Monday, July 4, 2011

Antidepressants....When to go off it and How?

My analogy for taking antidepressants is like flying a plane.  Taking off is difficult, as is landing the plane.  It may take 2-4 weeks to have an effect, and during these two weeks, you may experience some annoying side effects like haziness or "fogginess".  Sometimes, the depressive or anxiety symptoms may worsen with suicidal thoughts during this initial period, so close monitoring is required by your Doctor and the treating team.

When you have been titrated to an effective dose, then you will be on "autopilot mode".  It will be relatively easy and stable, and will require less monitoring than initially.

Now, when you "land the plane" or get off the antidepressants, then it will be difficult again.  When you land the plane, you would not land it during a middle of a storm would you?  So similarly, when it's time to take you off the antidepressant, it will be wise to choose a time of stability.

My rule of thumb for the duration of use of antidepressants is:
  • For first episode, aim for 6-12months depending on the case.  Your Doctor together with your psychologists or counsellor will guide you here.
  • For the second episode or "relapse", we may aim for 2 years.  Again your Doctor will guide you here.
  • For subsequent major episodes, some authority will suggest long term use.  However, every case is different again, so your Doctor will help to guide you here. 
Few important last reminders about going off antidepressants. 
  • Do it under the guidance of your Doctor and try not to "just go off it".
  • Have an assessment by your Doctor or treating team prior to going off it.
  • If you were to land a plane, you would come down slowly and similarly, go off your antidepressants slowly over a period of 4 weeks is a general guide.  Again, this will be different for different people.  If someone is more unstable as evident from their past history, I will go even slower.
  • Once you are off your antidepressants, be on the lookout for early signs of relapse.  Remember that the earlier you can address it, the better the outcome.

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