Today Brooke Siem is here to talk all about her road to recovery after spending nearly half her life on antidepressants.
In this day and age it’s so important to talk about this kind of stuff. People take meds, it’s just the way it is. They can have a very positive impact, but when you decide it’s time to come off them, it’s important to do it in a safe, healthy, informed way. That’s what Brooke is going to share with us today.
She is a chef, author, Chopped champion, and we’re just so excited to have her on the blog today. You may have already met her when she was a guest on The Skinny Confidential HIM & HER Show where she dives deeper into her childhood and how she got started with antidepressants.
Let’s welcome Brooke to the blog.
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♡ Introduce yourself to The Skinny Confidential audience and tell us about MAY CAUSE SIDE EFFECTS.
Brooke Siem: My name is Brooke Siem and I’m 37 years old. Like so many millennials and Gen Z’ers, I’m a “career slasher.” Rather, I’m part of the modern tribe of professionals who, thanks to varied interests and the gig economy, work multiple jobs (and write books) in wildly different sectors.
I am a writer/chef. MAY CAUSE SIDE EFFECTS, which came out in September of 2022 is my debut memoir but second book. It’s about the year I spent in severe antidepressant withdrawal, all while traveling around the world. Antidepressant withdrawal is a common, very real phenomenon that varies in extremity. Some people experience mild discomfort while others end up hospitalized. Yet, it is largely ignored by the mental health and psychiatric community. I wrote the book because it’s the story I wish I’d had while I was going through hell.
I’m also the co-author of Prohibition Bakery, a cookbook based on my (now closed) boozy bakery in New York City. I’m also a Food Network “Chopped” Champion (Season 32, episode 6, available on Hulu), a 2014 Zagat 30 Under 30 honoree, a graduate of Middlebury College and the Institute of Culinary Education, and have written for The Washington Post, EatingWell Magazine, The New York Post, and more.
♡ Explain a little bit more about antidepressant withdrawal.
BS: First, it’s important for me to acknowledge that I am not a doctor and everything here is for informational purposes only. If you’re happy with your psych drugs and think it’s right for you, great. You do you. But not everyone wants to stay on them forever, and some people can’t stay on them forever. For those folks, it’s imperative that you consult with your physician before switching or stopping any psychiatric drugs.
That said, many prescribers are ignorant to the reality of antidepressant withdrawal and don’t know how to practice safe deprescribing. It may be necessary for you to do the research and educate them on the subject. A good doctor will acknowledge that they don’t know everything and commit to learning more about it in order to help you live the life you want. A bad doctor will dismiss your efforts, ignore the information, and maybe even gaslight you into questioning your decision to taper off antidepressants in the first place. If that’s the kind of doctor you have, fire them and find someone who will listen to you.
Now for the “explain like I’m five” version of antidepressant withdrawal: when you take an antidepressant over a period of time, the daily dose of chemicals prompts the brain to expect and adapt to whatever drug you are taking. In physiology, there are no free passes. Everything is a trade off. In the case of SSRIs (selective serotonin reuptake inhibitors, better known as Celexa, Paxil, Zoloft, Lexapro,and Prozac), their use leads to an excess of serotonin in the brain. Because the brain can’t process this overabundance, it compensates by shutting down serotonin receptors. SNRIs (Pristiq, Cymbalta, Effexor) affect serotonin and norepinephrine, and NDRIs (Wellbutrin) affect norepinephrine and dopamine.
If someone wants to stop taking their antidepressants for whatever reason or the dose changes, the body needs time to adjust because the balance of neurotransmitters and receptors is off. In some people, this adjustment period—antidepressant withdrawal—can cause a variety of mild to severe physical, psychological, and emotional symptoms including but not limited to low mood, sleep troubles, nausea, brain zaps, sensory overload, inner agitation (known as akathisia), hallucinations, violent intrusive thoughts, and severe mood swings.
Unfortunately, these withdrawal symptoms can last months or years and are commonly mistaken for a return, relapse, or emergence of another condition like anxiety, depression, or bi-poloar, which leads to misdiagnosis and often, more psychiatric drugs.
♡ What was antidepressant withdrawal like for you?
BS: It is thought that the longer a person is on antidepressants, the more difficult withdrawal can be. I found this to be true in my case. I’d been on these drugs since puberty, so when I saw a psychiatrist and started to come off them at 30, my body went haywire.
All of my senses intensified, to the point where I would start sobbing in the middle of the street because Manhattan was too loud. I struggled to wear clothes because the fibers felt like a million little needles on my skin. I had violent visions of hurting myself and others. I developed a stress induced autoimmune disorder called nodular vasculitis, where the blood vessels in my legs and arms constricted, creating dozens of tender, BB-sized lumps under my skin. I bent an ironing board in half out of rage. I stopped sleeping and struggled to regulate my body temperature (which is why I was sitting in the freezer in my bakery.)
From the outside, it literally looked like I was having a psychotic break…but I’d just been pulled off 37.5mg of Effexor XR, known as a “therapeutic” dose, too quickly.
♡ What can people do to identify and avoid antidepressant withdrawal, if possible?
BS: Not everyone experiences antidepressant withdrawal. Research shows that 56% of people coming off antidepressants experience some sort of withdrawal, with half of those people describing their symptoms as severe. That means about half the people who stop taking their antidepressants don’t have any issues.
That’s good news, except for the fact that there’s no way to know which camp you fall into. Because antidepressant withdrawal can be so debilitating, something called hyperbolic tapering is currently considered the most effective way to mitigate withdrawal symptoms.
♡ What is hyperbolic tapering?
