Adventures in Psychiatry: When to stop medication?

This is something I have been pondering a lot recently. Despite my decade of experience within this realm, making the decision that I am well enough to come off my anti-depressant has never been clear-cut. Yes, I have had months of stability since cutting my dose of venlafaxine in half - from 150mg to 75mg - so that in itself is a good indication that my brain is doing ok, however coming off venlafaxine takes months and it is akin to alcohol withdrawal in terms of the reaction it evokes. 

The sole reason I haven't approached my GP, who would have no problem in my decision to lower my dose again, is because I have been through the withdrawal from venlafaxine once before and it was hell. Simply put, I'm avoiding putting myself through it again because I have other stuff going on in my life and I can't be out of commission for a month while I'm stuck in bed throwing up, shaking and crying. 

I do want to come off venlafaxine, so much, but timing is a crucial factor. Life needs to be stable and good, I need to be physically strong enough to cope with it and mentally ready for the chaotic emotions that come with the hell of withdrawal. Granted, last time I stopped it cold turkey which was incredibly dumb on my part and definitely attributed to just how much I suffered, so maybe this time will be different but I'm just not sure I'm ready to take that risk just yet. 

There are a few things that have prompted this: I guess the primary one is that with our infertility referral in motion I am very aware that my being on antidepressant medication doesn't bode well for me in terms of what I will be offered compared to if I was medication free. While there is no evidence to suggest that venlafaxine is harmful during pregnancy, that is only because it is incredibly unethical to test which is fair enough. I am also painfully aware that even though mental illness is very common and those that need medication to function are no different to diabetics needing insulin, within certain medical specialties there is still a stigma around this side of medicine and it is entirely possible I will be treated differently and even told not to come back until I am off the venlafaxine. It wouldn't be the first time I've come across comments such as "if you're on antidepressants you're not well enough to be a mother..." and such...

Secondly, I'm pretty fed up with having to take it. It may just be where my thinking is at right now than anything else, but it's a reminder of just how unwell I got 18 months ago and I get stuck in the memories of that absolutely terrifying time in my life and I don't like it at all. I could do with going to therapy to process it more but I'd rather not part with £50 a week on something I just want to forget. I'm aware that's contradictory and makes little logical sense, but this is mental health we're talking about and more often that not there are some cognitive pathways that are in knots and produce this kind of stuff... 

Finally, it would be amazing to go back to university medication free but there is a part of me that does wonder if I should stick with the venlafaxine as a precaution, just to make sure that the chances of depression showing its face again are reduced during what will be one of the hardest academic challenges of my life! I don't know. 

Perhaps I can try to reduce in August and see how it goes. June is full of travel and July has a holiday with my friends - there's something I never thought I'd say! - and I'm hoping that I will be taking my driving test that month too so I certainly want my brain to be on my side. 

It's a tricky one. If I could offer any advice to anyone reading this considering the same thing, please just make sure you're well enough and prepared to go back to your old dose if it doesn't work out too well. 

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