I was first prescribed antidepressants for chronic, low-level depression in 2013. That doesn’t make me special; Harvard Health Publishing estimates that 1 in 10 women ages 18 and over are on antidepressants, and women are twice as likely as men to take antidepressant medication, according to national survey data released by the Centers for Disease Control and Prevention (CDC).
For a while I took my pills religiously. Then I just…stopped. Every so often I’d notice the edginess and despondency that meant my depression was in a full-blown downward spiral, and I’d remember, Hey, I have something to help with that. But despite proof that they worked (I do feel better when taking them), I never seem to be able to make taking these meds a habit.
My apathy over taking my antidepressants is also not uncommon, apparently. Research shows that nearly a quarter of antidepressant prescriptions are never filled and 30 to 60 percent of all patients commencing treatment with antidepressants stop taking the medication within the first 12 weeks. Women are less likely to adhere to their prescriptions than men.
These meds are presumably prescribed for a reason—personally, I find that taking them relieves the anxiety and melancholy that can at times be paralyzing. So why aren’t women like me following through?
“I was convinced I could use sheer willpower to conquer it.”
Niki C., 38, was first prescribed antidepressants for anxiety, OCD, and ADHD; since then she’s been prescribed antidepressants three more times. But she’s always made the decision not to take the meds almost as soon as they were prescribed—in some cases, her mind was already made up when the doctor was handing her the Rx; in others, she changed her mind immediately after filling the script.
“I was convinced I could use cognitive behavioral therapy [a common type of talk therapy] and sheer willpower to conquer it,” Niki says. “I worried that, as I stopped taking the meds, the symptoms would come rushing back, and by relying on medication I would never really recover.” In most instances Niki didn’t bother discussing her decision with her doctor (when she did, they advised her to stay in touch and reach out if she changed her mind).
Talk therapy is really effective at treating depression for some people, says Maureen Sayres Van Niel, a psychiatrist in Cambridge, Massachusetts, and president of the American Psychiatric Association Women's Caucus. “There's a continuum of treatments for all people with depression that starts with lifestyle changes, including things like meditation, following a healthy diet, and talk therapy,” she explains.
The truth is, most doctors try to avoid using medication if it's not necessary, Sayres Van Niel says. But having a therapeutic relationship with a doctor to handle those emotional ups and downs—and the correct response to them—is especially vital. “Occasionally I doubt my decision,” Niki says. Her emotional state hasn’t changed much since she opted out of taking her meds, but the fact that antidepressants are there as a safety net is enough for her. “I know I can always get another prescription if I need to, and that there’s help for me if I need it,” she says.
“I told myself I didn't need it.”
When Brita F., 32, was first diagnosed with generalized anxiety disorder and low-level depression after experiencing panic attacks in college, she stuck with her prescription for only a summer. “Then I convinced myself that I didn’t need it,” she says. “I thought, I feel better now, so I’ll just be better.” But subsequent panic attacks forced her to get back on the medication.
People assume that the reason to take an antidepressant is to treat a bout of depression, and obviously that’s true. But antidepressants also help prevent a relapse of depression, says Ashwini Nadkarni, an associate psychiatrist at Brigham and Women's Hospital and a professor at Harvard Medical School—even when you feel better, the meds are still valuable. “Just as people stop taking antibiotics [too early] when their symptoms of infection go away, women will also stop taking their antidepressant when symptoms of depression go away,” she says. “But prevention is a very important role for medications—people tend to forget that when they seem well.”
Brita ended up going off her meds on two more occasions. “I’d just forget to take it for a day and nothing bad would happen; then I’d take them for a few days and forget again. Finally my prescription ran out, and I just didn’t refill it,” she says. But without medication her anxiety steadily increased. “I just didn’t realize it because I was so used to that baseline. I thought that it was normal,” she says. “The catalyst for getting back on antidepressants was always a major panic episode or downward spiral.” For the past year and a half, she hasn’t missed a single dose.
Taking an antidepressant as a preventive treatment can prevent relapse; less than a quarter of people who continue taking medication relapse in one to two years compared with 50% of the people who don’t use an antidepressant as a preventive treatment, according to a 2015 study. “Some people can come off and not need it again until something big happens in their life, but there are also people who need at least a low-dose maintenance to prevent the problem from coming back,” says Sayres Van Niel. “The important thing is to have a working relationship with a psychiatrist to figure out what you need.”
“They made my depression worse.”
There’s a reason antidepressants come with a black-box warning from the Food and Drug Administration: They can be associated with an increased risk of suicidal thinking, feeling, and behavior. That’s what happened to Jandra S., 29, who was prescribed antidepressants for anxiety and depression. “The first time I took antidepressants, I didn't even notice that my symptoms were getting worse,” she says. “I just remember hitting a low point—on the verge of suicide—and I couldn't remember how I got there.” She stopped taking the meds about a month after being prescribed them.
