe irritability. For some people, these symptoms are mild and brief. For others, they\u2019re genuinely debilitating.<\/p>\n

\n
\n

\n

Have a question you want me to answer in the next Your Mileage May Vary column?<\/strong><\/h2>\n<\/p>\n<\/div>\n

Feel free to fill out this anonymous form<\/a>! Newsletter subscribers will get my column before anyone else does, and their questions will be prioritized for future editions. Sign up here!<\/a><\/p>\n<\/div>\n

Why has the psychiatric establishment been slow to research withdrawal struggles? What would fixing the research gap require? <\/strong><\/p>\n

The failure here is multilayered. Part of it is a funding problem. Federal research funding in psychiatry has been heavily tilted toward basic neuroscience and drug development, understanding the brain, finding new molecules, at the expense of studying the everyday clinical realities of how people actually experience medications, including what happens when they try to stop. Tapering and deprescribing just aren\u2019t where the prestige or the grant money has been. Nearly four decades after the approval of Prozac, there is not a single high-quality randomized controlled trial that compares specific methods of tapering patients off antidepressants. That\u2019s a remarkable gap.<\/p>\n

Part of it is ideological. There\u2019s been a prevailing attitude in psychiatry that withdrawal is rare and mild, \u201clow on the list of priorities<\/a>,\u201d as a group of prominent psychiatrists once put it in a letter to the New York Times.<\/em> This dismissiveness has been enormously damaging. Patients who experience severe withdrawal have been told it\u2019s just their depression coming back, or that what they\u2019re experiencing isn\u2019t real. Clinicians who are trained to see medications primarily as solutions naturally have difficulty recognizing them as sources of harm.<\/p>\n

Part of it is methodological. The tools we have to measure withdrawal are inadequate. We don\u2019t have good ways to distinguish withdrawal from relapse. We don\u2019t know what tapering strategies actually work best under rigorous conditions.<\/p>\n

Fixing this would require making research into iatrogenic harm, that is, harm caused by medical treatments, a genuine funding priority. It would require developing better measurement tools, running proper tapering trials, updating clinical guidelines, and training clinicians to take deprescribing as seriously as prescribing. Deprescribing should be the bread and butter of every working psychiatrist, not outsourced to fringe critics of the profession.<\/p>\n

Speaking of critics of the profession, how do you see the MAHA movement and RFK Jr. fitting into this? Is their war on antidepressants<\/a> complicating psychiatry\u2019s ability to course-correct?<\/strong><\/p>\n

I\u2019m deeply concerned about the direction of that movement. RFK Jr. has said things about antidepressants that resonate with many people who\u2019ve been harmed by them. He\u2019s echoing language that has circulated in prescribed-harm communities for a long time. But RFK Jr. and the MAHA movement are not equipped to navigate the clinical and scientific complexity here. Their political agenda and funding decisions will not lead to better research and better clinical care. They will, in all likelihood, lead to confusion, distrust, stigma, polarization, and possibly restricted access to medications for people who need them.<\/p>\n<\/div>\n

Sigal Samuel
Read More<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

If you\u2019ve been taking antidepressants or anti-anxiety medications for years, you might have certain questions. Do you still need the medication? How would you know if you didn\u2019t? Does it make sense to stay on it indefinitely, or do you owe it to yourself to see what life would be like without the medication? I<\/p>\n","protected":false},"author":1,"featured_media":895342,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30690,31415],"tags":[17944,11069],"class_list":{"0":"post-895341","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-conversation","8":"category-honest","9":"tag-conversation","10":"tag-honest"},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/posts\/895341","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/comments?post=895341"}],"version-history":[{"count":0,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/posts\/895341\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/media\/895342"}],"wp:attachment":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/media?parent=895341"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/categories?post=895341"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/tags?post=895341"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}