Meta symptoms of SSRI withdrawal

Derail

SSRI withdrawal causes many symptoms, both physical and emotional.  In some cases, the emotional symptoms can combine to create larger symptoms, meta symptoms.   Renewed or new depression is one of the most common symptoms of withdrawal.  Depression is an inward emotion.  It forces the patient to examine themselves in an overly critical manner.  In that compulsive self examination, other symptoms can emerge.  It’s not the healthy self examination of mindfulness or self awareness, it is an uncontrollable focus on the negative.  The patient doesn’t see themselves in a mindful light, but through the dark lens imposed by the depression.  Even joyful memories are seen in that distorted way.

Regret and Guilt

The depression of withdrawal forces the mind to pick negative aspects out of any event and focus itself on that exclusively.  That single minded focus creates regret in the patient.  Many times, it is out of proportion to the event itself.  Regret and guilt are very similar to each other.  They feed on each other.  Withdrawal pushes the mind to see guilt in places that the patient normally wouldn’t.  Withdrawal depression narrows the focus of the mind to see only the negative in an event.

I only remember a few things from my 10th birthday.  My parents had organized a party for me and invited several friends to come over.  I had wanted toe clips for my bicycle for a long time, and was very happy that I got them for my birthday.  Being 10, I wanted to install them on my bike right away.  During withdrawal, the nature of that memory changed.  Instead of remembering the happiness of the event, I focused on the fact that my parents scolded me for installing toe clips instead of playing with my friends.

Compulsive memories

One of the symptoms of SSRI withdrawal is renewed memories.  While taking the drug, memories are largely suppressed.  Many patients report that they do not have a good sense of what happened to them while they were on the drug.  They know the larger arc of events, but many of the details are missing.  The emotional nature of memories is likewise suppressed.  During withdrawal, the emotional tie to memories is reawakened.  It doesn’t happen in a linear way, though.  Instead of recalling memories in an associative way, where one memory reminds you of another, memories flood into the conscious mind without context.  It can be profound or trivial, the only commonality is that the memory is not recalled, it is imposed on the mind.  It is a sign that the mind is reordering itself, cataloging memories and emotions into a new order.

For more than a month I couldn’t get the image of a fast food restaurant out of my mind.  I ate lunch there 2-3 times a week for a year, 4 years ago.  The restaurant didn’t have any particularly strong memories associated with it for me.  Every time I tried to go to sleep, though, the image of that Wendy’s just wouldn’t leave my mind.  There was no guilt or other emotion associated with the image, I just couldn’t see anything else when I closed my eyes.

Fear of relapse

At first, withdrawal is unrelenting and overwhelming.  The symptoms occur continuously.  As time goes by, symptoms begin to break up.  Withdrawal becomes a cyclical thing.  There are times when symptoms are severe, and times when they are light.  People call them Windows and Waves.  A window is a period where symptoms are lighter, waves are times when symptoms are more pronounced.  There is an inevitable fear that arises from feeling better.  It’s not intuitive to an outside observer, but it is a real phenomenon for the person going through it.  Withdrawal creates a mental relativism where the way you feel at the moment feels like a permanent state.  Combined with uncontrollable negative self examination, waves begin to feel “realer” than windows.  That breeds a distrust of windows.  There is always the fear that a window is just a prelude to another wave.  Windows and Waves are closely connected, they are part of the cycle of recovery in SSRI withdrawal.  There is some validity to that fear of relapse in the beginning.  Windows will revert to waves, just as waves will break up into new windows.  As time goes by, the windows become longer and the waves become shorter.  There is no point in time that the patient can point to when the severity of waves falls below the level of awareness.  It’s one of the subtleties of withdrawal that progress can only be measured once it has occurred.  You just realize one day that you haven’t experienced a wave in a long time.  The last window has just extended longer than the others, with no wave afterwards.  The fear of relapsing into a wave lingers, though.  It becomes one of the central thoughts during recovery.  Slipping into a wave feels like getting sick, just mental instead of physical.  It begins with a subtle feeling of instability.  It then progresses into more profound feelings of despair.  Waves are very difficult to deal with.  The entire context of the mind has been altered.  There is little memory of feeling better, just the emotions associated with the wave.  So, when the wave breaks up into a window, there is a legitimate fear of the next, seemingly inevitable, wave.  The inevitable thing about withdrawal is that recovery will happen, though.  Many people have experienced prolonged feelings of despair, even suicidal ideation, and recovered themselves in the end.

