What's actually happening to Toby on This Is Us, according to a doctor
Does the show get antidepressant withdrawal right? And what can you do if you think a loved one is suffering? We break down the answers to both.
We’re only three episodes in, but it’s been a big season of This Is Us for Kate and Toby so far. (Spoilers ahead, so if you aren’t caught up, please head over to NBC.com or Hulu’s landing page for the show to watch the episodes before proceeding.) The show hasn’t been shy about touching sensitive topics, from binge eating to bulimia, adoption to IVF and now, antidepressant withdrawal.
We’ll catch you up. Kate seems to have rebounded from her miscarriage and is full steam ahead into the idea of trying again with Toby. It was an emotional blow when they discovered that they both have fertility issues (as do these 17 celebrities), Kate’s exacerbated by her weight, Toby’s by his use of antidepressants. Toby, ever the go-big-or-go-home romantic, abruptly stops taking his pills to help the process when in a turn of events, Kate is accepted for IVF by a doctor who previously said no.
What happens next is like watching a car crash in slow motion. It starts small. You see Toby having to ready himself for some interactions. He seems sad and introspective before gathering himself to face Kate and the others for the premiere of Kevin’s movie. But the situation quickly devolves. Yes, he seems to have hot flashes and shaky hands. That’s worrisome. But then he blows up at Rebecca who, for the record, is riding Kate pretty hard about her personal decision to undergo IVF.
It’s shocking and gut-wrenching, since he’s just trying to be a good partner for Kate, but is it accurate? Metro turned to Dr. Antonio De Filippo, Medical Director at Arete Recovery, a Delphi Behavioral Health Group facility to explain the reality of antidepressant withdrawal and to weigh in on what This Is Us did and didn’t get right.
“These are not typical symptoms,” Dr. De Filippo tells us of Toby’s hot flashes, shaky hands, mood swings and sudden aggression. Although he tells Metro those symptoms might manifest if a person has bipolar disorder and is not correctly taking their prescription, it’s not typical of other forms of depression. “In fact,” he points out, “they are actually side effects of the medication, especially if someone has too much serotonin.”
Antidepressants actually boost your number of receptors, and they in your gut as well as your brain. Dr. De Filippo got more specific with us, saying, “When you take antidepressants, you gain more receptors of the neurotransmitter that the drug is manipulating, such as serotonin.” So if you stop taking your medication cold turkey, “those receptors are left empty, which sends a panic signal to the brain.”
Dr. Filippo underscores the importance of always following your prescribing doctor’s instructions when it comes to discontinuing medication use and avoiding antidepressant withdrawal. Yes, like you probably suspected, they’re going to wean you off the medication slowly, but Dr. De Filippo notes that the speed at which they do this “depends on the type of the medication and its half-life.”
Speaking of Toby, did he do the right thing by flushing his remaining pills? We know he should have talked to his doctor and come up with a plan to lessen the dose, but is this the right way to get rid of extra medication? “Flushing your medication is generally not the best idea,” Dr. De Filippo told Metro. “The best thing to do with leftover medication is to give it to a medication takeback [sic] that the DEA does on occasion.”
Toby right after flushing his antidepressant medication on This Is Us. Photo: Courtesy of NBC
Unfortunately, the DEA only holds National Prescription Drug Take Back Day twice a year. This year, that’s on October 27 (the last one was in April 2018). You’ll have to locate a collection site near you, but they offer resources for law enforcement agencies that wish to host a collection site, so check those in your area as well. Don’t have time to track down a location one day out of the year? Your next best bet is to “put them in water and coffee grounds and throw them in the garbage,” Dr. De Filippo tells us.
If you think a friend or family member has stopped taking their medication and is suffering from antidepressant withdrawal, Dr. De Filippo says the best way to deal with it is to talk to them directly about their prescription use if your relationship allows for a frank discussion. “Confirm what is going on,” he urges.
You might even be concerned about the opposite problem: someone you love misusing or taking too much medication. In either case, Dr. De Filippo urges transparency. The doctor might have upped their dose, which changes their habits around taking the medicine. “If you are responsible for the loved one (such as in a parent-child situation) you can perform a pill count on a day-to-day or week-to-week basis,” he suggests. “If you are unsure, you can always let their physician know and ask for them to approach the patient with the problem.”
It’s not a conflict of interest for you to voice concern to their doctor. “Even if the physician cannot disclose information to you, you are always free to make suggestions and voice your concerns,” Dr. De Filippo tells us.
Now it’s just a wait and see on whether anyone in the Pearson clan talks directly to Toby about his medicine use or behavioral changes. Even if the symptoms don’t quite lineup with antidepressant withdrawal, it’s a serious topic, and we hope that real and fake families alike take it seriously.