Hi there Parabolan - that is a relatively long time to have been on antidepressents! As you are aware Escitalopram is an SSRI and therefore has particular indications for depression and anxiety, as well as sometimes used in the treatment of OCD. If you feel that you are in a position in your life where these conditions or symptoms are no longer affecting you and you have overall general stability and wellbeing in your life then reducing or coming off your Escitalopram (with medical advice but also being allowed to make an informed decision) may not be such a bad idea. You may even notice positive effects such as an increase in being able to feel empathy as well as feeling less emotionally 'flat'.
I am shocked that your doctor said you shouldn't bother especially if they were initially prescribed for depression as a teenager and it's been longer than 25 years - I am assuming that you no longer feel depressed or anxious if you are considering discontinuing them.
It is definitely recommended to gradually reduce your dose of SSRI as OP has previously mentioned. You are much less likely to experience withdrawal symptoms such as brain zaps or rebound depression and anxiety if you slowly titrate down your dose. If you have been on them for more than 25 years then I would have thought there would be no rush to come off of them so make things easier for yourself and take it slow!
20mg of Escitalopram is approximately equivalent to 40mg of Citalopram which is a relatively high dose so I would personally reduce 5mg at least every four weeks (under medical supervision) and with that you should not experience too much discomfort at all. The length of time you have been on them really does suggest that you should gradually reduce your dose and you could even try remaining on a lower dose (say 10mg) for a short-term to ensure that you are remain mentally and physically stable before continuing to discontinue altogether.
You also mentioned that you "use and abuse" other medication "recreationally" and that is also something important to consider before discontinuing your SSRI especially if your pattern of use is impulsive, destructive and/or chaotic - only you can know if you feel ready and stable enough to reduce your SSRI without aggravating your mental health if other substances are involved... I hope I have managed to give you some helpful and informed insight.
The good news is that the withdrawal symptoms from SSRIs (when reduced gradually) are generally pretty mild and are usually nothing close to the discomfort or withdrawal experienced to that from opiates or benzo's - so long-term you have a pretty good chance to become and stay SSRI free given you no longer need the medication. I wish you the best of luck!
