Waking Up After 20 Years: My Experience with Antidepressants, Apathy, and Tapering
A Personal Look at the Challenges of Long-Term SSRI Use and Finding My Way Back
I was reading the New York Times website last night and came across this opinion article, which stopped me dead in my tracks. It actually discussed the often-overlooked challenges of long-term antidepressant use and withdrawal, issues I’ve experienced firsthand.
As someone who has been on an antidepressant for 20 years and finally tapered off in the 20th year (these last five months), I found myself wanting to advocate for those like me the article was talking about.
It resonated deeply because it covered issues I know all too well: the tough parts of relying on SSRIs long-term and the withdrawal process, which is often harder than people realize.
It highlighted a gap in understanding – while these medications can be incredibly helpful, the full picture of how they work, especially over decades, isn't completely clear. As the NYT noted previously:
Antidepressants are now thought to work at least in part by helping the brain form new connections between cells. Researchers aren’t exactly sure how increasing serotonin with an S.S.R.I. causes these synapses to regrow. One possibility is that the medications also increase levels of other brain chemicals, called growth factors, that help those connections form and spread.1
This lack of understanding translates into challenges in practice. My own journey involved family doctors who, while well-intentioned, seemed unprepared for the nuances and complexity of long-term SSRI management and safe tapering protocols.
I had been at the highest allowable dose of Zoloft for over four years (200mg daily) and found myself emotionally blunted and apathetic. I’ve felt like I’ve sleepwalked through the last 10 years of my life: work, weekend drinking to feel something, and repeat.
The article pointed out:
Selective serotonin reuptake inhibitors, or S.S.R.I.s (the most commonly prescribed form of antidepressant) were originally studied for short-term use and were approved based on trials that lasted only a few months. But people quickly began taking the drugs for extended periods. Now patients are likely to stay on antidepressants for years, even decades. Of those who try to quit, conservative estimates suggest about one in six experiences antidepressant withdrawal, with around one in 35 having more severe symptoms. Protracted and disabling withdrawal is estimated to be far less common than that. Still, in a country where more than 30 million people take antidepressants, even relatively rare complications can affect thousands of people.
Fear kept me on the medication for years. The withdrawal symptoms I experienced when I first tried to taper in my 20s were terrifying, and my family doctor at the time didn't seem to grasp the severity, suggesting it should be a quick, easy process.
The NYT author, a psychiatrist, echoed these challenges:
Like every psychiatrist, I have patients for whom antidepressants are transformative, even lifesaving. But I also see a messier, less advertised side of these medications. There are patients with sexual side effects that they hadn’t known could be caused by their antidepressants because previous doctors never warned them. I’ve had patients experience manic episodes or suicidal thoughts with specific antidepressants, and patients who no longer need to take the drugs, but suffer severe withdrawal symptoms when they try to taper off.
My first attempt to taper in my mid-20s led to a return of the symptoms that scared me right back onto the medication. Over time, the SSRIs positive effects seemed to diminish, leading to dose increases just to maintain an equilibrium.
What I’ve Learned
This past year, I’ve focused intensely on my mental and physical health in preparation for tapering off my SSRI. It’s led to profound realizations.
About Myself on SSRIs: The Slow Boil of Emotional Blunting
One of my biggest realizations was understanding the extent of my emotional blunting. It’s really difficult to explain. People ask, “How could you not know your emotions are blunted?”
I’ve thought about this a lot. How did I end up here? How have I gone years without recognizing the numbness?
The best analogy I have is the lobster in the slowly heating pot of water. Why don’t they try to get out as they’re being cooked alive?
They don’t realize the danger because the water temperature increase is imperceptible until it’s too late.
That’s what long-term SSRI use felt like for my emotions. I wasn’t able to notice the effects because my dose has steadily increased for over two decades—from 25mg, to 50mg, to 100mg, and eventually, 200mg.
Welcome to the boiling pot, Andy.
Another way to say it. If you haven’t felt deep emotions for many years, how are you supposed to know you haven’t felt deep emotions?
It’s a bit like asking someone when was the last time they felt the feeling of “awe” if they’ve never felt awe before. “How am I supposed to know? What does awe feel like?”
I’ve known for a long time I’m a very stoic person going back to my childhood. I wasn’t prone to huge emotional swings. So when the SSRI mellowed me out further, the gradual blunting wasn’t perceptible; it felt like an extension of my nature, making it even harder to detect.
What often gets minimized are the profound impacts that emotional blunting can have on a person’s life. They’re subtle, but they can have lasting effects.
Beyond Blunting: Discovering SSRI-Induced Apathy
As I was doing my research preparing to taper, emotional blunting didn’t feel like the whole story. It couldn’t describe the utter sense of indifference I felt to most things in life. No excitement, no deep sadness, just…existence.
It wasn’t until I saw the term “SSRI-induced apathy” while researching2 that it clicked. THIS was what described my emotions after many years on an antidepressant.
I spoke about this realization on TikTok along with what SSRI-induced apathy is:
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Imagine the cumulative effects of both emotional blunting and apathy on one’s life. Where does motivation come from if you feel indifferent, how can you cultivate relationships, pursue growth, chase your dreams, simply demand more from life? You can’t. And I couldn’t.
I’m not blaming the SSRI for all of my life’s struggles — that wouldn’t be accurate or fair. There are of course things I’ve needed to work on. But the apathy and blunted emotions made the personal work much harder.
