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.
James Heaney 