By Amanda Law, RN BSN CCM

It is 11:51 AM, and I am already frantic. In under 10 minutes, I have a final video interview for a senior learning and development specialist position, which consists of a one-hour panel interview with current department members, during which I will present a topic of my choice in nursing education for 15-20 minutes. My laptop camera won’t work; I’m having trouble getting my computer to connect to the Zoom interview. I have horrible diarrhea, and my face is visibly diaphoretic, melting off my newly applied makeup. How am I going to pull this one off? I am genuinely interested in this job, and I believe I am well-qualified for it. I have prepared for the interview, and my presentation is polished. I, on the other hand, am not ready. I am on day six of coming off duloxetine, and I am struggling. As a nurse, I understand the neurochemical basis of withdrawal; as a patient, I am living the consequences in real time. The time has come, I’ve most feared —the juxtaposition of my professional readiness and my physiological struggles, brightly highlighting a reality we often overlook in healthcare: the profound intersection of personal health experiences and professional responsibilities.  

I have been prescribed depression medication since I was 18 years old after ending an abusive relationship. I am now 41 years old. I am happily married to the love of my life, and I am a mother to two exceptional children whom I love dearly. I have a network of wonderful friends who not only encourage me but also hold me accountable. I am involved in community service work and serve as an active member and commissioned leader in my church. Yet, I now find myself in the final interview stage of the most significant career opportunity of my life, chemically restrained by a medication I no longer need nor want to take.  Instead of a difficult time in life, which should have included therapy with education on coping skills and potentially medication for a short period, I failed myself by blindly taking a drug for over 20 years that has no recommended safe discontinuation tapering schedule without severe withdrawal effects. I leapt at the hope serotonin norepinephrine reuptake inhibitors (SNRIs) gave me when I was 18. Still, now, I look at the beautiful life I have built around me and realize I am utterly handicapped by a medication I should no longer be taking.  

Anyone who has attempted to discontinue SNRIs understands the complexities of withdrawal symptoms (Horowitz et. al, 2025). The catastrophic mood swings, debilitating nausea and diarrhea, electric-like zaps all over the body, insomnia, and extreme fatigue had all but taken me and my family out for the last 6 days. Basic tasks, such as getting my computer up and running and signing in for an interview, seemed impossible. I was having severe panic attacks in public places I’d been to countless times. Discontinuing duloxetine even caused me to hear my own internal voice telling me, “Everyone can see you struggle, and they all know you can’t get your life together.” This judgmental internal voice silenced every other voice, and my own condemnation is all I could hear on a constant basis. I couldn’t even understand the feelings I had that were coming at me all at once- how could I explain them to anyone else if they did notice? How do I succeed without letting anyone know what I am going through? The fear of failure haunted me- and I hadn’t even started yet.  

I made it through the interview literally by the grace of God. It was my best interview I have had and my presentation on “Building a Resilient Workforce: Incorporating Mental Health Awareness in Training” was impactful. I sat through my own internal voice telling me I was going to fail and as difficult as it was, I forced myself to lean into my fear and vulnerability. I prayed for strength and grace and developed a new voice. I realized at that moment I had been listening to the wrong voice guiding me all these years. My resolve hardened to come off duloxetine and over time the symptoms have gotten easier to deal with. I was offered the senior learning and development specialist position, beating out 21 other applicants that day in my interview.  

I have learned so much through this journey, and for that I am forever grateful. I have learned that antidepressants, while lifesaving for some, failed me. For half my life I took this medication daily, even when it truly wasn’t needed. I used to frame this as a personal weakness- a sign that I had silenced my own voice. However, my perspective has shifted because I am learning that advocacy doesn’t begin with our patients; it begins with ourselves. Today, I am standing not only as a nurse, but as my own mental health advocate—dedicated to listening to my true inner voice, questioning the care I do not agree with, and ensuring these decisions align with my actual needs. 

Join us as we Innovate. Advocate. Celebrate Case Management.
While the official celebration runs October 12–18, we’re recognizing case managers all month long with inspiring education, CE opportunities, valuable resources, networking events, prizes, and more. Let’s honor the vital work of case managers and the impact they make every day! https://cmsa.org/about/national-cm-week/

Bio: Amanda Law, BSN, RN, CCM, is a Senior Learning & Development Specialist at Centene Corporation. She brings clinical and case management expertise in transitions of care, member engagement, and professional education. Amanda designs training programs that promote evidence-based practices and resilience among care managers. She lives in Heber Springs, Arkansas with her husband and two children, where she enjoys homesteading, sourdough baking, and building a warm community around lifelong learning.