Last year after Thanksgiving, I publicly shared my postpartum depression (PPD) story. It was scary to put it out there, but it was also liberating–as if talking about monsters makes them less scary. Since then, I have been extremely humbled by all the moms and moms-to-be (and even husbands of moms-to-be!) who have told me how sharing my story has helped them or resonated with them. It just goes to show there’s so much more than we see on the surface and that we are often less alone than we may believe.
I didn’t think there would be another part to the series back in January when I wrote “Part 3,” but here we are! At that time I didn’t exactly know when or if I would be getting off of my antidepressant, but now we’ve come full circle. A lot has happened in the last 10 months since I last wrote about this topic. The world has changed a lot; I have changed a lot. What hasn’t changed a lot is that PPD is still common and still happening–maybe more than ever during this time.
I wanted to share a little bit of how I’m doing and how the process of tapering off antidepressants went for me, just to be transparent about the whole experience. My friends and family may have seen my updates about this on social media already, but this goes into more detail as I often find comfort in relating to the not so talked about details when reading about other moms that have gone through PPD. I also have some thoughts about medication and therapy stigma that I’ll expand on here. I know medications can be a sensitive topic, but it’s important topic to talk about as well. So in the spirit of giving Tuesday…here goes!
Disclaimer: Lots of text ahead as with my previous posts. I’ll try to break it up with our family Christmas photos (for lack of better images), and because they lighten the mood and reflect the genuinely good place that I am in now.
Part 1 – Beyond Pregnancy — My Battle with Severe Postpartum Depression
Part 2 – Beyond Pregnancy (2) — My Struggle With Taking Antidepressants
Part 3 – Beyond Pregnancy (3) – My Recovery from Postpartum Depression
Tapering Off My Antidepressant
My psychiatrist and I had decided to keep me on my Zoloft for at least a year, once I started showing signs that it was working. Technically, if you go by the books, it should probably be to keep the medication going for at least 6 months to 1 year once remission (or stable mood) is achieved. I’d say it took the Zoloft about 2-3 weeks to stabilize my mood and energy, and then maybe another month after that to fully feel like the anxiety was starting to subside.
It’s interesting to me that anxiety is the symptom that they told me should abate first, but it was actually the last one for me to dissipate. But I think that’s because I had insomnia to throw into the mix, and it took me at least 3 months to taper down and off my sleeping medication until I was only on melatonin supplements. For the non-medical readers, melatonin is a natural substance your body makes to regulate your circadian rhythm. Think of it like a vitamin.
I had started my optimal dose of Zoloft around the end of May 2019. A year later, by mid-June 2020, my psychiatrist had a check-in with me and told me she thought I was ready to start tapering. I was excited and kind of nervous, but I felt like I was in a good place. I think things had been going really smoothly since mid-December 2019 when our first holidays with baby came around, and I finally found myself dozing off for naps on my own without a mounting anxiety or pressure about falling asleep. I even started to skip my melatonin around this time and I was thrilled that my body was showing me it could fall asleep on its own. If you read the other parts, I explained how insomnia and breastfeeding were huge contributing factors to my personal PPD.
So we really probably could have started tapering down earlier, but I think it was a good idea to be cautious, given how severe my overall symptoms were in the beginning. At the June check-in, we agreed to drop the Zoloft dose 25% and to continue that for a month. I felt no difference on this dose at all, which was a good sign! At the July check-in, we dropped the dose again in the same increment. Again, I didn’t feel a single change.
This went on in 25% increment drops for a month at a time until September. Each time the dose dropped, I really couldn’t tell the difference and I wasn’t the least bit worried until that September check-in.
September 9, 2020. I’m not sure what I was expecting that day when my psychiatrist called for our video chat. Our schedules didn’t always perfectly line up a “month” later, so this call was actually roughly a week earlier than the 1-month mark of being on my last dose. Maybe I thought we’d cut the dose in half one last time, or wait another week or so to give it the full month on this dose.
But my doctor told me that she felt I was ready to stop the next day. I mean, I was sleeping well; I was functioning in my day-to-day; I felt like me again–as me as I could be before I had a baby. For the past 9 months after completely stopping sleeping medications, I had basically functioned as well as I could, even amidst a global pandemic. The idea of stopping the next day kind of caught me off guard, and it was definitely an emotional day. But hey, the day had come.
It was time to let go. I wasn’t as scared like I was when stopped my sleeping medication. But I was cautiously excited, nervous, and hopeful all tangled into one.
