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The honest conversation about antidepressants I wish my psychiatrist had with me

How to think about long-term use, dependence, and withdrawal — according to a professional.

If you’ve been taking antidepressants or anti-anxiety medications for years, you might have certain questions. Do you still need the medication? How would you know if you didn’t? Does it make sense to stay on it indefinitely, or do you owe it to yourself to see what life would be like without the medication?

I don’t believe any of us has one true self, so I don’t think you can “owe” it to a central self to act in this way or that. Instead, I offered an alternative way of approaching this dilemma in a recent installment of my Your Mileage May Vary advice column.

But beyond the philosophical question of what you do or don’t owe yourself, there are medical questions that might still gnaw at you. Some people worry, for instance, about the withdrawal symptoms they might experience should they try to taper off selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed type of antidepressant. Others worry that perhaps they’ve become dependent on a drug and are not sure how to feel about that.

Since I have no medical training, I can’t give medical or psychiatric advice. But one of the most interesting voices tackling these questions is Awais Aftab, a psychiatry professor at Case Western Reserve University School of Medicine. I came across him through his insightful newsletter, Psychiatry at the Margins, and a piece he wrote for the New York Times calling for psychiatry to engage honestly and transparently with patients’ concerns about antidepressants, rather than ceding that conversation to those — like RFK Jr. and the MAHA movement — who would exploit it for political ends.

Aftab is critical of the psychiatric establishment’s failings, but he doesn’t throw the baby out with the bathwater; he is very aware that for some people, antidepressants can be lifesaving. I reached out to him because I knew he’d have a nuanced take on all these questions — some of which have niggled at me as someone who’s been taking an anti-anxiety medication for years. Our conversation, edited for length and clarity, follows.

Do you need to know who you’d be without antidepressants?

Why are so many people unsure how to think about the meaning of taking antidepressants, especially long-term? Are most psychiatrists failing us in some way? Or is ambivalence just an unavoidable feature of living at a time when medical progress keeps handing us choices that come loaded with tradeoffs?

I think it’s both, honestly. Let me start with the deeper issue. Medical progress keeps giving us more and more control over aspects of our lives, such as our moods, our anxiety, our emotional reactivity, but that control is imperfect and comes with genuine tradeoffs. [The philosopher] Bill Fulford has articulated the idea that scientific progress creates new technologies which create new choices for us, and this increasingly brings the full diversity of human values into play. More choices mean more uncertainty, more ambivalence. That’s just the moral cost of living in a world where these options exist.

“We can choose to take antidepressants or not, continue them or stop them, but we can’t choose not to have the choice. And the uncertainty is genuine.”

We can choose to take antidepressants or not, continue them or stop them, but we can’t choose not to have the choice. And the uncertainty is genuine. “Are the drugs helping?” “Do I still need them?” aren’t always easy questions to answer for any specific person.

That........

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