This is why the NY Times article struck such a nerve for me. It felt like someone was finally lifting the curtain on SSRIs and acknowledging what many of us long-term antidepressant users have experienced—emotional blunting, apathy, and difficulties tapering off the medication.
Rethinking the Approach to Mental Health Care: Family Doctors vs. Mental Health Specialists
My recommendation to anybody now if you are struggling with anxiety, depression, apathy, etc. is to talk with your family doctor but get a referral for a psychiatrist/therapist. I would strongly advise you against walking into your family doctor’s office and letting them write you a prescription for an antidepressant or antianxiety medication unless you cannot function normally.3
In my experience, many primary care physicians aren’t equipped with the specialized training for complex mental health cases, especially regarding long-term medication management and tapering protocols. Their training often focuses on identifying symptoms and prescribing corresponding treatments – usually medication. This model might work for flu or pneumonia, but mental health is far more complex.
We now know that trauma can manifest in real, physical symptoms4. If you’re only treating the surface-level symptoms, you’re ignoring the issues beneath the surface potentially causing the symptoms.
This is the source of my pain and frustration with the care I received. “Here’s a pill. Follow up in a month.” There was little exploration of why I was anxious and how to build healthy coping mechanisms beyond medication.
SSRIs: Short-Term Relief vs. Long-Term Solutions
A crucial point for me: SSRIs are not long-term solutions. While they take weeks to actually work, they can provide relief for people really struggling to live a normal life. That is absolutely when medication can and should be used.
As mentioned in the NYT article, antidepressants were originally studied only for short-term use and there is still sparse research showing the efficacy and safety of long-term antidepressant use.
If your doctor prescribes an antidepressant but doesn't discuss a holistic, long-term plan for managing anxiety or depression (including therapy, lifestyle changes, etc.), I urge you to seek a psychiatrist or therapist who specializes in mental health.
Tapering Requires Expertise
Most family doctors, in my experience and from online accounts I’ve read, lack specialized knowledge in safely tapering patients off antidepressants, especially from higher doses or long-term use.
The first time I tried to taper off of an SSRI was in my mid-20s. I had just moved back into my parent’s house while I started full-time in an MBA program and I felt I had the support system to get off the medication.
Under my family doctor's guidance, I tapered off completely in a month after 5-6 years of use. It was disastrous. All my symptoms came back, including debilitating panic attacks.
I didn't understand then how complex tapering was, and neither, it seemed, did my doctor. This highlights why tapering should ideally be overseen by a mental health professional familiar with gradual dose reduction protocols (like hyperbolic tapering).
Be Your Own Advocate
If there's one overarching lesson, it's this: You must be your own health advocate. No one else will do it for you.
But what does this mean in practice?
It means doing your own research (from credible sources). It means preparing for appointments. It means speaking up, asking questions, and not blindly accepting the first recommendation.
Medical professionals are not bad people, by any means. But the system often incentivizes brief appointments rather than deep, holistic care.
Come prepared to share your story, your research, and your goals. Treat your doctor as a knowledgeable consultant, but remember you are the ultimate decision-maker for your health. If the first suggestion is medication, ask about alternatives, complementary therapies, potential side effects, the long-term plan, and the exit strategy (tapering).
Build Your Support Team
Advocacy also means building a dedicated mental health support team. Your family doctor alone is unlikely to be sufficient for complex mental health issues.
I would suggest finding a:
Therapist: A good therapist can help you understand the roots of your symptoms (anxiety, depression, trauma) and develop coping strategies.
Psychiatrist: If medication is deemed necessary (even short-term), a psychiatrist has specialized training in psychopharmacology, including managing side effects and overseeing safe tapering protocols. Many work collaboratively with therapists.
The goal shouldn’t be indefinite medication unless absolutely necessary. It should be understanding the underlying causes while using tools (which may include temporary medication) to help you function and heal.
Next: How I’ve Tapered Off My SSRI
Next week, I’ll share the details of my tapering journey: the preparation, the slow process, the supplements and lifestyle changes I incorporated, and the team that supported me. This is the guide I wish I'd had years ago. My hope is that it provides valuable information and encouragement for others considering their own path.
Disclaimer
This goes without saying, but I’m not a mental health professional or a physician. These are my experiences and my opinions, though I’ve done considerable amounts of research and have worked with multiple medical professionals in tapering off my SSRI.
Please work with a qualified doctor or therapist if you are suffering from anxiety, panic disorder, depression, or any other mental health issue. Don’t ever stop taking your antidepressant cold turkey as that is very dangerous. Only taper off your antidepressant under the medical supervision of a qualified doctor.
I first found this term in an article but I unfortunately can’t locate it. But do a quick Google search and you’ll find various patient forums and medical literature.
Medication can certainly help you in the short-term to function so you can go to work, take care of your kids, etc. if you currently aren’t able to,
A really good book on the link between trauma and illness is Gabor Mate’s The Myth of Normal.
Hi, Andy! This was such a good such article, I just recommended Above Anxiety, and thank you for being so honest about your journey! This is exactly the kind of content Substack wants and needs, especially since RFK, Jr.'s role as Health Secretary has meant a renewed debate about health and fitness! Excellent work! 🖤❤️
Important topic. I agree with you that a specialist in mental health should be involved. It also important to be working on the issues. Great article.