The Antidepressant “Withdrawal”
And then came withdrawal.
This, I was not expecting.
In pharmacy school, we were always taught to beware of serotonin syndrome–which is too much serotonin agents all at once. And we were taught to never suddenly stop an antidepressant and to taper off without guidance of a provider. But, I did taper…over the course of 3 months!
The first 3 days after stopping my Zoloft, I felt incredible. I felt like nothing had changed at all and my mood was better than ever. I was so wary of gauging any mood or energy changes and deficits, that it didn’t even occur to me that I could later have antidepressant discontinuation syndrome. Mind you, this really happens mostly if medication is stopped suddenly, but I knew better than that. Again, I had tapered!
The first symptom I started to notice was a weird, queasy nausea. In fact, by the 6th day after stopping the medicine, I was so nauseous that I actually feared I was pregnant. I hadn’t felt that nauseous since I was pregnant. To be clear, my pregnancy nausea wasn’t severe and it never got so bad that I threw up, but it definitely felt uncomfortable enough where I would want to curl up in a ball and lie there. Not only was there nausea with discontinuing the Zoloft, but I would get these sudden dizzy spells where I had to stop and sit down or hold on to something sturdy because it felt like I might fall over.
I actually bought a pregnancy test at work during lunch (the pharmacy was next door) and took it right when I got back to my office because I was genuinely a bit worried that I might be pregnant. It was negative, much to my relief. But then I couldn’t figure out why I felt like I was going through first trimester again. For a few days, I couldn’t get off the couch after work because I was just so dizzy, nauseous, and tired.
The first time a dizzy spell hit me was when I walked into a supermarket. I actually thought it was because of the really bad air quality (hazardous that day) because there were Northern California fires raging at that time and I had only worn a cloth mask, not an N95 mask, upon leaving the house. I also had a strange numbness and tingling down my left arm to my left thigh when leaving the store. I seriously thought I was having a stroke for a brief second with the dizziness and tingling (and because I am also a hypochondriac).
The numbness and tingling is what prompted me to think about my Zoloft because when I had started my Zoloft in the first place, I remembered feeling a lot of tingling and random “zaps” in my arms. A week after my psychiatrist told me to stop the medication, I was messaging her to ask if I was having some sort of “serotonin withdrawal.” She replied that it was possible, although it probably should have been less likely given how long we tapered for.
I guess it might have been helpful for me to cut that last dose in half one more time, but we didn’t know. Based on my experience with Zoloft and even trazodone for sleep (another antidepressant as well), I realized I was probably really sensitive to shifts in serotonin in my body because I always had nerve tingles when introducing and now discontinuing the medications.
Pharmacy Pearl: Antidepressants with longer half-lives like Prozac generally have less risk for discontinuation syndrome, and tapering over at least 6-8 weeks will also lessen withdrawal symptoms. Sometimes doctors will switch you over to Prozac when discontinuing an antidepressant for this very reason.
I decided to stick it out and stay off the Zoloft since my doctor said the symptoms should go away after a week or two. I didn’t exactly want to restart the medication and re-taper for longer. I had nausea and dizziness symptoms for a week, and then they got a little less intense in the second week. By the third week, I would still randomly get hit with a dizzy spell for a few seconds, steady myself by holding the wall or something stable, and then everything would be fine again. However, it was much less frequent. Nausea was barely noticeable by then, although the zaps in my arm would also still come maybe once every other day.
I’d say by the 4th week, I completely forgot about the symptoms. And while I never felt like I was “relapsing,” I did notice an interesting phenomenon. It was almost like I was able to feel. more. Feelings now felt clearer, deeper, sharper somehow. And then it suddenly dawned on me… that maybe all this time on the Zoloft I had been muted or dulled in feeling the super highs or super lows to help me stabilize my days. But now I could actually viscerally feel an emotion again.
For example, I heard my wedding song on the radio and during that first week of medication discontinuation and started bawling in the car. It was a good kind of cry–nostalgia at its best and also an ache thinking about my daughter getting married one day far in the distant future. But also, the last time I had burst out crying like that over a song on the radio in the car was when I was pregnant, so it did add a little to my panic (and confusion) early on… Anyway, it might sound a bit scary to have emotions flooding back, but I actually welcomed them and felt I was in a better place to deal with them now because the therapy had run its course.