The best way to deal with the window/wave cycle is to recognize that it is occurring.  It’s difficult to think of waves as temporary phases in recovery.  Somehow, it’s easier to believe that the windows are the temporary phases.  Being mindful of the cycle between windows and waves helps.  Just as windows are temporary in the beginning of withdrawal, waves likewise become temporary as recovery progresses.  Think of the last time you started a new job.  At first, all the new information felt overwhelming.  It’s easy to think that you will never absorb it all.  You quickly become accustomed to the new routine, though.  Eventually, the daily tasks lose their overwhelming quality and become easier to accomplish.  Withdrawal is similar in some ways.  At first, it’s very hard to believe that it will ever end.  Eventually, you begin to reclaim yourself, and it gets easier the longer you do it.

2 Responses to “Meta symptoms of SSRI withdrawal”

  1. jon rees Says:

    I have been on a variety of SSRIs for nearly ten years now for obsessive compulsive disorder. At one point I realized that my emotions were dead, and I wanted to laugh and cry and experience life again. I also make a living with my brain as a PhD analytical chemist, and I needed my clarity and acuity back in my brain. Therefore, I began tapering off of Luvox CR 4 months ago, and have been free of the drug for 4 weeks. The clarity of mind, when it is there, is remarkably refreshing. I had forgotten what it was like to be free to think again. However, I am still experiencing the waves described in your post, and can only hope that they wane with time. I want to be me again, the way I was before the buffet of SSRIs were pushed my way. The fear of relapse is very real, and lurking around the corner. I am assuming this will be a months long process as my brain recovers from the assault of SSRI use, yet I take it one day at a time. The more mileage behind me, the less steep the road becomes. If you too are on the road to recovery from SSRI use, I believe it will be worth it.

    If you are thinking of going off of your SSRI, consider one thing. Read the list of effects that SSRIs cause in your body (I refuse to call them “side effects”). Here is a short list from the paxil insert: “anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania.” Aren’t these lists of symptoms you were taking the SSRI for in the first place? When you meet with your psychiatrist or psychologist (or most often both), are you treating your “illness” or are you treating the effects of the drug? How can you tell the difference.

    I would never give medical advice, and I am sure there is a disclaimer somewhere, but SSRIs don’t have to ruin your life. With good support such as that which npanth provides, I believe we can become SSRI free. I have read some of the other posts that npanth has written, and find them quite accurate and helpful. I wish luck to all, and at this time especially me!

    • npanth Says:

      Isn’t it amazing to feel that clarity return? I was astounded at the ways I changed when I got entirely off Paxil. I became creative and thoughtful in a way that I had completely forgotten about. It’s a bit insidious how the drug steals that away from us. When I reinstated on Paxil, it really felt like a blanket was lowering over my mind. It was like the description in Daniel Keye’s Flowers For Algernon. I could feel my mind slipping away into that grey fog again. As I’ve tapered, it has been slowly lifting, again. I can’t wait until I get off Paxil, again. It will be for good, this time. I need to taper slowly to avoid symptoms, though. It’s a Faustian bargain, but I think I will get the better of it in the end.
      It’s very hard to tell the difference between symptoms that are caused by the drug, withdrawal, and a pre existing condition. There will always be some doubt about some of them. the best way to approach it is to try to be mindful about the causes of what you’re feeling. If you can’t find a trigger to explain what you’re feeling, then it is most likely caused in some way by the drug.
      I never did more than a cursory study of the insert on my Paxil before I tried to stop taking it. I know I should have been more careful, but how many things in our lives do we take on faith or trust? My doctor said I needed this drug, put a prescription in my hand, and I started taking it. I didn’t start to question it until 10 years later. It didn’t dawn on me that many of the problems I had been struggling with for years were caused by the drug itself. The steady, clock like depression faded away. The excess weight faded away. I realize now that Paxil made profound changes to my personality and cognition. The drugs mask their effects on the mind, though. While the patient is taking it, they don’t realize that many of their symptoms are iatrogenic. I assumed that Paxil was keeping my steady depression from becoming chronic. I didn’t realize that Paxil itself was causing it.
      “The more mileage behind me, the less steep the road becomes” Indeed, that’s so true of the way that withdrawal works. I hope you feel better soon.


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