I'm one of those people that suggest weaning yourself off of psychiatric meds, but I try to be very careful about it. I think it would help to hear my side of the story a bit.

Psychiatric meds have a lot of issues. Doctors observed in the 1950s that messing with levels of neurotransmitters in the brain could induce euphoria in schizophrenic patients, turned around and tested this drug on depressed patients, and claimed it was a cure for depression. This is kind of the birth of the "brain soup" theory of mental illness. Change the ingredients in the neurotransmitter soup and the disease disappears, so this is clearly what caused it.

However, the early drugs were messy and altered a whole bunch of neurotransmitters and had unintended side effects, so drug companies tried to design a drug that would target what they thought was the most important neurotransmitter - serotonin. Cue Prozac, the first SSRI, in 1987.

Now I'm not saying Prozac doesn't work, because in 60-80% of people, it works more than well enough to buy time to get them up and about and in therapy and feeling better. But here's the real issue with antidepressants, and also with other big blockbuster drug, especially statins: once a market leader is out there being prescribed, other drug companies target it and simply try to design drug analogues. In clinical trials, all they have to do is prove their drug is equally effective as compared to the leading alternative. Cue Zoloft, Wellbutrin, Lexapro, Celexa, Paxil, etc. They pretty much all do the same thing, but work slightly differently and have different side effects for different people. Why? Nobody really knows. But once the first one was approved that was a poster child for the brain soup idea, labs around the world started working on churning out alternatives that only had to be equally as effective as Prozac.

SSRIs have been linked with increased suicidality, sexual dysfunction, weight changes, anxiety, insomnia, hallucinations. Why? Nobody really knows. And what about the 20% of people that they don't seem to work very well for at all? Why? Nobody really knows. The real issue here is with the serotonin brain soup theory in the first place: it turns out that a lot of people with depression have low levels of serotonin. Some people with depression have medium levels of serotonin. Some people with depression have high levels of serotonin. Artificially lowering serotonin levels with drugs doesn't seem to reliably cause any kind of depressed mood. The entire idea is based on a flawed logical premise: if aspirin makes headaches better, does not having aspirin necessarily cause headaches? Thankfully there are a lot of academics researching these concerns, and I am very hopeful that more of these fundamental questions will lead to better drugs in the future.

Doctors should really be up front about what they're prescribing, and patients should know. This is the best we have, and these drugs help a lot of people, but they don't work for everyone, and they're not something we really understand yet. The most effective treatment is using these drugs as a bridge for a couple of months or years to get yourself into therapy, make positive life changes, and find a way to keep yourself functioning. Pretending that they're a long term cure is infuriating.

I have been to two great psychiatrists that have been up front with me about the benefits and risks of SSRIs, and those conversations were fantastically helpful. It made me feel like I was in control and making an informed decision and that someone was trying to look out for me instead of pushing pills on me, and so I made it a goal to improve other areas of my life and get off the drugs. It gave me direction and a motivation that I could cling to instead of feeling totally hopeless.

So I gently advise people on SSRIs to talk to their therapist or doctor about weaning off them over 3-6 months if things are still improving. Not having aspirin doesn't cause headaches, but it sure helps to have aspirin around when your head is killing you so much that you can't be arsed to take a shower or move anywhere.