Ask a Therapist: "I'm Thinking of Quitting My Antidepressants. How?"
Welcome to Ask a Therapist, a new monthly column where a licensed professional—not Dr. Google, not your judgmental co-worker, not your college roommate who tends to shoot from the hip—gives honest answers to the big questions that are keeping you up at night. They'll tell you when you're in a toxic relationship, how to move on from a traumatic memory, techniques to better manage your finances and worry less between paydays—and they'll also give you a no bullsh*t reality check when you have a shortcoming to confront. Here, we have Sherry Amatenstein, an NYC-based therapist, author, and editor of the anthology How Does That Make You Feel: True Confessions from Both Sides of the Therapy Couch. Today she's answering questions about daydreaming, mental health meds or lack thereof, and chronic job dissatisfaction.
I want to quit my antidepressants. How?
I am, well, happy to address a question that affects large swaths of the population as one in six Americans are on psych meds. There are a variety of reasons you might want to stop taking a drug, including unpleasant side effects, feeling stigmatized that you have a "mental illness," the drug’s expense…but should you quit? There are factors to seriously consider before discontinuing.
To be clear: I am not an advocate for eternal medical intervention unless you have Major Depressive Disorder (MDD) caused by chemical imbalance, which often necessitates drugs being a permanent part of your mental health maintenance regimen.
I tell patients with situational, mild, or moderate depression that the point of meds is to stabilize them emotionally so they can focus in therapy on understanding the roots of their unhappiness and how to recognize and better handle future depressive episodes. Once you have had a serious depressive episode, there is a 50 percent likelihood it may recur, at which point you might need to resume taking meds to lessen the severity of the relapse.
Okay, you understand the decision to get off Effexor, Prozac, or whatever, is not a lark. Here is where I am a zealot: You are forbidden to stop the drugs cold turkey and without supervision. Side effects from withdrawal can include intense anxiety, insomnia, even what is called a Brain Zap—brief, repeated electric shock-like sensations in the brain.
You must work with your psychiatrist on tapering your dosage. According to the latest research, this is a process that can last months, in some cases years. It’s essential to gently ease your body into such a big transition.
To ensure you have the psychological toolkit to go it on your own, don’t end therapy simultaneous with weaning from the psych meds. And as we say in the mental health biz—should you need us, our door is always open!
I’ve been having these regular fantasies about becoming someone amazing or important. Why?
It took me a few minutes to focus on your question as I was imagining myself basking in my standing ovation after delivering a TED Talk on The ULTIMATE Meaning of Life, followed by an offer from Oprah to host a TV show on OWN. But enough about me…
Seriously, you are not alone in this habit. A 2010 Harvard study, which utilized a smartphone technology to track the thoughts and feelings of participants, found that 47 percent of the time our minds are wandering.
There is the type of wandering that involves musing about what you’re going to cook for dinner while listening to a co-worker drone on at a meeting, to daydreaming about chillaxing on a beach, to pondering what you wish you’d said to the jerk at last night’s party who said, “Wow, you must really like those hors d’oeurvres,” to brainstorming a creative approach to a vexing problem.
Then there is the worrisome kind of fantasizing—wherein you spend 60 percent of the day lost in your mind, seriously impacting your real-life relationships and ability to function. While not recognized by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), this problem has been dubbed Maladaptive Daydreaming. Symptoms of MD include extremely vivid daydreams featuring their own characters and plots, and making facial expressions while fantasizing. MD differs from psychosis because there is an awareness these fantasies are exactly that. Sufferers might also have ADHD, depression and/or OCD. There are even MD online support groups.
As to why you can’t resist being seduced by daydreams of being amazing or important, perhaps you don’t consider yourself a uniquely fascinating person just because you are you! Your fantasies might be a distraction from the dissatisfaction you feel in yourself and your life. But when you emerge from fantasy, you crash land into reality. Ultimately the best "treatment" is to work on loving yourself and making your waking hours something you want to experience.
Every time I start a new job, I hate it after about six months. I’m going to be 30 soon, and I’m worried about my future. What’s wrong with me?
The up side is your awareness that while coming to hate one or two jobs in quick succession can be coincidental, having the same thing continuously occur is likely about you.
A patient I’ll call Jen came for therapy after quitting three jobs in one year. At our first session, she shared, “I started each job thinking, ‘This is it. This is the one that will make me happy,’ but it never was.”
Gradually we unwove her history. Growing up Jen embraced challenges such as participating in a piano recital or enrolling in a class for accelerated students. But her father frequently proclaimed himself unhappy with her performance. Consequently, when the adult Jen tackled something she cared about, the familiar childhood anxiety arose that her efforts weren’t good enough; she wasn’t good enough. A boss complimenting her on a task well done only heightened her fear—surely she’d soon be unmasked as a fraud and kicked out the door. The only way to ease her distress was to leave on her terms—resignation. Coming to realize that her father’s criticism had emotionally scarred her, she decided to tell him his parenting style had left her feeling inadequate. He apologized, saying his aim had been to motivate his smart daughter.
A few months into her next job Jen woke up with the familiar chest tightness and sweaty palms. But she told herself, "I am more than my anxiety. This isn’t necessarily about my job; it’s just a bad habit." She took deep breaths, indulged in a long shower, got dressed and went to work. Two years later, she’s still getting up in the morning and going to work. She said to me recently, “I won’t stay there forever. But I’m over being a serial quitter. I’m more about making thoughtful, not impulsive career moves!”
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