Support for Weaning off of an Antidepressant

This might feel like a strange topic to bring up during a pandemic—shouldn’t we actually all be getting onto an antidepressant medication right now because of all of the hardship and worry that is happening in the world? The answer is, no, not as a first resort. We can learn from this time. We are being asked to understand ourselves in new ways and not just go back to the way things were, once outside circumstances make that possible. We are changing, and change can be very good. Consider it a kind of healing crisis.

Conventional antidepressants do have their role. They stabilize our nervous system and our emotional life and they can wonderful, life-saving medicines in the right situation. I prescribe them when needed and appreciate their support, but reserve them for when life is truly too overwhelming and there just needs to be some quiet pause. Conventional antidepressants are not the end-all/be-all, however, because they don’t bring movement. They hold you. They hold you steady when you are tipping and about to topple off of your stool, but they don’t necessarily help you build a stronger foundation to rest upon. To find a new way of being we need to make changes. Think of this as the difference between someone holding you up on your stool, lending a helping hand, versus getting out the glue, screws, or sandpaper to finally fix and even out the legs of a stool which has been tippy for a long time. If we fix the uneven legs of our stool, then we can sit on it with more security, more uprightness, more faith in our own strength.

In our general culture, we do not have very many pathways or perspectives for navigating change. Medicine too often focuses on controlling symptoms and that is different than resolution, different than healing. Sometimes we also have to loosen and let go for things to shift in a lasting way.

So, let’s see if we can chart out a potential pathway for health that is actually being fed by the coronavirus crisis. Healing requires preparation, enough vitality to make a change (you can’t grow a plant in sand, there needs to be fertile soil), and then a toolbox of more specific helpers.

STEP 1: Preparation

There are a couple of consistent ways that people prepare for making a shift.

  • One possibility is to go on a retreat or a pilgrimage. People have been doing this for millennia. Changing your outside activities, creating space, being simpler and quieter in what you do, helps you reorient. More space in the outside world allows you to better reconnect to your inner “North star”, your individual guiding light, as opposed to perpetually reacting to the demands and patterns of the outside world. With most of the world currently under lockdown or shelter-in-place requirements, we are all (willingly or not) retreated from the outside world. We are being given a chance to re-orient.
  • Second, whether lived through or only imagined, another important process is the prioritization that comes alongside serious illness and death. Most everyone has a list of things which they know they could easily cast aside if a loved one became serious ill and needed to be cared for. We do this for ourselves as well—if I am going to die soon, what is important for me? Before I die, what would I quit doing, where would I go, who would I spend more time with? In the face of real or threatened illness and death we ask, what doesn’t matter anymore? What is a husk that can be shed? We are all encountering illness and the possibility of death. Some are right now working with the true illness; most everyone feels the sizable emotional and spiritual energy that goes into imagining what could occur with the illness. We are being given a chance to re-prioritize.

Retreat and prioritization. Those are basic ingredients for change. The direction of that change will be unique for each person.

STEP 2: Vitality.

Sometimes we just have to build up new forces before we can even consider a change. How do we do that?

  • Healthy rhythms build vitality. Keep meal times, sleeping and waking rhythms regular, and add in time for movement.
  • Nourishment through care of the body builds vitality. Oil dispersion baths, yarrow liver compresses, even a hot water bottle on the belly at night help build up our life forces (you can still do these at home by yourself)
  • And then there is the nourishment that comes through the use of specific healing substances (remedies). Many anthroposophic medicines have been dynamically mixed and stirred, potentized, to bring the plant or mineral ingredients into a more vital state. That is part of why we take such care in selecting and using medicines that may be different than what you can buy at the local health food store.
  • When we share and collaborate, that helps bring vitality too. This is precisely why we need each other. We all need help from someone else at certain times of life, and when our life forces are low, we can’t do it all on our own.

