Separating SSRI withdrawal symptoms

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SSRI withdrawal symptoms are very complicated because they are primarily emotional in nature.  This makes diagnosing the difference between existing symptoms and those caused by SSRI withdrawal very difficult.  In withdrawal, it is the scale of emotions that define the problem.  Anxiety, depression, fear, even psychosis, are part of the normal human emotional spectrum.  In normal thought, all of these emotions come and go, but are regulated.  An irrational thought may float to the surface, but it is quickly dismissed as inappropriate.  During withdrawal, the normal regulation of thought is short circuited.  The control that we’re so used to exercising over our internal mental landscape disappears.  Rational and irrational thoughts hold the same weight in the conscious mind.  A healthy person who experiences an emotionally traumatic event still feels the full range of emotions, but is able to parse through them all and choose the appropriate response.  If he is cut off in traffic, all of the possible responses are available.  Ramming the car, cutting them off in return, speeding up, slowing down, tailgating, and ignoring the incident all surface in the mind of the driver.  Usually, a person will choose the most socially acceptable response.  It is the function of our higher brains to control our responses.  Withdrawal turns that process on its head.  Instead of evaluating the available responses and choosing the one that best fits into our internal social beliefs, the emotion with the most power overcomes the others.  A normally passive person may lash out in anger or fear during SSRI withdrawal.

One of the key tasks during SSRI withdrawal is to separate the emotions that are caused by withdrawal from those that rise normally.  Beyond the emotions themselves, it’s important to separate the scale of emotions as well.  Anxiety is a normal emotion, it is a programmed response to danger.  The difference during withdrawal is that the scale of anxiety is not regulated as it normally would be.  One of the complicating factors during withdrawal is that emotions have been suppressed during the period of SSRI use.  In a way, the drug takes over the emotional regulation task from the patient.  The patient is, in effect, relearning how to regulate emotions without the effect of the drug.  It’s almost as if the mind is cataloging what is required to regulate each emotion, one madness at a time.

There are several strategies that can be used to parse through the scale of emotions during withdrawal.  The least effective is to try to remember how you reacted to similar situations before starting the SSRI.  Memory is a tricky thing.  Trying to remember the scale of an emotion years later is even trickier.  Events and emotions tend to drift in our memories as we recall them.  Each time we recall an event, the memory is affected by our experiences.  We are essentially interpreting the memory based on what we’ve experienced since.  Memories are not stored in blocks like a computer hard drive.  Instead, different elements of the event are stored in different parts of our brains.  These separate elements are then gathered together to compile a composite memory of the event.  For example, the memory of a high school dance is separated into many different elements.  The smell of a corsage may be influenced by a trip to a garden that you took many years later.  When the memory of the smell is combined with the memory of the dance, you may unwittingly change the memory by combining elements of the garden into it.  Not specifics, your mind would immediately recognize garden elements intruding into the dance memory.  Instead, emotional elements of the garden trip may influence the way you recall the dance.  That is the pitfall in trying to remember your pre SSRI emotional responses.  Your memories may be influenced by experiences you have had since.  Also, since you were not specifically trying to capture your emotional responses at the time, they become more susceptible to memory drift.

Trying to gauge how other people respond to an emotional event is likewise very difficult.  Observing a person’s response does not give a good indication of their internal mental state.  It’s very hard to associate their external response to your internal state.  First, you are relying on your interpretation of their response.  Then, you have to compare how you feel to that interpretation.  Just like personal memories can be influenced, interpersonal emotional interpretations are susceptible to our own experiences.

The best method to parse out withdrawal symptoms from normal emotions is to practice mindfulness and self awareness.  Keeping a journal can help.  It’s really the ongoing experience of withdrawal that teaches the most about the differences.  Withdrawal symptoms come and go during the process.  As they wax and wane, your personal norm becomes more apparent.  Everyone has a different “normal”.  Pay attention to how you are feeling when your symptoms are slight, and apply that knowledge to the times when symptoms reassert themselves.  Most people who start taking an SSRI did so because of an existing condition, be it anxiety, depression, etc.  Separating that baseline from withdrawal is the goal of practicing mindfulness during withdrawal.  Pay attention to the rise and fall of emotions.  Don’t berate yourself if you overreact to a situation.  That’s very common in withdrawal.  Instead, use that experience to recognize what caused the overreaction.  That recognition and awareness will help you reassert the control that seems so fleeting during withdrawal.  As control returns, the worst symptoms of withdrawal should become more manageable.

In the long term, the mindfulness required to track withdrawal symptoms becomes helpful because you will eventually have to address the original symptoms that first prompted you to start taking an SSRI.  Being aware of emotional triggers and your response to them will provide more emotional stability as time goes by.  Not only can emotional self awareness provide relief from withdrawal symptoms, but it may also provide a method for managing underlying anxiety problems.