Areas › Low mood and hard feelings › When everything feels flat
Never come off an antidepressant on your own. The taper belongs to the prescriber, and for some drugs it needs to be slower and longer than people expect.
The moment to raise this is before anybody acts, not afterwards. If a client is feeling better and starting to think about stopping, that thought is worth saying out loud in the room, so the conversation happens with whoever prescribed it rather than in front of the bathroom cabinet on a Tuesday night. Knowing the risk exists and naming it early is your part. Designing the taper is not.
Qur’an and Sunnah
Of the three who stayed behind, the Qur'an says the trial ran until 'their very souls closed in around them', and then God turned to them in mercy (Quran 9:118). A hard passage is described as something a person is brought through, which is a reason not to walk into this one unaccompanied.
وَعَلَى ٱلثَّلَٰثَةِ ٱلَّذِينَ خُلِّفُواْ حَتَّىٰٓ إِذَا ضَاقَتۡ عَلَيۡهِمُ ٱلۡأَرۡضُ بِمَا رَحُبَتۡ وَضَاقَتۡ عَلَيۡهِمۡ أَنفُسُهُمۡ وَظَنُّوٓاْ أَن لَّا مَلۡجَأَ مِنَ ٱللَّهِ إِلَّآ إِلَيۡهِ ثُمَّ تَابَ عَلَيۡهِمۡ لِيَتُوبُوٓاْۚ إِنَّ ٱللَّهَ هُوَ ٱلتَّوَّابُ ٱلرَّحِيمُ
And to the three men who stayed behind: when the earth, for all its spaciousness, closed in around them, when their very souls closed in around them, when they realized that the only refuge from God was with Him, He turned to them in mercy in order for them to return [to Him]. God is the Ever Relenting, the Most Merciful
Qur’an 9:118read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
What the research says
A meta-analytic review of psychological interventions delivered before people met criteria for depression found they reduced the risk of a later depressive episode by roughly a fifth. Those were prevention trials in people who were not currently ill, not studies of tapering. The relevant point is that a planned stop is a moment when putting something in place has measurable value, rather than a moment to hope for the best.
van Zoonen K, Buntrock C, Ebert DD, Smit F, Reynolds CF, Beekman AT, Cuijpers P. (2014). Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions.. International journal of epidemiology doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
A gradual reduction gives the body time to adjust, which prevents most of the trouble that abrupt stopping causes.
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
Whether a medicine works can turn on something as ordinary as taking it with food or moving it to bedtime.
If a treatment reliably produces strange sensations, describe them beforehand. Expected strangeness is far easier to sit through than strangeness that arrives unannounced.
Ask what the behaviour does for them, and then ask how they would like to feel instead. Both questions open more than telling them to stop ever does.