STEP 3: A Toolbox of Helpers

Here are some additional factors to help us consider the different “legs” of our stool, and better recognize where an underlying imbalance may lie:

Medical Treatments:

  • Treating depression symptoms does not need to be like an on/off switch, either you are on an antidepressant or off of one. In fact, feeling like you have to decide between getting conventional or natural supports for depression is an artificial choice. There are many good, safe, natural tools for working with depression. It is very possible to combine and overlap “stabilization” (with a conventional antidepressant) and “guidance” (with a natural or anthroposophic medicine). Working with someone who is experienced and knowledgeable about this process helps. Stabilization does a job for us; Guidance helps us remember how to do something we have forgotten or never learned how to do in the first place.
  • Bridging is helpful. I recommend building in a bridging time where additional supports are given and experienced before trying wean off of any kind of an anti-depressant medication. This is also true for sleeping aids and ADHD stimulants (where the weaning process is often quite similar).

Biographical Rhythms. (Predictable) disorientation actually underlies some depressive episodes:

  • There are predictable times when we are ready for change, though it may show up initially as a feeling of confusion, sadness, or “itchiness” where at some deeper level we know that what has been no longer really fits.
  • These waves of re-orientation follow a seven-year rhythm. Every seven years we are given an opportunity to grow and re-orient. Not every seven-year change is important for every person, but if you ask people to look back at times of major change in their biography, important phases very commonly fall onto the seven-year rhythms (or involved a partner/spouse/parent/child/coworker who was experiencing a seven-year rhythm). The change usually happens in the year leading up to the birthday, i.e. the year between our 6th/7th, 13th/14th, 20th/21st, 27th/28th, 34th/35th, 42nd/49th, 55th/56th, 62nd/63rd, 69th/70th, 76th/77th, birthdays. We re-evaluate. The usual type of questions that come up: Am I doing the right thing? Am I honest, am I true to myself? Am I ready to stop avoiding something I’ve been avoiding forever, or am I ready to stop carrying something that no longer belongs to me?
  • You might think you are going crazy, but really you are shifting and self-initiating change from the inside, even if it does not make much sense in relation to the outer world around you. Speaking about the archetypes of these rhythms can help you gain important perspectives.

Body-Mind Connections:

  • Sometimes we are holding a pattern that we don’t even know about. Or, we do know about it, but don’t know how to change it. Different types of depression relate to different physiologic patterns. Within anthroposophic medicine the mirroring between unconscious physiology and emotional/mental habits is fully acknowledged, and very helpful! You can read about an example here: gallstones and your mood.
  • Diverse types of depression in fact relate to many different organs. These include kidney, lung, heart, spleen, reproductive and nervous system function. Anthroposophic support of physical and metabolic health offers an important additional pathway for making change (similar understandings of organ function are also found in Chinese medicine and many other traditional healing streams).
  • Find tools that will provide a pathway for going beyond the view that depression is just something in your head. Treating the body in precise ways can deeply influence our emotional and spiritual well-being.

Grief and Release:

  • Grief is normal with change. There are seven steps of change—what in anthroposophic medicine are described as the “life processes”—breathing, warming, nutrition, secretion, maintenance, growth, and reproduction. We need all of them, but a part of us may get stuck in only one of them. We need to look to see what is stuck, and then work to release it.
  • When does something, good or bad, move from being a loss or trauma to a “biographical fact”? Biographical facts are true things that have happened, that affected our life in important, defining ways, but which can now be worked with in such a way that they no longer have to define us (even if we still have a tendency to react towards things in a particular way). Through this process losses and traumas are not gone, but they can move. We feel less trapped.

A last point is that the correct combination of needed supports will admittedly be different for each person. Having multiple viewpoints, multiple tools, multiple threads, makes possible an individualized medicine. That’s quite different from the broad, standardized prescriptions of an SSRI or other antidepressant medication. Individualized medicine is not as swift or simple, but it allows, encourages, and works to guide a new way of being.

This is a good time for taking new steps.

Dr. Blanning

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