When Less Is More: Why Coming Off Antidepressants Is More Complex—And More Empowering—Than We Think

A woman in her late 30s meets with me over Zoom, unsure. “I’ve been on these meds for over fifteen years,” she says. “They helped—maybe even saved me—but I don’t feel like myself anymore. Is there a way off?”

It’s a question more people are asking. And one psychiatry is still learning how to answer well.

Historically, our field has focused on how to start medications, not how to thoughtfully help someone stop them. But that’s finally changing. A growing number of clinicians are turning their attention to deprescribing: the careful, person-centered process of reducing or discontinuing psychiatric medications when they may no longer be necessary.

This isn’t about being anti-medication. It’s really about being pro-person. And it’s about supporting the nervous system and the whole self—not just removing a pill.

Why Deprescribing Matters

Psychiatric medications have helped millions. But many were prescribed during moments of acute crisis—divorce, trauma, postpartum distress—and then quietly continued for years or decades. In some cases, that’s appropriate. But in others, it might not be.

Over time, patients describe feeling emotionally flat, chronically tired, disconnected from their bodies, or unable to fully access joy or creativity. Others experience loss of libido, cognitive fog, or subtle side effects they’ve learned to tolerate—but never really questioned.

When they try to stop, withdrawal symptoms hit hard. Brain zaps, insomnia, panic attacks, flu-like symptoms, crying spells. They’re told it’s a relapse. But often, it’s not. It’s the body recalibrating without the medication.

Why Withdrawal Isn’t a Straight Line

Antidepressant withdrawal—sometimes called “discontinuation syndrome”—can be intense. It’s also frequently misunderstood. Symptoms include:

• Brain zaps or electrical sensations

• Dizziness, nausea, or digestive upset

• Emotional lability, irritability, or crying spells

• Sleep disruption and vivid dreams

• Intrusive thoughts, anxiety, or depersonalization

  
  

These reactions don’t mean you’re broken or that your depression is coming back. They mean your nervous system is working hard to find a new balance.

Key Principles in Thoughtful Deprescribing

1. Go Slower Than You Think

Tapering is not flipping a switch. It’s rewiring the system—and the nervous system needs time to adjust. Faster tapers may provoke withdrawal symptoms mistaken for relapse. Slower, more flexible approaches are safer and more sustainable, especially for antidepressants, benzodiazepines, and antipsychotics.

2. Track, Pause, Adjust

Symptom tracking—mood, sleep, anxiety, energy, physical symptoms—helps you stay oriented. If symptoms spike, a pause (or small dose adjustment) may help you stay the course.

Tapering isn’t linear. There’s no shame in slowing down—only wisdom in listening to your body. For a lot of patients, this often becomes a practice in healing your relationship with yourself through self-compassion.

3. Support the Whole System

This isn’t just a brain-based process. The gut, immune system, hormones, circadian rhythm, and trauma responses are all involved.

Foundational support can include:

• Anti-inflammatory, blood-sugar-stabilizing nutrition

• Daily movement (even light stretching or walking)

• Sleep hygiene (dim light at night, consistent bedtime, nighttime snack)

• Nervous system work (breathwork, vagal toning, IFS, somatic therapy)

• Targeted supplementation (e.g., omega-3s, magnesium, amino acids)

Mindset and Emotional Work

Many patients begin tapering with a belief that they should be able to finish “in a few months.” That belief often leads to disappointment, fear, or shame when symptoms arise.

Here’s what helps:

• Expect the process to take time—six to eighteen months is not unusual

• Journal your experience—not just symptoms, but emotional shifts and wins

• Normalize “waves” (periods of symptom flare) and “windows” (relief)

• Use compassionate, non-catastrophic self-talk: “This is hard, but I’m healing”

  
  

Cognitive Behavioral Therapy (CBT) can be especially helpful here. CBT is a structured, evidence-based form of therapy that helps people identify and reframe unhelpful or distorted thoughts—like “I’m failing,” “I’ll never feel normal,” or “I can’t do this without meds.”

During tapering, it's common for old beliefs about worthlessness, fear of relapse, or internalized stigma to resurface. CBT offers tools to:

• Recognize these thoughts as patterns—not truths

• Replace them with more balanced, supportive perspectives

• Build confidence through small behavioral steps and mindset shifts

  
  

Whether done in individual therapy or within a support group, CBT can provide an anchor—especially when emotional waves feel overwhelming.

Support Groups Help—More Than You Might Expect

Deprescribing is deeply personal. But it doesn’t have to be lonely.

Support groups—whether peer-led or facilitated by a psychiatrist, therapist, or coach—can reduce fear and increase success. Research supports this: a 2021 BMC Psychiatry review showed improved outcomes for those in structured tapering communities. Lived experience forums like The Withdrawal Project and clinician-partnered groups offer:

• Validation and shared language

• Accountability and practical tips

• Emotional safety during tough weeks

• Hope from those who’ve walked ahead

  
  

Group-based support doesn’t eliminate the hard moments. But it makes them more bearable—and far less isolating. That said, support groups aren’t universally helpful.

They might not be the best fit when:

• Conversations become symptom-focused without tools or solutions, which can increase fear or hypervigilance

• Participants reinforce one another’s avoidance or despair, rather than growth and flexibility

• There’s a mismatch between group tone and individual needs—some people need calm containment; others may seek action and strategy

• A person is highly suggestible or anxious, and reading others’ difficult stories increases distress or self-doubt

  
  

In some cases, a structured therapeutic relationship—like 1:1 therapy with CBT, somatic work, or trauma-informed care—may feel more stabilizing than a group. As with everything in tapering, the key is individualization. Support looks different for each person. Remember that what matters most is feeling safe, empowered, and seen.

Where Ketamine Therapy Might Fit In

For some, tapering brings up emotional states that were long suppressed by medication—grief, trauma, existential fear. These aren’t necessarily signs of illness returning. They may be healing surfacing.

Ketamine-assisted psychotherapy (KAP) can be a powerful tool in this process.

• It can help people process unresolved trauma or grief

• It may offer relief from distressing symptoms without reinstating daily medications

• It supports neuroplasticity, allowing new patterns of emotion and behavior to form

• When combined with therapy, it deepens insight and emotional resilience

  
  

It's important to keep in mind that ketamine isn’t a replacement for a thoughtful taper. Expectation setting is key. But it can be a bridge—supporting stability and clarity during vulnerable moments, and expanding what’s possible in healing.

For Clinicians: Rethinking Maintenance as the Default

In psychiatry, we’re trained to aim for stability. Maintenance dosing often becomes the default. But sometimes the best question is: Is this still the right support at this stage of life?

• Has the original condition changed or resolved?

• Are there signs the medication is now numbing, rather than helping?

• Is there a new direction emerging—one that needs space?

  
  

Deprescribing opens up a different kind of conversation—one about identity, possibility, and agency. And it’s one more clinicians need to feel empowered to have.

Final Thoughts

Deprescribing is rarely straightforward. It’s not just about what dose to reduce or when to stop. It’s about walking with people as they navigate identity, emotion, and biology in real time.

Some people will stay on medications—and find real benefit there. Great! Others will choose to come off—and find their way through it with support, clarity, and self-trust. That's great too.

But when someone is ready to ask the question, “What if I don’t need this anymore?”—we need to be ready to help them explore it. Slowly. Thoughtfully. Together.

Sometimes doing less creates the space for something new to grow.

A kind reminder: This blog post is designed as a general guide. This is not a substitute for personalized medical advice, nor is a patient-physician relationship established in this blog post.