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fi nally begun to fade and we’re starting assistant clinical professor of psychiatry empathetic. She works hard. And she’s a
to take care of our heads the same way we at Columbia University, “and the brain is primary-care doc, God bless ’er. She’s not
take care of our bodies. Depression still complicated.” in it for the money.
carries liabilities that are at least as dire It may take months for you to under- Yet even she’s wrong on this one. “We
as the meds used to treat it—substance stand how your medication has altered taper really slowly now,” Dr. Ramsey says.
abuse, cognitive impairment, increased your brain. “Depression puts your life in a “Much more slowly than we used to.”
risk of heart disease, a more than 20 pattern that takes focus and intention to According to a recent Lancet study, in
times greater risk of suicide—and much undo,” Dr. Ramsey says. “It’s not like, Oh, fact, you should ideally be on the off -ramp
better substantiated. And discontinuing wow, my symptoms are gone, great. You for months. (To be fair to my primary-
antidepressants entails risks of its own: have to repair things with people, and you care doc, there’s no reason she would
relapse, primarily. Then there are all have to repair things with yourself.” know this, given that even the American
the potential withdrawal symptoms— Timing is another factor. Like maybe Psychiatric Association’s own guidelines
fatigue, headaches, achiness, sweating, your dog just died, or you just got divorced, still say “at least several weeks.”)
insomnia, nausea, vertigo, anxiety, or you’re due for a romantic getaway— The Lancet study also suggests, inci-
irritability—which can sometimes go on probably not the best time to wean yourself dentally, that your risk of withdrawal is
for months or even years. off the medication. vastly decreased if you lower your dose
According to Peter Kramer, M.D., gently. Instead of a “Look, Ma” leap off a
the éminence grise of modern psychi- 300mg cliff , in other words, it’s gonna go
atry and author of Listening to Prozac better if you do it by halves—300 to 150,
(among a half dozen other books), 150 to 75, and so on.
people considering going off their meds It all depends on the details, of
can always refer back to one guiding ONE FIFTH course—the drug you’re on, how long
principle: “In general, it’s better to be off OF GUYS TAKING you’ve been on it, and the size of the dose.
medicine if you don’t absolutely need Which is why it’s really important to talk
to be on it.” ANTIDEPRES- it through with a doctor.
By way of justifi cation, Dr. Kramer SANTS HAVE BEEN “I try to anticipate the side eff ects
cites something an old mentor once told you’re going to have and then try to antic-
him during his child-psychiatry train- DOING SO ipate what the options are,” Dr. Ramsey
ing: “I never had to go back to a mother says. “I want to hear about your mental-
and say, ‘Remember that med we had FOR TEN YEARS health game plan. Are you eating well,
your child on? They did some studies, and OR MORE. are you exercising, are you getting lots of
it turns out it makes children smarter!’ ” omega-3’s and zinc and vitamin E?”
On the contrary. If anything, the news He may even go full herbal and pre-
always seems to be bad. (Remember Fen- scribe Saint-John’s-wort—just as eff ective
Phen? Vioxx? Darvon?) at treating depression as SSRIs, studies
This doesn’t mean everyone should shed suggest. Even the herbals can have side
their meds like last year’s fashion and Even the season can aff ect the decision. eff ects, though, and interact with other
take a purity pledge. There’s a calculus to Winter can be pretty rough, after all. medications—yet another reason to resist
be considered. Why not wait for the birds to return? the urge to wing it. Consider this the fi rst
“The main thing is you want to see There are also your dependents to con- test in returning to a nonmedicated life. If
someone doing really well for nine sider. If you don’t have any, the decision is you can do this right, then maybe you truly
months, with no hint of any recurrence,” a lot simpler—if things go badly, the only are ready to go it alone.
Dr. Kramer says. one who suff ers is you. I am. I think. It’s been only two weeks,
And—to be crystal clear—this is My two kids are older now, and the so it’s kind of hard to say.
assuming there’s no history of suicid- going is easier. The wife and I are getting Something else Dr. Ramsey said:
ality, hospitalizations, or multiple on fi ne, and I’ve been doing pretty well for “There’s a two-month period where no
prolonged episodes, because there’s a at least a year. matter what happens, you wonder if it
diff erence between a single bout of mild So, okay, now what? was because you stopped your meds.”
depression and the recurrent, more It’s tempting to go cold turkey. Then at I can live with the lack of clarity,
severe variety. The latter you do not mess least I could turn my back with a show of because even though the meds are gone,
with. But even if your depression isn’t bravado and recoup some self-esteem. they left behind something important:
acute, it still makes sense to give the But no. a better sense of what works in life. A
meds at least a year to do their thing. “Halve the dose for a week and see how clearer picture of what that looks like.
“Medications work by changing the you do,” my primary-care doc says. This was the gift. Now I just need to
brain,” says Drew Ramsey, M.D., an I like my primary-care doc. She’s hold on to it.
MEN’S HEALTH / December 2019 87
