The struggle of withdrawalDuring some of the worst periods of disequilibrium I experienced while I was tapering I consulted a very helpful blog hosted by a man named James, with whom I have remained in contact. James had an articulate and helpful way of explaining what was happening during these storms and it enabled me and many readers of his blog to help navigate them. James explained the struggle of withdrawal as experiencing “waves” and “windows.” He has graciously given me permission to highlight his material here:

One of the frustrating parts of withdrawal is the way that symptoms fluctuate over time. People call them waves and windows. At first, withdrawal is unremitting and there seems to be no respite from the symptoms. After some time, which varies from person to person, symptoms begin to break up into cycles. There are times when symptoms aren’t as bad, and other times when they are quite severe, which I call the wave/window pattern. It’s not a universal pattern, but it seems to be true in for the majority.

Waves

Waves describe those times when symptoms are more severe. Symptoms can be physical or emotional. It feels like getting sick. When you start to get a cold, you can feel little changes that presage the illness. A sore throat or headache, then the full symptoms of the cold start in a day or two. A wave has similar precursors. Usually, physical symptoms are the first sign that a wave is coming. A stiff neck, headaches, and dizziness are some of the symptoms. A day or two later, the emotional symptoms become more pronounced. These symptoms include obsessive or compulsive thoughts, depression, or anxiety. It can be helpful to break waves up into different parts. Knowing that each part of a wave is coming, and what to expect next, can make the whole process easier to handle. The reason we’re so adept at knowing the cycle of a cold is that we’ve had them off and on all our lives. We’re aware of the subtle changes in our bodies that tell us that we’re getting sick. In the same way, it takes some experience before you can separate the parts of wave from each other. It takes still more time to develop ways of dealing with each part of a wave.

Physical symptoms of a wave are hard to mitigate. There isn’t much you can do about general joint pain, headaches, or dizziness. You can try analgesics like aspirin or ibuprofen, but those aches are fairly resistant to those kinds of pain killers. Dizziness is likewise difficult to deal with. Withdrawal dizziness isn’t just something that happens when you stand up or spin around. It’s hard to believe that you can feel dizzy when you lie down, but it happens in withdrawal. Try to use the physical symptoms as a sign that there are new symptoms coming that you need to deal with.

There isn’t really any way to avoid the emotional symptoms of a wave. There is no way to “suck it up and get over it.” The anxiety, depression, and obsessions of a wave are just as real as the screen in front of you. The fact that our rational mind would recognize that it’s not real or overblown doesn’t mean much when you’re experiencing it. That’s the essence of a wave. It’s not rational. Obsessive thoughts can be about almost anything from the benign to the surreal. Self harm can suddenly seem like a rational plan.

In normal thought, the entire spectrum of emotions are right below the surface. When you’re cut off in traffic, you have several choices.  You can ignore it, respond verbally or visually, speed up, slow down. In withdrawal, thoughts that would normally be dismissed gain the same weight in our conscious minds as socially acceptable thoughts. The only way to mitigate the emotional symptoms of a wave is to be mindful of the difference between normal thought and the unnatural power of irrational thought that occurs in a wave. It’s very hard to pick apart which thoughts are your normal responses and which ones are caused by the wave. They mingle together in a chaotic way. That’s what makes your reactions to a window just as important as your reactions to a wave.

Windows

Windows are those periods of time when symptoms are not as pronounced. At first a window might even fool you into thinking you’ve beat withdrawal, you’re free. That’s the cruel joke of SSRI withdrawal. Windows and waves are intertwined together. The way withdrawal works for most people is that the windows slowly, ever so slowly, get longer, and the waves get shorter.  A window is more than a vacation from symptoms. It is a huge relief to have some time off from feeling miserable. Savor the good times in withdrawal, because that is what you have to look forward to in recovery. More than relief, though, windows are an opportunity to prepare yourself to deal with waves in a better way. Try to pay attention to how you feel.  Examine the way you think, the way you respond to things. Try to recognize the way that you automatically choose responses and thoughts. Emotionally, a window is a return to the normal way of parsing thoughts. Paying attention to the thought processes during a window makes it easier to impose that same kind of structure during the next wave. It’s that mindfulness that you’ll need during the next wave.  After a while, you can tell when a thought is out of character, and consciously dismiss it.

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