What If the Diagnosis Is the Withdrawal?

There is a question I wish we asked a lot more in mental health: What happened to this person before we decided what was wrong with them?

Sometimes what looks like a psychiatric disorder may actually be a nervous system in distress. I know this personally.

I’m Jenn, therapist and co-host of The Gaslit Truth Podcast, and in the three years I have been deprescribing Lexapro, I have experienced something that frightened me deeply. I had suicidal thoughts and homicidal thoughts. Thoughts that felt completely foreign to who I was. I knew myself well enough to recognize that these thoughts did not feel like me. My experience was that they were part of medication withdrawal.

That experience changed the way I think about the people who sit across from me.

It also changed the way I think about what happens when someone develops frightening symptoms after starting, stopping, switching, or changing the dose of a psychiatric medication. Too often, the immediate question becomes, What diagnosis explains this? But there is another question we need to ask first: What changed?

That is at the heart of our latest episode of The Gaslit Truth Podcast, where Dr. Teralyn Sell and I sit down with Sendil.

Sendil describes a journey that began with treatment for blood pressure and eventually turned into an escalating list of psychiatric medications: benzodiazepines, an SSRI, sleep medication, and an antipsychotic. Along the way, he experienced insomnia, racing thoughts, gastrointestinal distress, brain fog, sexual dysfunction, and suicidal intrusive thoughts that felt completely alien to him.

What struck me most was how quickly the crisis itself became the focus, rather than stepping back and asking what might have caused it.

Sendil describes being frightened by thoughts of harm and becoming afraid to be around his newborn twins. Imagine being a new father, horrified by thoughts you don't identify with, and then trying to figure out whether those thoughts mean something about who you are. That is an incredibly vulnerable place to be.

And this is where I recognize something from my own experience.

When I was coming off Lexapro and experiencing suicidal and homicidal thoughts, those thoughts did not suddenly reveal some hidden part of my personality. They were occurring in the context of medication withdrawal. That distinction matters. A frightening thought can easily become evidence of a psychiatric diagnosis when we don't carefully consider the medication timeline and the physiological changes happening at the same time.

A symptom is not an explanation.

Insomnia is a symptom. Anxiety is a symptom. Racing thoughts are symptoms. Intrusive thoughts are symptoms. Brain fog and sexual dysfunction are symptoms. None of those things, by themselves, tell us why they are happening.

So why aren't we asking more often: What medications were started? What was stopped? What changed? How quickly did the symptoms appear? Could withdrawal be part of the picture?

This is not an argument against psychiatric medication. It is an argument for informed consent.

People deserve to understand what they are taking, why they are taking it, what adverse effects may occur, and what stopping the medication might involve. They deserve to be able to ask questions and educate themselves without being treated as difficult or noncompliant.

And they deserve clinicians who are willing to consider that a medication may be contributing to the very symptoms they are being asked to treat.

Sometimes what gets called "doctor shopping" is actually a person searching for someone who will listen. Someone willing to look at the entire timeline instead of immediately adding another diagnosis or another prescription.

Sendil eventually found answers through patient education, peer communities, Medicating Normal, and learning about careful deprescribing. His story is not a prescription for what everyone else should do, and medication changes need to be individualized and approached carefully. But his experience illustrates something important: patients are capable of becoming informed participants in their own care.

Maybe we need to stop asking only, "What's wrong with you?" and start asking, "What happened? What changed? What came before this?"

Sometimes the answer will still be a psychiatric disorder. Sometimes medication will still be appropriate. And sometimes withdrawal, medication effects, physical health, nutritional issues, stress, sleep, or several factors together may be part of the story.

We need to be willing to look at the whole picture.

My experience coming off Lexapro changed the way I listen to people. I know what it is like to have thoughts that feel completely foreign to you and to wonder where they came from. I also know how important it is that we don't automatically assume those thoughts define the person experiencing them.

Sometimes the story behind the symptom is the part nobody bothered to investigate.

That is the conversation we're having on The Gaslit Truth Podcast. Check out The Psychiatry Trap: How One Prescription Turned Into 14 Psych Meds on YouTube!