Psychiatric Medication Taper and Insomnia

antidepressants drug side effects psychiatric medications rethink health tapering

Tears streamed down her face.

“I can’t take it anymore” she sobbed. “All of my old, stupid worries are back, and I haven’t slept in a month, and I feel like I’m going to crack.”

She was down to 3mg of the antidepressant citalopram and the journey thus far had been marked by the shift in mindset that I hold space for every time I meet a new patient. The shift from fearing to embracing, but this was a challenging window.

Never a meditator, an exerciser, or a foodie, she had resolved several decades of constipation, lost 12 lbs, reclaimed her youthful glow and libido all in the space of our first month of work together. She became a believer. Now strictly adherent to her long-term diet, meditating and exercising daily, and working with an energy healer, she had made the mindset shift through the direct experience of her own self-healing potential.

Her medication taper itself, thus far, had been highly empowering.

Accustomed to a dark night passage as a hallmark of the transformative power of psychiatric medication taper, I found myself wondering if there was more in store for her, as we neared her final 5 mg.

Ask anyone who has had the courage to offer themselves a psychiatric medication free chance at life, and they will likely tell you about their battle with sleeplessness during the withdrawal process.

There is the apprehension that sets in the moment your body hits the bed – here we go again – like some Sisyphean task that never works but must be engaged. There’s the middle of the night waking, and then if a few hours are mercifully granted toward the early morning, there is the morning waking to acute anxiety like there’s a machete being held to your neck.

Like so much in life, there are multiple narratives operative here.

  1. Antidepressants mess with sleep

It makes good sense, biologically, that coming off of antidepressants would require a recalibration from the disturbance to sleep that these meds induce. According to the Psychiatric Times,

“…class effects of SSRI therapy appear to include increased sleep onset latency and/or an increased number of awakenings and arousals, leading to an overall decrease in sleep efficiency.12,13 Virtually all of the SSRIs examined have been noted to suppress REM sleep.1 Clinically, reports of a change in the frequency, intensity, and content of dreaming can be associated with SSRIs, as well as the occurrence of these symptoms on discontinuation.”

  1. The taper is a stressor on the body

When you body has adapted, on a cellular level, to the complex stimulus of a psychiatric medication, tapering, even slowly, sets off alarm bells. This kind of acute stress can drive immune imbalance so that you become sick more easily and autoimmune illnesses flare. It can also induce functional impairment in thyroid so that your neurologic health, energy reserves, and metabolism are taxed. And then there’s the effect of the stress response hormone cortisol on our blood sugar, which can lead to middle of the night waking. It’s a difficult process all in the service of detoxification and regaining homeostasis.

  1. Insomnia is a form of spiritual challenge

Points 1 and 2 make good physiologic sense. But this third point is the one that most colors my speech when I sit with women who are in the thick of it. Psychiatric meds change consciousness in ways we don’t understand. They divorce us from our very souls, which may have something to do with how they drive impulsive suicide and homicide. As women come off of these medications, I watch them being born. I watch them waking up. I watch them reclaim themselves.

It strikes me as eminently possible, then, that insomnia is a built-in part of this initiation process for some. It is a special kind of spiritual challenge, perhaps cosmically designed to break down the part of you that needs to be left behind on the path towards a more authentic you. The part that needs to be in control.

Insomnia is, in fact, a direct and efficient portal to the alchemy of forced surrender. Insomnia pushes people to their absolute edge, but rarely over it. This may be because we have assigned sleep a special value in the Western world – it equates to our productivity (good, solid sleep equals better performance) which equates to our value – and if sleep is threatened, we feel the fear on an existential level.  Our neurotic minds drape the macabre scene of our impaired performance capacity with catastrophe and extremism.

How does one fall asleep? You don’t even know anymore!

What if I never sleep again?

I’m going to turn into a dysfunctional idiot and everything is going to fall apart!

How am I ever going to deal with tomorrow if I don’t sleep at all!

Breakthroughs happen when we turn toward our mind and say, Enough. I give up. I don’t care. And I’m not listening. When we surrender. When we raise the white flag of hopelessness.

In fact, this is why I have come to see expressions of suicidality as representing a desire for the old self to finally die. As the full surrender. And when properly supported, this hopelessness leads to transformation.

