Dear fellow voyagers,
Nine years ago, in the middle of a particularly brutal-but-clarifying year of work upheaval, and during a regular check-in appointment with my neurologist, I learned that my chronic physical pain was one sign of the anxiety disorder that I never knew I had. Soon after, I was prescribed and went onto a low dose of Lexapro. Since I was also coming off of a pretty intense migraine drug at the same time, my adjustment was extra bumpy: my body felt like it had the flu and my mind felt like it was microdosing some mystery drug without knowing the effect.
I spent a month in bed recovering and watching Lisa Kudrow play Fiona Wallace, a ridiculously self-centered shrink. I laughed at Fiona’s cluelessness while cluelessly googling “How long does it take to adjust to ssris” over and over. Eventually, the headaches and nausea finally subsided. I started to feel better. The new drug was starting to work! My hot thoughts were starting to cool down.
For the next eight years, Lexapro acted as a thermostat for my brain. Instead of overheating and tunneling into my thoughts, the drug taught me what it felt like to gently turn down the temperature and keep moving forward. I was grateful to Lexapro and gradually inched up my dosage, eventually landing at 20 mg, where I stayed for the next eight years. I never thought about getting off. Why mess with something that was working?
In 2022 I had a good handle on my mental health, was in a job I loved, and my family was healthy.1 But my chronic pain was getting worse.2 I sought out more doctors, more physical therapists. Finally, I got lucky: with the help of my sister-in-law, I found a brilliant surgeon who was a great listener, and in early 2023 I had a hysterectomy that addressed many of the pain issues I was facing including— surprise! — my migraines. Slowly, tentatively, I started to believe I could be healthy.
That same belief convinced me to try life without Lexapro.3 If Lexapro were crutches for the brain, I felt my brain had finally healed to the point where it could “walk” without support. I was curious about what would happen if I started to go down on my dosage. First, I lessened my dose from 20 to 15 mg. Months passed. I went down again to 10 mg. More months. Then 5 mg. For the two weeks surrounding the step-downs, I warned my family, friends, and colleagues that I might be irritable.4
On March 1, 2024 I took my last dosage of Lexapro. This last step, from 2.5mg to 0 mg, was supposed to be the hardest. I braced myself for the inevitable storm. When it hit, I moved into observation mode. What would happen without my brain’s thermostat? I soon found out. My emotions were labile: I was furious one minute, crying the next. My stomach hurt. I had what felt like morning sickness despite no longer having a womb.
Finally, miraculously, as I believed it would, the storm began to pass. The side effects loosened their grip. My appetite came back. My headaches went away. After a year, the end is in sight for my transition off Lexapro. I see blue skies on the other side. It hasn’t been an easy journey, but it has felt worthwhile in a Wizard of Oz Dorothy’s red slippers “I always had it in me” way.5 👠
Remember, crutches exist to help you heal.
Because there is so much (stupid, unnecessary) stigma around mental health medication, it can be hard to find coherent, realistic narratives of people who went on SSRIs, loved and appreciated them, and then went off them when the time is right.6 That is what I hope I am sharing here.
If you are scared to try medication because no one can tell you for sure how it will affect your body and mind, I get it. Experimentation is intimidating, especially if you’ve never done it before. Remember that your brain is resilient. What’s important isn’t whether you use brain crutches or not. What matters is that you find tools that give you the hope, energy, and belief that you can heal.
I’d love to hear in the comments from those of you who had your own experiences with brain crutches. What would you tell someone else who is scared to give them a try? What was it like to go off of them? How do you describe the role of SSRIs in your life?
Be well, dear voyagers. Love, Meredith
COVID, obviously, sucked.
Migraines, nausea, lightheadedness, cramps, lower back pain, Achille’s tendonitis, iliopsoas tendinopathy in my hip, all the sexy stuff.
I did not make this decision lightly. I knew any medication changes involving brain chemistry require patience and experimentation. I talked to my doctor about it, though sadly the most helpful detailed information about titrating actually came from online research.
It helped me to remember that brain was trying to grow back its own natural serotonin supply, and that wasn’t always a smooth process. Everyone else was much nicer to me about the transition times than I was to myself.
My mental health goal is to be able to answer “yes” to the following questions: “Do I feel confident in my ability to navigate mental health challenges? Do I know which tools are there for me when it comes to mental health? Do I know which tool to use when?”
Of course, some people stay on SSRIs their whole life! The jury’s still out on the science of long term SSRI use.