Dear Dr. Andrea,
I am a woman in my late 20s who was diagnosed with obsessive-compulsive disorder as a teenager. My biggest trouble spots were obsessions about something harming my loved ones or my family, often the idea that I would do something to cause that to happen. So I had a lot of rituals and compulsions and therapy helped a lot along with medication. I have felt stable for the past few years and have weaned down to a low dose of the antidepressant I was on, and I still check in with my therapist a couple of times a year for refresher sessions and to manage stress. My OCD itself is quite under control. I’ve been having a goal to get off the meds for good at this point in my life, and when the year started I decided this would be it. I still had it in mind even through the stay-at-home orders. I have felt pretty stable and my job is good, and although I am stressed more than usual like everyone is, I still want to stick to my plan. But it also sounds unwise to wean off medication for anxiety-related issues when the world is so uncertain and everyone is freaking out. Do you think it’s a bad idea?
— Ready to be off
The events of the past few months — both the pandemic with all its ripple effects, and also the tragic death of George Floyd at the hands of the police and the ensuing protests, which happened after your letter was written — have shaken American culture to its core.
And although it’s quite fashionable to say that we’re all in this together, that’s a gross oversimplification. Just as someone who has lost a family member to the covid-19 virus is experiencing something different than someone who has lost a job (and someone who has lost a job is experiencing something different than someone who is struggling with a lack of social activities), no two people are living through exactly the same effects, and the variation is wide. And that’s true in an even more stark manner when it comes to the systemic racial injustices being exposed.
So, don’t get caught up in what your path is supposed to look like given what’s going on. Look at what it actually looks like. You know yourself best, after all.
That said, there are definitely some things to consider. When you say you’re stressed more than usual like everyone else, how has that manifested? Do you have coping mechanisms that feel solid and functional? Would you recognize when you weren’t coping well, and what would you do about it?
I’m also curious to know the trajectory of the obsessions and compulsions themselves — whether they intrude at times even on the medication (which is expected), and how you are able to handle them when they do. What tools do you have in place specifically for those on a daily basis?
It’s also important to think about why you want to go off the medication in the first place. I’m not doubting the wisdom of your rationale so much as wanting to make sure that there aren’t extra pressures in there (like sticking to a certain timeline no matter what, or believing that the meds/off-meds variable says something about your self-worth) that are holding more weight than they should. If you view going off the medication as a step to take while you observe what happens, that is ideal — rather than a switch to flip that you shouldn’t ever go back from.
Of course, it would be helpful to discuss this with your therapist — it seems as great of a time as any for one of those semiannual check-ins. And it’s also a good idea to hear the opinion of the professional who prescribes your medication — and to take seriously any advice about the pace of weaning.
I’ll give you my gut instinct, though: You are wise to be mindful of the fact that this is a stressful time, but if you’re not actually struggling, and you feel like the same path still fits, then there’s no immediate reason to change course. Just stay honest with yourself. Have some specific markers to look for — and be willing to adjust your plan if need be, without viewing it as a defeat.