Cases like Jandra’s are “very, very rare,” says Sayres Van Niel, but the risk shouldn’t be minimized. That’s another reason it’s so important to have a doctor to discuss these situations with.
The second time Jandra was prescribed antidepressants, this time to help manage the severe anxiety and panic attacks brought on by another medication, her reaction was similar. “I remember sitting in my car after work one day and I felt completely numb, detached from everything and everyone," she says. "I remembered my previous experience with a different antidepressant and decided to see if not taking them helped.” Again, she stopped taking the meds after just over a month.
Once off her prescription, Jandra recalls, she felt much better. “It was a marginal improvement at the time, but I remember recognizing the change and feeling so relieved,” she says. “I do still struggle from time to time, though. I actually started biohacking my anxiety and depression, and that's been enough to keep it at bay.”
Antidepressants take time to work—typically four to six weeks to kick in, and up to three to six months to reverse the problem they were prescribed for. “During that time, someone’s actual depression can get worse,” says Sayres Van Niel. “If someone has serious depression or is suicidal, that period can be very tough. And they have to be really carefully helped along during those periods.” Sometimes that means going back to the drawing board and reevaluating tools like lifestyle changes, meditation, and talk therapy. “The approach has to be suited to the individual,” says Nadkarni. “My job is to offer treatment choices, and recognize that people will take the approach that best suits them.”
"I didn't want to admit that I needed something to help me feel normal."
Niki S., 29, stopped taking her antidepressants nine months after her doctor prescribed them to help her deal with extreme anxiety in certain situations. “My doctor thought it would help level out my moods, which in turn would help with my anxiety,” she says. “I knew they wouldn’t kick in right away and wanted to give them a fair chance, so I wanted to try for at least six months.”
Eventually the lingering stigma around antidepressants got to her. “I would mention being on an antidepressant and people would look at me like ‘Oh, my God, she’s suicidal, she’s crazy, etc.’ when I really just needed something to balance or level me out,” she says. “Pride was a huge issue for me—I didn’t want to have to admit or accept the fact that maybe I needed something in my life to help me feel ‘normal.’”
It’s disappointing that there is still so much stigma around mental health. “Despite all of the research that shows depression is a neuroendocrinological—or medical—illness," says Nadkarni, "many women continue to feel a strong sense of shame or reduced sense of self-efficacy about their depression because they believe that they should be able to control their symptoms without having to take a medication. Even though people will start a medication with the resolve to take it, a subtle sense of shame will take over, keeping them from remaining adherent.”
Niki quit cold turkey and opted for other methods of stress relief, like exercise and reading. “I didn’t want a medication to define me, and I wanted to show myself that I could do this by myself and for myself,” she says. “I think I made the right decision trying to better my coping mechanisms for my mental health, but there are definitely days where I feel like I could benefit from still being on medication.”
The real issue is that mental health problems—even ones as common as depression and anxiety—are viewed as a weakness. “This idea that you should be able to fix it yourself or snap out of it persists,” says Sayres Van Niel. “But the whole reason you go on antidepressants is that there's some kind of biological imbalance—and biological means it’s out of your control.”
Why You Shouldn’t Go Off Antidepressants Without Talking to Your Doctor
My own reasons for going off my meds have been nebulous. Sometimes I didn’t want to accept that I needed a medical crutch to be happy; other times I brushed off that lag in inertia, one of the cardinal signs of depression, as simple laziness. At the moment I’m not taking any—and for now, at least, I honestly don’t feel like I need meds. But I know that when I do get to a point where I feel like I need to be on antidepressants again, I’ll schedule an appointment with a doctor ASAP.
If you’re taking antidepressants, there’s absolutely nothing wrong with wanting to get off them—for whatever reason. “I think most doctors are happy to get people off medication,” says Sayres Van Niel. “But you have to do it in a way that makes sense scientifically.”
It may be easier to stop taking the pills cold turkey or to opt out of refilling a prescription, but it’s important to remember that antidepressants are serious chemicals. Getting off meds suddenly can cause physiological responses like headaches, dizziness, mood changes, and fatigue. There’s also a risk of rebound depression: You think you feel better, but cutting off those chemicals can cause a resurgence of symptoms, possibly even worse than before.
Even if you’re not seeing a doctor weekly, you want to have a therapist or your prescribing M.D. on deck to go over the proper way to get off your meds. If that’s your goal, they can help ensure you wean off antidepressants the right way—and ensure you won’t have to go back on them.
Ashley Mateo is a writer in New York City covering health, fitness, and travel. Follow her @ashleymateo.
Originally Appeared on Glamour