Areas › Low mood and hard feelings › When everything feels flat
Discontinuation gets mistaken for relapse constantly, by clients and by clinicians. The mistake runs in both directions and both directions cost something.
Read withdrawal as relapse and a person concludes they will need the tablet for life, when what they needed was a slower taper. Read a real relapse as withdrawal and a treatment that was working gets abandoned. Ask when the last dose was, what the symptoms actually feel like, and whether this is the same low mood as before or something different wearing its clothes.
Qur’an and Sunnah
'If evil touches him he loses all hope and becomes despondent' (Quran 41:49). Hope collapses fast, which is why a bad few days after stopping deserves looking at before it is treated as the whole story.
لَّا يَسۡـَٔمُ ٱلۡإِنسَٰنُ مِن دُعَآءِ ٱلۡخَيۡرِ وَإِن مَّسَّهُ ٱلشَّرُّ فَيَـُٔوسࣱ قَنُوطࣱ
Man never tires of asking for good, but if evil touches him he loses all hope and becomes despondent
Qur’an 41:49read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
What the research says
A meta-analysis found that mindfulness based cognitive therapy added to usual care reduced relapse in recurrent depression, with the clearest benefit for people who had already had three or more episodes. That is evidence about preventing relapse, not about withdrawal. It is here because relapse is a real and quantified risk, especially with several episodes behind you, so neither explanation should be waved away when somebody feels bad after stopping.
Chiesa A, Serretti A. (2011). Mindfulness based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis.. Psychiatry research doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
Two different things can arrive at the same moment, so the question is which pattern the symptoms fit.
This one is still a draft. It is waiting on a scholar and a clinician to read it before it is published.
Near this one
The standing side-effect list is sexual difficulty, less appetite, an unsettled stomach, disturbed sleep and headache. Sexual side effects are common, and almost nobody raises them unprompted.
Depression is not one thing with one address. Fatigue, blank concentration, lost libido and the loss of pleasure do not all come from the same place, so it helps to name which one you most want moved.
With the fast acting treatments, the plan for what happens afterwards matters as much as the treatment itself.