BS: Hyperbolic tapering is a term coined by psychopharmacologist researchers Mark Horowitz and David Taylor and is applicable to all psychiatric drugs, from antidepressants to benzodiazepines to antipsychotics. The current guidelines recommend short, two to four week tapers, but research shows this isn’t well tolerated by patients. Horowitz and Taylor’s work determined that a much slower reduction—around a 10% cut per step down—is better tolerated.
For example, Pfizer only manufactures Effexor XR in 150mg, 75mg, and 37.5mg doses. Prior to Horowitz and Taylor’s work, if you’re taking 150mg of Effexor XR and want to taper down to zero, your doctor might prescribe 75mg for two weeks, 37.5mg for two weeks, and then you’re done. Any withdrawal effects would likely be assumed to be a relapse of the original condition, and in all likelihood, you’d end up right back on the Effexor XR or another drug (or two or three.)
With hyperbolic tapering, you’d make a plan with your doctor to start with a 10% reduction. Ten percent of 150mg is 15mg, so 150mg-15mg is 135mg. If you’re feeling good after a few weeks at 135mg, you’d cut out another 10%—13.5mg—for a total of 121.5mg. And so on down to zero.
Of course, Pfizer doesn’t make 135mg or 121.5mg capsules, so what do you do? Ideally, you get custom doses made through a compound pharmacy. Unfortunately, compound pharmacies don’t exist everywhere and can be financially prohibitive. In that case, people literally have to become their own drug lords, counting beads with tweezers, weighing on drug scales, and shaving tablets with a razor. It’s frustrating, tedious, and absurd that people have to resort to this, especially for a drug they were told was safe and had few side effects.
It’s also important to note that we’re still in the infancy of psychiatric drug withdrawal research. Hyperbolic tapering isn’t perfect and it needs to be tailored to each patient. Some people can handle bigger jumps, other people may only be able to step down a 1-2% at a time. I’ve even heard of cases where people can no longer metabolize their drugs at all and need to get off them ASAP to avoid further toxicity.
♡ Where can readers find more resources?
BS: My book, MAY CAUSE SIDE EFFECTS, was written to not only help people in antidepressant withdrawal feel seen, but to help prescribers and family members better understand what their patients and loved ones are experiencing. I hope it leads to more compassion and less misdiagnosis.
For more research-focused work, Pulitzer-prize finalist Robert Whitaker’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America should be required reading. Mark Horowitz also has all of his papers available for free on his website. Mad In America is another invaluable, research-focused resource. Physician and journalist Ben Goldacre’s Bad Science: Quacks, Hacks, and Big Pharma Flacks explains and reveals the not-so-secret underbelly of FDA drug approval (spoiler alert: it involves ghostwriters, data manipulation, and lots of money.)
For benzodiazepine withdrawal (can also be applied to antidepressants), The Ashton Manual, written by the late Dr. Heather Ashton, is a great place to start.
♡ What did antidepressant withdrawal teach you?
BS: More than anything, it taught me that happiness is a skill. I’d spent so many years depressed that I’d convinced myself happiness was something some people had and some people didn’t. I wasn’t one of the lucky ones, so why bother trying?
But antidepressant withdrawal was a crash course in following my instincts. Without these drugs numbing my emotions, I quickly learned what was and wasn’t good for me. Bad people, bad situations, and bad choices all flared up my withdrawal symptoms.
As I did the deep emotional work and went through the excruciating process of shedding all that was wrong for me, my withdrawal symptoms alleviated. It required leaving everything I knew and built—my Manhattan apartment, my business, even my beloved dog—and walking into a new life with no job, no plan, and few resources.
Without anything left in my life to blame my problems on, I had to face the reality that the constant was me. I was my own biggest problem. I decided this was great news, because all other variables were eliminated. I was the one in control. When I started following my intuition, my outer life became more aligned with my inner life, which in my opinion, is the definition of happiness. When I ignored my intuition, I created dissonance and discontent. It’s a constant practice, and one that I am still honing. But I can honestly say my life in the past seven years has been exponentially better than the fifteen years when I was medicated.
♡ What is your favorite meal to cook?
Ah yes, the important stuff. Because writers aren’t known for their riches, I still cook to pay the bills. My go-to meal is crispy, pan seared bone-in, skin-on chicken thighs. It’s super easy if you know a few tricks:
+ An hour or so before dinner, take the bone-in, skin-on chicken thighs out of the fridge and place them skin side up on a plate or cookie sheet. Generously salt the skin, (use more than you think you need) and let the chicken sit at room temp for at least a half an hour and up to an hour.
+ When you’re ready to cook, dry the chicken with a paper towel. The salt will have pulled moisture out of the skin, so patting it dry gets rid of the moisture and lets you wipe off excess salt.
+ Turn the oven on to 450 F and heat a little oil in a stainless steel skillet or cast iron skillet over medium heat. Put the chicken in skin side down. Now don’t touch it for a good 7-10 minutes. Cook the chicken low and slow and let fat render off the skin.
+ If you’re feeling extra fancy, you can add a bit of butter, a few crushed garlic cloves, and a couple sprigs of thyme to the pan. Baste the chicken occasionally with the herby, garlic-y drippings.
+ Flip the chicken when the skin is golden and crispy and put the whole pan in the oven to finish cooking. Thighs are done when a meat thermometer reaches 165 degrees. Serve immediately with drippings drizzled on top.
♡Where can readers find you and your work?
BS: I’m all over the internet @brookesiem and people contact me through my website, brookesiem.com. I am also available to guest podcasts and speak at events both nationally and internationally.
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We hope you found this post useful, whether you or someone you know might be ready to come off their medications soon. Just remember to always do your own research and consult with your doctor when it comes to this.
Be sure to stalk Brooke on IG and pick up her book to learn more about her journey.
x, The Skinny Confidential team
+ for more on med withdrawal, check out this post.
++ stalk these wellness hacks you can do for free, right now.
BROOKE’S BOOK RECS:
