# My Head Hurts: Reducing antidepressants *9 June 2025*  <br> **It's important to say, I'm not a Doctor. The following is my personal experience, please speak to your GP before you make any changes to your medication.** My head hurts. I'm trying not to look at the clock. It's still dark; early June in the UK, so maybe 3-4 am? The next thing that comes into my mind are the drugs. In the last six months, I've probably spent more time thinking about the drugs than anything else. I've become something of a Google expert on the subject. This tends to be the pattern: for a couple of weeks after reducing my medication, most mornings I wake with a headache, then usually I can't get back to sleep. I've always needed my eight hours, so the cumulative effect of getting only four or five, is beginning to tell. My social life has diminished to almost nothing. Up to this weekend, I'd met one friend this year. There's an irony, that withdrawing from the drug you take for depression restricts your life to such a degree it's difficult not to feel depressed. ## How I got here Late last year, I went to see my GP. My long-term IBS and the resulting constipation has been getting worse. The leaflet that comes with medication (the one you usually throw away) is titled *'Information for the user.'* Information for Amitriptyline 'users', is 4,000 words in very small type. In the long list under *'Possible side effects'* it says, can cause "Bad constipation, a swollen stomach, fever, and vomiting in 1 in 1,000 people". I'm pleased to say, I wasn't vomiting, but the connection seemed worth checking out. When the GP — who, for the record, is very caring—realised I'd been taking Amitriptyline for about 25 years, she looked visibly concerned. Never an emotion you want your doctor to portray. She referred me to the local Mental Health Team for some specialist advice. After a long assessment, and an interminable wait, they agreed with the GP. Yes, I should change medication. They just didn't want to commit themselves on what it should be! The sort of 'specialist' advice I could have given.  Back with the GP: Her Registrar, prescribed 40 mg Fluoxetine (Prozac to you and me). He said, take it for a couple of weeks and then stop the Amitriptyline. Taking both together, I immediately started experiencing some weird side effects, but as it was only a couple of weeks, I carried on. The day after I stopped the Amitriptyline, I felt as though my head was going to explode. I paced around for most of the night, taking painkillers as often as I could, but they had very little effect. Fortunately, it was the weekend and I didn't need to work. I spent the days on the sofa and the nights with little or no sleep. ### *"In hindsight, the prospect of a little constipation seemed quite pleasant!"* On Monday morning, I went to see the pharmacist. I explained I'd barely slept for two nights and couldn't settle. Apparently, the guidance says stopping Amitriptyline, without tapering, should be fine. The pharmacist suggested taking half a dose for a week and try again. A week later, the headaches were back with a vengeance and I still wasn't sleeping. I decided to go back on the original dose. My head made it clear it didn't like me messing about—I had a huge panic attack and the side effects seemed to get worse. In hindsight, the prospect of a little constipation seemed quite pleasant! Back at the surgery, I saw the GP, not the Registrar. She didn't like me taking the two drugs together, but wasn't sure what to recommend. She gave me another prescription for Amitriptyline and referred me to a psychiatric consultant. Which I'm grateful for, it seems to be the only option available, but I'm never going to get to see a psychiatrist. The waiting list is huge and, to be honest, I'd be wasting their time. This is a textbook case of where recent underfunding of the NHS will cost us all more in the long-run. A [recent report](https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2025/01/06/7.5-million-referrals-on-waiting-lists-doesn-t-include-mental-health-patients--cautions-rcpsych) by the Royal College of Psychiatrists said that there are 1.6 million people on mental health waiting lists in the UK. They went on to say: > “Mental illnesses can be treated effectively, particularly when they are identified early, but delays to care put people at risk of developing a more complex illness which can harm their long-term health and prevent them from being productive. Worryingly, the number of people waiting for mental-health care has risen by 29% over the last two years, with some waiting for two years or more". I am far from an urgent case, and I'm lucky to work from home; there are many mental health implications of long-term home working, but that's another post. Many days over the past few months I would have been unable to commute to an office. Enough, that, I'm sure, it would have jeopardized my employment. At that point, I stop paying into the system and start needing to take out. ## So what next? Taking both drugs together was just about tolerable. But I knew I couldn't continue taking the Amitriptyline long-term, especially mixed with Fluoxetine, which I'd now been taking for a few months. I imagined my neurons, settling in with the new cocktail, one I was going to have to disturb soon. [Dr Mark Horowitz](https://markhorowitz.org/), who wrote the book on antidepressant withdrawal, says, that antidepressants should be reduced by 10% of the previous dose. So, my 25 mg would be 22.5 mg, then 20.5 mg, etc. You can see the problem, drugs aren't available in infinitely smaller doses. I turn to the web and buy some milligram scales. For a law-abiding middle-aged man, even this online shopping seemed like a risky act. I imagine the Drug Squad kicking my door down at any moment (they didn't, btw). I knew the Amitriptyline needed to go, but we'd rubbed along OK; longer than many marriages. It was the Fluoxetine that was spoiling the party. Fluoxetine also comes in handy capsules. Opening those seemed less Breaking Bad, than crushing Amitriptyline tablets with the back of a spoon! However, out came the spoon and the aluminium foil and over a period of a few weeks, I reduced the Fluoxetine from 40 to 30 mg. But I couldn't ignore my ever decreasing stash of Amitriptyline; would the GP give me another script? Trust me, it's a great question to ponder at 4 am. ## Facing reality The NHS wasn't going to come charging over the hill to save me any time soon, I needed to bite the bullet. One reality of getting older is the realisation that you have to take responsibility for your own health. You may have a loving partner to help, but it's your responsibility. So, I've slowly been reducing the Amitriptyline. My head is far from happy about it and doesn't let me forget it. I recently dropped to 6 mg (still with 30 mg of Fluoxetine). I have enough Amitriptyline to give me two weeks between reductions. Not ideal, but at the moment manageable. I like to think, once I'm completely off of Amitriptyline and my head has had some time to settle, I'll reduce the Fluoxetine. I've been on antidepressants for so long, I don't know the real extent of my depression. But for the moment going from two drugs to one is the priority. I'll let you know how that goes! As I mentioned, [Dr. Mark Horowitz ](https://markhorowitz.org/) offers the most practical, professional advice I've found online. The academic papers are impenetrable, to me at least, but he has useful [links to newspaper articles.](https://markhorowitz.org/media-articles/) The UK mental health charity, [Mind](https://www.mind.org.uk/information-support/drugs-and-treatments/antidepressants/withdrawal-effects-of-antidepressants/), also has some good advice. Take care out there. Nigel <br>The next post in the series: [[My Head Hurts 2]]. <br> > [!Comments] > As yet, I don't have any way to accept comments directly on the blog. Feel free to [email me](mailto:[email protected]) and I'll post your comment below. > > If you want to email in confidence, that's also perfectly fine - just make it clear in the email.