After being medicated for 12 years, it feels like my pill bottles have become an extension of my own body. Pill popping has turned into an art that comes as naturally as breathing. At this point in my life, coming off of my meds isn’t something I can see happening anytime soon, or anytime at all, for that matter. As my 24th birthday rolled around, and I realized I’d been medicated for exactly half of my life so far, I couldn’t help but wonder — am I going to be on meds forever?
In middle school, I was diagnosed with generalized anxiety disorder and started seeing a psychiatrist who prescribed me an SSRI to take daily and a benzodiazepine to take as needed — which ended up being almost daily. The doctor didn’t tell me how long I’d be taking these prescriptions, but I also never asked because it wasn’t something that crossed my little mind. All I wanted was to stop feeling so horrible. Not to mention, growing up and becoming an adult was unfathomable to me. With anxiety and impending doom clouding my mind, I could barely picture getting through the day in front of me.
Now that I’ve come a long way, living life as an adult who can make her own decisions, I constantly find myself wondering if I’ll ever get to a point in my life where I’ll be off my meds. Will my bank account ever get a break from monthly pharmacy visits? Will my nightstand ever not be cluttered with pill bottles?
The last time I was off SSRIs was two or three years ago, and needless to say, I was put back on them pretty quickly. I’ve never been off of Klonopin (which occasionally warrants concern from medical professionals), and the longest period I’ve been off of my SSRIs was maybe two months.
Who would I even be off medications? Would my personality be different? Would I be less sleepy? It’s interesting to think about, but at the same time, I don’t know if it’s something I ever will find out.
I spoke to two psychiatrists to answer my questions and address my concerns that I know I can’t be the only one thinking. Are we anxiety and depression sufferers who take medication for our conditions all doomed to a future of wellness only in the form of ingested pills? If we’re being treated with medication now, will this be the case for the rest of our lives?
As I assumed, there is no blanket answer, since everyone’s so different. But I did confirm that I’m absolutely not alone in my worries. Aparna Iyer, MD, a psychiatrist practicing in Texas, states, “This is a very common concern! People who present to my office are often unsure of how they feel about being diagnosed with depression or anxiety, and they often need the reassurance that they don’t necessarily need to be on antidepressants forever.”
As for length of treatment by way of medication, she says, “I think this varies based on the person. However, most of the time, I tell people that they do not necessarily need to be on their pills forever. While some people prefer to take a pill to help maintain their mental health, others adamantly insist that they only want to be on their antidepressants for a short period of time. I advise these patients to be aggressive in pursuing other forms of wellness, such as therapy, in order to ensure that if we decide to discontinue the medication at some point they will be ready to do so.”
Marra Ackerman, MD, psychiatrist at NYU Langone Health, has a rule of thumb that serves as a guideline. “There is a lot of individual variation. But let’s say you’ve had a particular episode of depression or flare up of an anxiety disorder, I typically would say it [the duration of treatment] is about 6 months to a year from the time of getting well — not from when the episode started, or when you started medication — but from when you’re well.”
Both psychiatrists stressed the role the number of depressive episodes plays in the duration of treatment by medication. If a patient has had 3 or more episodes, they’re way more likely to have another one. In this case, medication is likely to be continued for a longer period of time. If less than 3 episodes have taken place, a treatment plan with a shorter duration of medication could be put in place.
Then, what happens when a patient is at the point where they’re ready to stop medication? Dr. Iyer suggests:
“If the patient and I both determine that he is ready to come off his medications, I would try to first come up with a plan for how to taper off the medications in a way that reduces chances of discomfort. I would also educate the patient and his family on some of the warning signs that his symptoms may be reoccurring or worsening, which is a concern if the medication has been effectively managing these symptoms. I would also set up frequent follow ups so that I could keep a close eye on him, to make sure he’s managing this discontinuation well. That by itself gives the patient a lot of reassurance, to know that he is not doing this alone.”
Dr. Ackerman adds, “The risk of recurrent illness is much much higher with rapid discontinuation than with a taper. I prefer doing it over months if we have the luxury of time because we can check in and see if the symptoms are actually getting worse as we go down. When we’ve gotten to the bottom, it’s easier to titrate back up”
All in all, you may have more power than you think when it comes to whether or not you’re going to be medicated indefinitely, because there is no hard and fast rule about it. There’s not a test to measure if you’re truly ready, and the only way to know if you’d fare well off meds is…well…if you came off of meds, while following a robust self-care plan including therapy.
So, am I going to be on meds forever? I might be, but I know that if I’m ever willing to take the plunge and taper off, I’ll have therapy and a support system to keep me going. If a trial period off meds didn’t work, I could always get back on them. I’d rather be a more stable, mentally healthy person no matter what it takes — even if it means I have to take pills to be that way.