On Tapering off of Prescription Medications for PPD
Posted Mar 25 2013 11:42am
L2 is almost two. In just two more months, he will celebrate his birthday and I will celebrate having gotten through those incredibly amazing, and sometimes rough, first two years of birthing and then maintaining a little person. Faster growth and development happens in the brain and body in those first two years than at any other time in the human life. It's astounding to me! I've almost managed to navigate being the guide for two completely different little boys through this incredibly overwhelming and humbling (for the mama) process of transitioning from a newborn to a toddler twice now.
A few months ago (actually back in December, right after Christmas), I began to feel it was time to consider the process of weaning from the medication that I took to (very briefly treat, and then) prevent postpartum depression and anxiety in 2011 after suffering it so severely after my first son in 2007. Because I had been so married to all things natural before, during, and for a bit after my pregnancy with L1, even once I had agreed to take psychiatric meds beginning at six weeks postpartum, it seemed that I never stopped planning for or anticipating the day that I would no longer take them. I was consumed with what were probably even obsessional thoughts about being able to function as a non-depressed mom, and even more-so being able to sleep without the aid of medication. I voraciously read and discussed research regarding recurrence of symptoms and relapse and had decided that my magic number was 18 months. Knowing my very rigid self at the time (in early 2009), I am quite certain that it was probably18 months to the day after I had begun taking SSRIs and other medications for my severe PMAD, that I began the process of no longer taking them.
I want to warn you that I do not, as in DO NOT, recommend this to anyone else. Clearly I am a freakishly over-informed, but completely non-medical-professional person. So, yes, I can rationalize my choice to taper off my meds the first time without being under the direct care of a mental health provider. However, I realize now that I still probably should have done things differently. Not because my plan didn't work, but because it was irresponsible for me to have done it. So I'm telling ya...talk to your doc before, during, and after tapering down or weaning off your meds. It's the smart thing to do. Don't be a dummy like I was the first time, going it alone; especially when there are so many trained folks who can help you.
Anyway, back to then. Tapering off my meds was probably so easy for me the first time is because a) I was so damn hell-bent on being drug-free from day one. b) I went so slowly that I am surprised a pill cutter was able to cut the halves of halves of halves I was taking at the end of the process. c) I had read a ridiculous amount of research about how to do this safely and with the least side effects, as well as the lowest rate of relapse. d) I talk to a ton of people who are mental health professionals on a regular basis, even though they never "treated" me as their patients (people I have professional relationships with whom I refer to and who refer their clients to me for peer support.). These are folks who can spot problems with meds or a shift in mood or wellness across a crowded ballroom and so I was confident that they would give me the nudge (or hammer over the head) if they were concerned about how I was doing.
Thanks for sticking with me so far, despite my little lecture and tangent. I realize that you're probably reading this for one of two reasons: either you want to know how to successfully taper off of your meds someday (note: It is perfectly cool if you and/or your doctor feel that medication is something that is a part of your lifetime wellness plan, postpartum or not. Not everyone can or should wean off of meds. Period.) or you have been following my story for a long time and wonder how things are going with round two of "mission senza medicina". I'll get to all that now.
If your reason is of the how-to variety, then this part will be helpful, but is SO NOT MEDICAL ADVICE (I say that for liability purposes and just 'cause I care about you). I'm not going to give you details about the medications themselves or the doses, but I will tell you how I did things the first time around. Beginning at around 16 or 17 months (because all the research I mentioned above tends to land on the same result- 15-18 months on a therapeutic dose of a medication for a PMAD is the sweet spot for preventing relapse), I started taking a look at the calendar, planning to make changes at strategic times (i.e. not while traveling, while in the midst of a stressful project at work, in the middle of the holidays, or while hosting visitors, etc.). Once I had identified what seemed to be a smart window of opportunity for beginning the process, I strategized around which of the three medications I was on at the time would be the most difficult for me to physically and emotionally wean from. I identified the increments of dosage and time that I would stairstep through as I completely weaned from one medication, prior to tackling meds number two, and three. Now, while this happened to be the smart way for me to go last time (and is similar to my plan this time for the two medications I am on- as it turns out I didn't need a third this time thanks to early intervention and less trauma), it is not necessarily what your doctor might find best for you. I have heard of some folks slowly reducing their doses of multiple meds at the same time, with the end goal of being on lower doses or completely coming off of the medication. Just like symptoms and treatment plans are super unique, it's my educated guess that tapering plans should be just as individualized.