A month after stopping my Zoloft, I had a check in with my psychiatrist to see how I was handling not having any medication. The timing worked out that the discontinuation syndrome also ended when we checked in. It was a bittersweet call–our “final call.” After nearly 17 months of working together, she was discharging me from psychiatry. A part of me felt like I was parting ways with a really good friend.
And of course, I cried. We both did. But man, it did actually feel pretty good to be able to cry and feel on that level.
Medication Stigma and Fear of “Addiction”
So I have officially been off of Zoloft for 2.5 months now, and besides for those discontinuation symptoms, I really haven’t felt like I needed to go back on the Zoloft. I want to be very clear—I don’t tell my story about getting off of the antidepressant to make it seem like it is the end goal. Because it is not. And I also don’t tell my story to suggest that you should take antidepressants either. Every mama’s story is very individual and the therapy needs to be customized, especially taking into account for pregnancy and breastfeeding. Zoloft is one of the more preferred agents for breastfeeding mamas, though, but I was not breastfeeding when I started my medication.
The end goal is really for mama to be mentally healthy and present so she can give her complete self to being there for her baby and family.
Postpartum depression and anxiety are real illnesses to be treated, and the reason I laid out my entire journey is to show that it can go from extreme lows back to like “nothing had ever happened”–except that it has. You don’t get to be a mom without changing, and if PPD happens to play a part in that story, it leaves an indelible mark.
I tell my story to show you that it can be beat and that medications can help, even if they aren’t perfect and do cause some side effects. I illustrate this part to show that it is also possible to discontinue medications in the long run. My story is just ONE example and outcome of success with medications + therapy.
But I find there is SO much stigma and nervousness around antidepressants and medication, which I’m hoping to dispel. I know this stigma exists because I was guilty of it too before I went through it myself. Before my medicine even started to fully work, I was already wondering when I could get off of it and worrying about being on the medicine for too long. But why? Why did I worry about stopping before I even really began?
I want to emphasize that there is absolutely nothing wrong with taking antidepressants. You won’t get “addicted” to them.
Just imagine for a second.
If there were something in your toolbox that could help you get better, why wouldn’t you use it? Why does it sound so shameful to take medication? Would you be ashamed to take blood pressure medication to lower your chances of heart disease? Why is the mind not a respected body part like the rest of your organs? Doesn’t it deserve a chance to get better with all the possible options?
These are questions I now pose when new moms fearfully ask me about starting medication and how quickly would they be able to get off a medication if they did start. I admit, I also sheepishly asked my psychiatrist if I could become “dependent” on the Zoloft and never get off of it. Never in all my schooling or rotations or residency had I been told that antidepressants would be “habit-forming.” But I guess I wanted to hear it from someone who had worked with these drugs closely for years because the things you learn in the books are different than real clinical experience. My doctor confidently told me, “No, you cannot get addicted to your Zoloft.”
This next section I am quoting my psychiatrist’s explanation. She explained it as such:
- Antidepressants increase the amount of neurotransmitter available, which then upregulates (increases) the number of receptors.
- The receptors that the antidepressants affect generally are not involved in the ‘pleasure center’ of our brains (like drugs and nicotine) and we don’t derive pleasure from having them manipulated.
- Antidepressants remove depression and anxiety, but they don’t make people high or happy.
- Addiction has not been proven as a result of an antidepressant.
So I hope that explanation above might ease any fears or uncertainties anyone might have about taking antidepressants long term. And to play to the other side, just because I was able to stop my medication, it doesn’t necessarily mean that other people need to have that same goal. I was also prepared to continue it if I noticed changes when tapering off because I much rather be a functioning mama to my daughter than whatever I was 2 months postpartum.
A great story I like to share is about a local mama friend I met at the park a month before the pandemic shut down everything. We somehow got to talking about our shared experiences with PPD and taking antidepressants. She told me she never plans to get off her antidepressant because she realized that she feels far better on it than she ever did in her life without it. It was something she never knew she was missing. I really admired her for realizing this and for telling me this so confidently. So this again highlights that everyone’s story can vary in their own way. And FYI, she’s a pediatrician!
Therapy Is For Everyone
What did I do about therapy then? The TL;DR is that I am planning to continue that for awhile, just less frequently. And that I think it’s actually quite helpful and I wish more people could do it regularly.