So here’s what I tell my patients if they hit patches of insomnia in their journey off meds:

Accept it

This is the cardinal rule. Say yes when you want to say no. Not, yes, like I love this! But yes, this is, in fact, happening. Imagine yourself to be an uninvested anthropologist with your headlamp on simply surveying the landscape. Witness and label. No preferences. No worries. No judgment. Only radical acceptance.

Get creative

If we are going to play with the concept of acceptance, then we might as well stop wasting energy on resisting. This reclaimed energy is of a very special caliber. In fact, when creatives experience insomnia, it’s often because something incredible can’t wait to be born from them. So use this strange window in your life to try out something audacious. Write stories. Paint pictures. Choreograph dances. In the middle of the night. You might find that some important insights await you in the fertile hours of this sleepless space.

Engage ritual

If you are honoring the sleep you may very well have taken for granted in the past, you wouldn’t make demands of it, you would bow down before it, right? So make a ritual before your bedtime. I recommend a “bedtime” of 9pm during this experience. Before then, you might take an epsom salt bath, diffuse essential oils, drink a sleepytime herbal tea, play some chill music, light some candles, or even self-pleasure. Make an ornate ceremony out of your courtship with your bed so that you can rebrand the experience your body has when it hits the mattress.

Double down on self care

It’s my belief that challenges and adversity are an invitation to get clear so that we can receive a message, insight, or life-changing intuition that will serve to guide us further along our path. In order to get clear, we have to quiet our bodies by honoring them. I never taper psychiatric medication without this month long protocol, but you’ll need to commit over and over again, each long day, to meditatingdetox, complete and total elimination of processed foods, refined sugar, alcohol, and coffee.

Honor your body’s rhythm by keeping the amber glasses on, your f.lux active, and only use candles after sundown. Consider a starchy snack like sweet potato with ghee and salt right before bed to keep your low blood sugar alarms from sounding.

In short, treat yourself really really well.

While some supplements can help calm your system, they can sometimes just reinforce the messaging that there is a problem here that needs to be fixed. Instead, I want to cultivate a mindset that works with the challenge. That says, ok, this is happening. And invites whatever latent gift might be within it to emerge.

Make room to fall apart

If ever there were a time to ask for support, it’s now. The process of coming off of psychiatric medication is a major, courageous leap into the wild unknown of the human experience. It is a rebirthing that deserves all the love, compassion, and home-cooked meals delivered that a baby’s birth would garner. Let your spouse, your roommate, your friends, your mom know that there may be days where you cannot do what your would otherwise do. Days where it just needs to all be let go. And that needs to be ok. This process is precious and cannot be treated like business as usual.

See this as your gift

There are many different birth canals from our many different sleeping wombs into many different welcoming arms. There are many ways to wake up from our slumber and take in the broader reality. If this is your challenge in this life, take it. Would you rather be the mother of a vaccine injured child regressed into chronic pain, speechlessness, and headbanging who now gets that she can’t outsource her agency to doctors, Pharma, and the government? It’s silly to compare struggles and tragedy, but it is helpful to maintain perspective at a time when your mind only shows you the darkness. There is a pearl in here for you and the oyster may threaten to poison you, but keep your eye on that pearl and envision how gorgeous it’s going to look on you, soon.

Thus far, I have never had a single patient develop permanent insomnia. Every single one of the women I work with, moves through this phase. It’s why I have come to believe that on a bedrock of high-level self-care, insomnia can be a spiritual challenge that can actually serve to liberate you further if you approach choose to work with it rather than fight it.

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About Dr. Kelly Brogan

KELLY BROGAN, MD, is a holistic psychiatrist, author of the New York Times Bestselling book, A Mind of Your OwnOwn Your Self, the children’s book, A Time For Rain, and co-editor of the landmark textbook Integrative Therapies for Depression. She is the founder of the online healing program Vital Mind Reset, and the membership community, Vital Life Project. She completed her psychiatric training and fellowship at NYU Medical Center after graduating from Cornell University Medical College, and has a B.S. from M.I.T. in Systems Neuroscience. She is specialized in a root-cause resolution approach to psychiatric syndromes and symptoms. Learn More