Now for timing...while many doctors will suggest mere days or a week at each lesser dose during the tapering process, I chose one month. I decreased my dose by 25% and then took that dose for an entire month before reducing again. Granted, I took twice the number of milligrams of an SSRI (the same brand I took this time) during my first postpartum period so this took a little while. I then tackled the second and third meds in the same way, though I was able to do so just slightly faster, until the last 25% or so, because both medications were meant to be more of anti-anxiety/obsession related in an effort to keep my incredibly overwhelming insomnia manageable.
I'm not sure exactly when it was, but prior to L1's second birthday I am pretty sure I was able to be completely free from taking prescription meds on a daily basis. In addition to herbs and homeopathy, as well as some other helpful tools like sleep cds, an anti-anxiety self-help program, massage, etc., I did continue to take an anti-anxiety medication on occasion to treat severe insomnia (which happened rarely despite my overwhelming fears) or the fairly infrequent anxiety attack (which tends to happen when I have had a triggering experience or one too many alcoholic beverages the night before). It's smart to have a go-to if you suffer from anxiety, so I don't recommend throwing your medication away (unless it is expired), even if you have completely weaned. Sometimes just the knowledge that you have it in your "toolkit"is enough and you won't need to actually take it. And other times? You might be thanking God you don't have to wait for a prescription because x, y, and z (or nothing at all) happened and you're having one hell of a panic attack that no amount of deep breathing will combat.
So this time, I'm using a similar strategy...slow and steady. And most importantly, under the care of a physician. Interestingly, a deep desire not to take medication is not the driving force of this taper. I don't really care about the stigma or if someone "finds out" and I've even gotten past my completely inflexible need for all things natural in my home. Moderation has become my friend for a multitude of reasons. Somewhat financial (we just can't afford to eat 100% organic foods as a family of four). Some in an effort to combat my inflexibility ("My child will not die from a hot dog, a Hi-C, or watching more than 30 minutes of television." repeat.). And partially because I feel strongly I need to practice what I preach. (I can't go to support group meetings or respond to posts in online groups urging moms who are suffering such severe symptoms to consider medication, if I'm secretly against taking it myself.) The truth is I'm not against it. I actually went on an SSRI this time around sharing openly that I would be okay with taking a low dose the rest of my life if I needed to. That first week or so postpartum scared me (again) enough to convince me that feeling that way long-term was not necessary and no way to live. The good news is that it turns out I have just felt normal and "good" for most of the time on the medication (the entire second postpartum period). I had reached that 18 month point that felt safe to give this a go. I'm blessed that the motivation of this taper is as simple as that.
So where I am today? I am on day four (or is it five?) of not taking any SSRIs. It happened accidentally. I actually intended to be on the 25% dose for a little longer. L2 is at an incredibly whiny phase and we have some traveling coming up. I thought it would be smart to wait until after. But then? I forgot to take my medication one afternoon. And by the next day, when I actually remembered, I was busy and kept telling myself I would go get a little 1/4 pill as soon as I completed just "one more thing". Except I just kept working, and then it was dinnertime, and then it was bathtime, and then it was bedtime. And then I feel asleep in L1's bed that night. And by then it was the third day. And it seemed kind of silly to take something I hadn't taken for like 60 hours or so. So I just didn't. And my brain didn't explode. And I didn't curl up into a ball and cry incessantly. And I didn't get a headache or a stomachache. But I did feel like I was going to pass out at church yesterday. And I did tear up when the Gospel was read and I heard the crucifixion story being read in great detail. And then I saw my older son sing beautifully, in front of about 300 people, about Jesus' entry into Jerusalem. And my heart swelled with joy. A normal, "awe, how sweet", kind of feeling. And I realized that I don't feel woozy or a little out of it because I have low blood sugar. (I couldn't quite come up with answers I should have known at trivia last night and words like "saucepan" are escaping me this morning.) It's because my brain is having to work out it's serotonin issue on its own, without the aid of that little re-uptake inhibitor.
So...these blips, or "brain zaps", will go away in a few days. I'm pretty sure of it. And if they don't, then I'll go back on that teeny tiny dose and try again another time. Because you know what? If this 5.5 year journey has taught me anything, it's that the only thing about my PPD, mental health, medication, or recovery that really matters to my family is that I am well. My kids don't care if I take 5 mg of this or .5 mg of that. All they really want is a mama who can give them big hugs, read them books, and jump on the trampoline with them. And I'm willing to do whatever it takes to give them that woman. In fact, I kind of I like her.