Tapering from Antidepressant Medication

Prescriptions for antidepressant medication increased dramatically during the 2000’s.  Several years have passed for those people who began this form of treatment, most often from a visit to their primary care provider. One of the more common questions that I receive is about whether, or when, it is possible to taper off or discontinue them. This is a complex topic, one that requires more deliberation than can occur within this blog.  Here are a few basic points to consider if you are giving some thought to attempting to stop.

A few of the reasons I hear most often are:

• Some people wonder about whether long-term of medications might produce undesirable effects, or whether the treatment is still necessary.
• Others are reluctant to always rely on a commercial product for their well-being. This is accompanied by skepticism about whether profit motives make it attractive for manufacturers to inappropriately benefit from patients that take medications indefinitely.
• Often when medications were started, sometimes many years ago, there was no overt discussion about the duration of use. Back then, there was understandably more attention on immediate symptom control.  It was more important to think about starting, not stopping. So there may have been little knowledge or awareness about how to stop, right from the outset.
• Medication from a primary care office was an expedient solution at the time, but ultimately people made lifestyle changes as well – and these seem to have made more of a difference in the long term. Discontinuing medication might appear to be a natural step in the recovery process.
• Summary research (‘meta-analysis’) suggests that psychoactive drugs provide a shorter-term solution, while psychotherapy produces more durable results.

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Physical Exercise for Depression: 10 Reasons It May Help, and 10 Ways To Make It Work

Regular physical exercise can help combat depressed moods. You won’t see this in advertisements, because there’s no product or procedure to sell. It is one of those solutions that costs very little (mostly in terms of your time), and is largely under your control.

Studies (and studies of studies) have established the beneficial effects of physical exercise for depression – even in comparison to medication alternatives.

As little as 10-15 minutes a day can make a difference. It might only constitute a brisk walk – although sustained cardiovascular exercise is desirable, if your medical situation permits it. Recommendations for optimal levels of physical exercise range from 20-30 minutes 3 times weekly to 35 minutes of walking 6 times a week.

Why is physical exercise such a valuable tool for managing depression? There are multiple theories, and in fact, a combination of these probably apply:

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CBASP: An Option for Tackling Depression

To successfully tackle depression, it’s important to choose the best treatment approach. Depression is a prevalent concern, with the Centers for Disease Control reporting that about 9% of the US population are experiencing it over a 2-week interval.   Because depression exists in so many ways, there is no one-size-fits-all approach. The condition may be mild, moderate or severe, and it may be a longstanding or a recent problem. Sometimes it is made more complicated by the presence of other health problems, or by the destructive impact it can have on interpersonal relationships. Medication and counseling can each be effective, and depending on the individual, might be offered singly or in combination.

Cognitive Therapy has become one of the most-established forms of non-pharmacologic treatment. The cognitive-behavioral techniques that were derived by George Kelly and Albert Ellis over 50 years ago, were later refined by Aaron Beck and made available through self-help programs like Feeling Good. But since then, many other, more specialized approaches have emerged.

Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is one option specifically designed for people who have chronic depression. Sometimes these people will have experienced depression since childhood. Stressful interpersonal challenges can exacerbate their problem, making it necessary to form new skills that are better suited for negotiating the kinds of demands that adults often confront. Some of the best results using CBASP have been found when it is combined with an anti-depressant medication, with 85% of patients improving by 50% or more in one large study.

Depression is a pernicious but treatable condition, and individual success at tackling it may depend upon carefully selecting a treatment approach. If it has been a recurring problem, or present for a very long time, then CBASP might be on the options that is worth considering.