Recent diagnosis and antidepressants

I’ve been on antidepressants for over 18 months (Sertraline) having been depressed on and off for 10 years. I’ve been very recently diagnosed as autistic (I’m 27) and I’m wondering whether I should come off the meds to try and figure things out better. Any thoughts?

  • As everyone agrees (pretty much) if you’re going to try to come off them then it’s so important to do it slowly and with the support of your gp. Did you see the recent episode of Panorama that was about anti-depressants? It talked a lot about coming off anti depressants and how challenging it can be. Some people were having to do it very very gradually to avoid withdrawal symptoms. 
    I admit that I’m biased because I had a really bad experience when taking anti-depressants so I’m not their biggest fan! But they do work for a lot of people so I think it’s very individual, everyone is different. Because I couldn’t continue with them due to severe side effects I had to find other ways to manage my mental health, and I feel grateful for the fact that I had to do that, because I understand myself better, and I’ve worked out some of the reasons, some of the triggers, and some of the things that really make a difference to my mental health in both positive and negative ways. My mental health issues had complex problems and they needed complex solutions (I’m still learning too). For example I had very dysfunctional parents and no drug was going to work that stuff out for me, I needed to understand what that did to me and how I could heal from it. 
    So everyone has their own unique situation. I wish you luck whatever you decide, because whatever works for you is what matters, not what anyone else thinks or feels. If you decide that you want to stick with the anti-depressants then that’s not a bad thing. Only do it if you feel ready, and good luck whatever you decide :) 

  • I had actually just tapered off sertraline in the couple of months leading up to my assessment and diagnosis, though at that point I was already pretty confident I was autistic. I would echo what others have said about speaking with your doctor, though I will also say that I only had to speak with mine once to set up a schedule for reducing my dose and it was absolutely fine managing the tapering-off/dose reduction process on my own.

    What I would say is that it's a good idea to start by figuring out things like sensory issues and meltdown/shutdown triggers so you can reduce those as much as possible before coming off the meds. I had already done quite a bit of that work just due to improvements in my work life and physical health, but it definitely helped to have a solid idea of what things had been autism-related anxiety triggers before. It makes a huge difference learning to tell the difference between anxiety and sensory overload, or between depression and burnout.

  • Always best to speak to your GP, but from personal experience, a GP cannot differentiate depression from burnout. I’ve had Sertraline for depression and it definitely got me out of a hole. However, I was strongly advised to take it again, but I was experiencing burnout not depression. They insisted it was depression. I know my body and mind, and refused. I had several courses of CBT, some of which were useful indeed. I didn’t need the medication. I feel better than I ever did now that I manage myself better (following diagnosis)

    If it’s working, why stop? If you feel you’ve made no improvement, or you’ve reached a plateau then talk about reducing your dosage and tapering off. And if you do, go very slowly. Slower than the GP will recommend.

  • I had bipolar when I just jumped off my meds, and honestly I don't think you need to talk to a Dr beforehand, or at least I didn't (but I had no choice I couldn't afford to be fobbed off by a Dr who doesn't actually live inside my head but could only go by what I at the time could only rudimentary at best communicate by spoken language, because the meds were making me worse https://community.autism.org.uk/f/mental-health-and-wellbeing/32415/do-antidepressants-work/301224#301224  ).
    You do need to let your GP know you have done this though (keeping your GP in the loop is not the same as asking their advice or permission) and schedule regular emotional check-ins, and you must not be isolated in your day-to-day, you need to have an active emotional support if you go off medication because the adjustment and re-adjustments can be rocky, something I was lucky to have and be able to pull myself out of bipolar depression "by my bootstraps".
    (Which some people make out is so easy, but it isn't, it is years of hard work effectively trying to CBT yourself and break out of the negative patterns yourself, you need to be really self aware and able to unpick your own emotions and thoughts in order to CBT yourself, so my route isn't something I'd ever recommend to anyone who is %100 alone, has alexithymia, or who just wants a qucik fix either.)
    I have made a full recovery long ago now obviously, but I wasn't an easy route and I can only offer that guidance for how I did it though. You are not Me. Ultimately you make your own choices, and must do what you feel is right for yourself.

    And actually as long as your meds don't make you absolutely dead inside and you don'y have alexithymia, could you try to CBT yourself a bit before you try and come off them? You'll need to at least get a reputable CBT self help book to do so. Because I don't know what you are like as a person I think you should build your foundations and safety net first. Because going off meds is like walking a tight rope, but no healing is ever linear, you do slip off and and you need to be caught if you can't pull yourself back up again and end up falling.

  • First of all, as others have rightly said,  don't come off without talking to your GP.

    That said, I realised/accepted my autism very late in life after years of treatment for depression and various antidepressants. Once I had accepted I was autistic and that what I had been experiencing was meltdowns and shutdowns, I was ready to come off mirtazapine. This I did very slowly under the supervision of my GP. After 3 months I am now off mirtazapine and able to manage my meltdowns and shutdowns with meditation exercises.  In particular I have been taught how to concentrate on my breath. This also depends on me realising I am approaching a crisis. 

    I must stress that this is my experience which may not be the same for others. In my case this was after I retired so without the stress of work.

  • I’m wondering whether I should come off the meds to try and figure things out better

    I would definately speak to your GP before considering this - coming off needs to be managed and controlled so that any resurgence of symproms that it was used to address can be tackled.

    It is not uncommon for autism to have accompanying conditions (ADHD, bipolar etc) so it really needs a doctor who knows about your original diagnosis for the drugs to review them in light of your recent autism diagnosis.

    I'm afraid it is a common issue for patients to want to manage their own medications without really understanding whether the condition this is used for is affecting their judgement. I've seen a lot of people who were bipolar go through this when they were having an episode and it rarely ends up not getting messy.

    It is up to you if you want to share the original diagnosis that led to the antidepressants - no need to if you are not comfortable in doing this.

    Good luck