Repetitive Thoughts in SSRI Withdrawal

It spins me round

SSRI withdrawal symptoms can range quite a bit.  There are physical symptoms, emotional symptoms, mood symptoms, and bizarre symptoms.  One of the more difficult symptoms to deal with are repetitive and recursive thoughts.  These are thoughts that keep repeating over and over again in the mind.  They can be about anything.  Sometimes, they feel like a dark mantra that won’t stop.

I talked to a person in withdrawal who repeated the same sentence for four hours.  “If only I could…”  It varied a little bit over time, but it didn’t really change for that whole conversation.  Repetitive thoughts grip your mind and won’t let go.  It’s very hard to break out of the mental cul de sac that they create.  Everything you try to replace it with inevitably leads back to the central thought.  Usually, the thought is a regret, or a memory.  It’s very common to critically review the past in withdrawal.  Somehow, the past becomes incredibly important and inescapable.  In our society, we grow up believing that the emotional and intellectual parts of the mind are separate.  “Mind over matter”, “Walk it off”, “Pick yourself up and go on”.  In reality, the intellectual and emotional parts of our minds are two sides of the same coin.  You can’t ignore one without damaging the other.

The first thing to do in combating a repetitive thought is to recognize it as one.  That seems like an obvious thing, but it’s not as clear in withdrawal.  Even irrational thoughts take on a certainty and weight that they wouldn’t normally have.  For a “normal” person, the memory of pulling a girl’s hair in kindergarten would be a passing regret.  In withdrawal, that regret becomes the centerpiece of an elaborate story about self inadequacy.  I was a terrible person for pulling her hair.  That has only grown as I have grown, and now I am the result of a lifetime’s worth of regret.  That’s the thought process in withdrawal.  It sounds remarkably like a diagnostic marker of depression, and it is.  That’s why withdrawal is often misdiagnosed as a new or existing condition.  The difference is that withdrawal is iatrogenic, caused by the drug, not a condition.

The thing that makes it hard to recognize a repetitive thought in withdrawal is that each step from the original thought feels natural.  The progression from the memory of pulling a kindergartener’s hair to a dark assessment of your adult life seems rational and correct.  We naturally filter out the more wild connections our minds are capable of making and don’t realize that something’s wrong when that check is missing.  In withdrawal, you need to make a conscious effort to moderate thought.  That’s not very easy when the thoughts are so persistent.

Breaking the cycle of repetitive thoughts is something that takes practice.  Being mindful of your thoughts is a frustrating thing at first.  It can feel like you’re just watching as things fall apart in front of you.  It’s important to keep trying to control those thoughts, though.  It starts with recognizing that a particular chain of thoughts is originating from withdrawal.  If you notice that the whole chain of thoughts keeps referring back to a single event to propel it, that is most likely withdrawal related.  It’s almost impossible to “discard” a whole chain of thought, but recognizing it can help in dealing with it.  Try to focus on something else, something with its own chain, like a story or a game.  It may not be in keeping with the societal norm of heroically overcoming a struggle to reach the happy ending, but the goal is to overcome, not to be a hero.

8 Responses to “Repetitive Thoughts in SSRI Withdrawal”

  1. Mindy Seguin Says:

    thanks James, very helpful.Happy Memorial Day!!!!!!!!!!!!!

  2. Mike Says:

    I can’t get songs out of my head during lex protracted withdrawal.

  3. Julian Says:

    This is really interesting – hadn’t even realized I was doing this until I read this article. I’ve been obsessing over 2 or 3 moments that have happened in the last 6 weeks since ceasing citalopram. I have no doubt they are important – they’re to do with the relationship I’m in currently and my fear that I’ve damaged it as a result of these 2 or 3 events where I’ve behaved irrationally. I think they have caused damage – but we’re still together and the relationship is very much fixable – I just need to put these memories in perspective and start to look forward not backwards….

    • npanth Says:

      It’s hard to contain the obsessive thoughts in SSRI withdrawal. The only thing I could do was keep reminding myself that the thought was propelled by withdrawal. Sometimes, that dissipates the thought, other times, it doesn’t. It’s gotten easier to dispel obsessive thoughts and anger as time goes on. It’s a combination of improved self control and a lightening of symptoms.

  4. Lilu Says:

    This is just brilliant. How did you come to realize this James? I’ve been noticing this pattern of reviewing everything that was said after certain interactions and conversations with people. The words keep playing in my mind in this feedback loop, as if I cannot stop reviewing, evaluating, and analyzing what I said and how they reacted. Usually it lasts one or two days after the interaction. And the only thing that helps is to distract myself with some other completely absorbing activity, like tv, or online research.

  5. Trish H. Says:

    I’m not sure how you got this insight into this part of the withdrawl process but from reading your articles, you are dead on the mark. Obsessive thoughts are part of the process and they haunt my mind on a regular basis. It’s difficult to stay busy enough to overrun the thoughts because I’m exhausted and dealing with other side effects of being free of all SSRI’s. I am happily clean of all mood altering drugs and it’s articles like this that keep me positive and let me know I’m not crazy and this is just part of the recovery process. I dismiss my bad thoughts because I know they are irrational and they are happening because my brain is trying to heal. It’s a struggle sometimes but there is hope and i can look back over the last two months and see great strides. I can only take one day at a time. Thank you for your insight and courage to write about something most people do not understand or want to understand.

  6. Laura Dee Says:

    Thank you, thank you, thank you.

    I’ve been struggling with withdrawal symptoms from Cipralex (Finland’s escitalopram) since my last cut (having read your blog I realize that 10 mg -> 5 mg was quite steep, however it was recommended so I went with it), but I had particular trouble with horrible, repetitive, mantra-like thoughts for weeks. I did suspect it was connected to my recent cut but I couldn’t find much at all on the Interwebs to help me. I’d get this incredible urge to say awful things to my wonderful partner who I share a home with (“I don’t love you”, “I cheated on you”, “I wish I’d never met you”), things that are ABSOLUTELY NOT TRUE AT ALL yet they’d repeat in my head like a broken record and feel frighteningly powerful and insistent. I’d also get urges to say similar things to my mother (she and my partner are basically the only two people I’ve regularly seen recently). I am so hurt and confused by these thoughts, not to mention ashamed. It’s like my brain wants to hurt these people who are doing their best to support me and it takes an incredible amount of willpower not to scream them from the top of my lungs.

    Eventually however the mental strain proved unbearable and I spent an entire evening sobbing about these horrors to my partner. I explained how I felt like there was a stranger in my head or implanted thoughts or… something, and I told him all the things that I was hearing/thinking, and I told him they weren’t true. I told him how terrified I was, and am. Terrified of this whole tapering process, terrified of what might be in store upon reaching the long-awaited and much-dreaded 0 mg.

    Turns out talking about those “false” thoughts and acknowledging their existence to him really helped quiet things down up there. My partner understood and reassured me that he knows that those words aren’t coming from me. Since that chat the “dark mantras” haven’t been nearly as deafening, and when they do crop up they’re easier to dismiss since I know that accidentally blurting out something horrid will be met with understanding and hugs instead of a break-up or whatever else I’d previously feared. Less stress. Makes dealing with all these other bast**d symptoms just a little less heinous.

    So uh, thanks again. I feel slightly less crazy again. Thank you.

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