As I write this, I am experiencing the “brain zaps” that accompany withdrawal from your garden-variety antidepressant. Specifically, I’m withdrawing from Celexa, a Selective Serotonin Reuptake Inhibitor (SSRI) that curbs depression by making sure there’s plenty of serotonin swimming around in your brain. Seratonin is one of the main feel-good neurotransmitters, along with dopamine and norepinephrine, that’s out of whack when you get severely depressed. Since I’ve been on Celexa for 11 straight years for bipolar II disorder, tapering off this drug was no small matter.
The impetus to cut it from my daily med cocktail, which also includes 200 mg of Lamictal and 150 mg of Wellbutrin, came from doing a life-long mood chart, as recommended by a book I purchased recently off Amazon. This text, called The Dialectical Behavioral Therapy Skills Workbook for Bipolar Disorder, suggested I track the ups and downs from birth to the present. Since I’m 37, this took a good 20 minutes, along with lots of paper and ink. When I was finished, I noticed something startling: I was the most stable during a short period of my mid-20s when I was not taking an SSRI as an antidepressant. From 23 to 25 I managed to stay out of the hospital and had very few drunk and disorderly episodes, plus I rarely drank and drove (yes, it’s sad that “rarely” is a feat, but this is an addiction site, so be nice). I purchased the book as a supplement to a DBT class I was taking at Kaiser, the result of being hospitalized earlier this year. Determined to use my new skills to stay out of the danger zone, I decided to assign myself homework in addition to the assignments and worksheets for the class. I must confess that outside of doing the mood chart, I haven’t really used much of the book.
There’s no real mystery as to why the Celexa destabilized my mood—SSRIs can be dangerous for folks with bipolar disorder by causing moods to spike into hypomania or mania. Prior to taking Wellbutrin at 23, I was on 20 mg of Celexa, but my psychiatrist took me off it once she realized I had bipolar disorder, not just unipolar depression. It’s true that Lamictal, the mood stabilizer I have also taken for 11 years, helps curb the hypomania and mania. Regardless, whenever I didn’t sleep properly (which happened pretty often), I’d wake up with bursts of frenetic energy at four in the morning and run around for three or four days all hyped-up and full of “brilliant” ideas, ideas for books, restaurants, one-woman shows, magazines and other random pursuits. This might sound like a wonderful euphoric high, but unfortunately in this state you spend all your time fluttering around in your “genius” mind while getting nothing done. Then the inevitable occurs—a big depressive crash.
What goes up must come down. I don’t know about other bipolar folks, but when I’m up, I forget the crash is imminent. I think I’m going to feel euphoric and blissfully buzzed-out for the rest of my life. An equally disturbing thing happens to my mind when I crash—I assume it will last forever, my brain generating little cognitive activity, my motivation withered, my hopelessness unwavering. These swings just didn’t occur when I was taking Wellbutrin and Lamictal. Sure, I had some mood swings and a few periods of mild depression, but nothing on par with what I’ve dealt with in recent years. The only reason I went back on Celexa is that I was stupid enough to go off all my meds at 26. After finding myself going out at night with ribbons tied all over myself (I thought it was cool) and nearly burning down my kitchen, it occurred to me that I needed to get back on them—stat. Because anxiety was also a big issue during that time, along with bursts of rage whenever my upstairs neighbor so much as walked on the seemingly paper-thin floor of my cheapo 1950s apartment building in West Hollywood, my new psychiatrist threw me on Celexa.
SSRIs can definitely ease anxiety and on it I found a lot of relief and a decrease in irritability and rage. Unlike Celexa, Wellbutrin is a norepinephrine-dopamine re-uptake inhibitor (NDRI) and can actually cause irritability, along with insomnia if you’re dumb like me and forget to take it first thing in the morning. But the wonder of Wellbutrin is that it can help ADD or ADHD folks focus. I’ve got that problem too, in a big way—it typically takes me an hour to send an email, empty the dishwasher or clean my room since I’m completing four other tasks simultaneously. So I went to see my psychiatrist at Kaiser, a really cool dude who miraculously never makes me wait when I show up for appointments, and he had no problem axing the Celexa from my daily cocktail. Not wanting to drop off one drug while increasing another, he didn’t increase the Wellbutrin despite me tapering off the Celexa, which I did in 10 mg increments over the course of two months.
SSRI antidepressants have a bad reputation when it comes to withdrawals—rageful outbursts, uncontrollable tears, insomnia and general inability to function seem par for the course. Then there’s the brain zaps, these awful shocking sensations you get in your head that are nearly impossible to describe to someone who hasn’t experienced them. They send you into a dizzy spell out of nowhere, and if they’re very strong and continuous, it renders you useless on the job or in a conversation. I hate them, and I knew they were coming because I experienced them when I tapered off Celexa in my early 20s. Back then, my psychiatrist put me on 200 mg of Wellbutrin at the same time I dropped off the Celexa, so this round I was terrified that I might get severely depressed since I was only taking 150 mg. But my doctor reassured me that Wellbutrin is a strong antidepressant and that he didn’t want to increase the dose unless it was absolutely necessary.
I’m glad he said this—my symptoms of depression have only lessened after getting off the Celexa. I’m also pleased to report that the cognitive impairment and dark despair I often experience during PMS, which lasts a whole two weeks for me, also vanished. And apparently I had underestimated the sexual side effects of taking the drug, one of the most annoying aspects of SSRIs. Luckily, even at 50 mg I still had a decent sex drive, but now that I’ve tapered off, I’m back to feeling like an 18-year-old. This sucks, since I just got out of a long-term relationship and am not in the mood at to go out and bang a bunch of strangers as a sober 37-year-old.
Aside from the brain zaps, tapering off Celexa has essentially been a breeze. I’m sure if I didn’t also have the Wellbutrin and Lamictal in my system my moods would be all over the place. Still, one of the main mistakes folks make when ditching any psychotropic med is going cold turkey. Please don’t do it. It’s not worth it, and it’s totally ill-advised by all psychiatrists I’ve ever spoken to. Making a med change always scares the shit out of me—I’m convinced I’ll spiral out of control and terrified of getting depressed. In truth, all the changes I’ve made have done the opposite. Already I feel so much more stable. I’m pleased to say that as I complete this essay, it’s five in the morning. No, I didn’t sleep well (probably due to drinking too much Diet Coke), but I’m certainly not so far gone I can’t finish this sentence.
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