You might remember this from my previous posts, but I had been seeing a therapist at work—one that work provided, completely free and completely confidential. I started seeing her last August, about a month after I had returned from maternity leave at the recommendation of another coworker. (And I do realize that I am incredibly privileged and fortunate to be able to have this option.)
It worked out since I didn’t really like my other therapist that was assigned to me on my psychiatrist’s team. It was absolutely nothing personal, but it was more that I didn’t think she truly understood me because she wasn’t a mom nor seemed to have the desire to be one. My work therapist was a mom of two older kids (young adults) and the other perk of seeing her was getting to meet in person for sessions…at least before COVID.
In the beginning, I saw her every other week during lunch for a few months. Then we went down to monthly sessions. There was a lull for two months when I was off of work for bonding leave in January, but I saw her (virtually) as soon as I returned in April. Last month we decided that we would decrease our visit frequency to quarterly (every 3 months), since all seemed stable.
I likely don’t need to be seeing anyone right now for PPD but honestly, I think going to therapy is so helpful. I actually think that everyone should get therapy on a regular basis, whether weekly, monthly, quarterly, yearly, etc. Because we all have stressors in our lives; it doesn’t have to be all baby-related. People have relationship stress, financial stress, family, living situations, work, etc. That all builds up somewhere and I really believe if we don’t relieve those tensions once in awhile, it erupts at some point like a massive earthquake.
Think about how children are so pure and innocent. They’re clean slates that get shaped from what we teach them. If we taught at a young age that feelings are okay, that communicating feelings is key, that we need to consider others’ feelings and gave everyone the tools they needed to cope and process and empathize, do you think maybe the world might a better place? Perhaps there might be less violence, abuse, bullying, anxiety, depression, etc.
I can only imagine what talking about mental health like how we talk about physical health at a young age could look like. Could we somehow incorporate it into our yearly health check ups? It might be revolutionary. It would normalize mental health overall. But until the system changes, recognizing that therapy is not bad is a start. In fact, it is quite instrumental in setting you up for success, in my opinion, and something everyone should have access to!
PSI Peer-Mentor program
The other thing I’ve been doing for the past 6 months is participating as a volunteer Mentor in a really cool Peer-Mentor program by Postpartum Support International (PSI). I have been working closely to support another new mom going through PPD/PPA for half a year now, and we do weekly check-ins. It has been nothing short of amazing and humbling to give back. The Peer I was matched with is such a sweet and wonderful mama that I will continue to be friends with after our session ends soon, and I feel so blessed to have had her in my life this past year.
I often talk about PSI, because after I started recovering from PPD, I looked into what more resources were out there that I missed, that I could pass on to other moms. I found that PSI had a wealth of resources that I wish I had utilized. PSI is a non-profit international organization committed to helping moms (and dads!) through that postpartum mood and anxiety disorders (PMADs).
I recommend checking out the Peer Mentor program if you’re a new mom going through a PMAD to be thoughtfully paired with another mom who has already gone through something similar and can relate more on a personal level. It can be so helpful and hopeful to know you are not entirely alone and that someone else survived it too. The director for this program is the sweetest mama who has has her own fair share of PMADs and is very compassionate and committed to finding the right matches for all mamas, peer or mentor.
If you would like to learn more about some of the other PSI resources I like most, I did compile them in another comprehensive blog post that I invite you to check out: “Break the Stigma – My Resources for Postpartum Depression, Anxiety, and Insomnia”
In Conclusion…
- Taper off antidepressants; don’t suddenly stop them.
- You might get some discontinuation symptoms when stopping antidepressants.
- Don’t be afraid of medications; they could save or change your life.
- You can’t be addicted to antidepressants.
- Therapy is pretty freaking awesome. I wish everyone could do it regularly, like a regular annual physical.
- Check out the PSI Peer Mentor Program–it pairs mamas currently going though a PMAD with someone who has already been through it before and you stay connected for at least 6 months.
- Need more PPD resources? Check out my other blog post here.
I’m hoping my transparency with my journey will be able to help someone else out there. Mental health is not talked about enough, and I feel the need to add a voice to the conversation for all the ones that are not happening. Maybe it’s a little bit repetitive, but for every person who has heard it, there’s another that still needs to hear it for the first time. It can be really lonely and scary going through PPD and feeling like no one else could possibly understand.
It’s true that each mama’s experience is unique, but please never feel that there aren’t other mamas out there who could empathize. You got this one in your corner, at the very least!
Wishing everyone a safe and happy holiday season!
xoxo,
Jas
