Content warning: Mentions of suicidal thoughts
I have been taking antidepressants for nearly five years now, and though they’re infamous for their side effects there is just one thing I can’t get over. Weirdly enough, I’ve made my peace with the weight gain, mood swings and sexual dysfunction – rather beat depression than beat my… – but I’m always in fear of withdrawal. To be completely honest, SSRI withdrawal (Selective Serotonin Reuptake Inhibitors, the most common class of antidepressants) and its gruelling side effects has been, and continues to be, likely one of the most destructive aspects of my life. With a good GP, and a psychiatrist who knows the ropes, there isn’t anything to worry about, but I have had to experience multiple instances of withdrawal. It blows. I’ve also found that it is often not talked about: both by people who take antidepressants, and the doctors that prescribe them. This also blows.
I started off with seeing a school counsellor in Year 13 to help deal with my depression and anxiety, but they really didn’t help a lot. Eventually, I got to go to some professionals who were much more equipped to help with my issues, and I was given antidepressants for the first time. I was able to go to a psychiatrist who put me on fluoxetine (brand name: Prozac). This was one of the worst months of my life as I suffered from thunderclap headaches which resulted in me with my head down on my desk in history not wanting to move at all because the pain was unbearable. I became hypersensitive to everything around me and increasingly more anxious but most importantly, I still felt depressed. I then moved onto escitalopram aka Lexapro which honestly just did nothing at all. I felt like a shell of a human being. Finally, I got put onto sertraline aka Zoloft which I still take to this very day. It was only in talking to fellow SSRI enthusiasts that I realised my dose of 150mg is significantly more than others, who usually are on 50mg. This is probably poor dosing on their part, but when so much is unknown about depression and SSRIs, doctors seem to love a ‘go hard or go home’ approach to prescribing.
Most people on SSRIs that I talk to are in two camps: they don’t work, or they have saved their life. Luckily I am on the latter side, but it should be known that without therapy, the drugs would not help so much. Any health professional you talk to will mention that SSRIs and therapy should go hand in hand for the best result. Those who believe that SSRIs don’t work, mention that the drug made them numb, a common fear for those considering taking the drug. It’s a prevalent misconception that it’s the drug making you numb, when truly, that drug is not right for you. Depression is the body's response to one overwhelming emotion, and since the body can’t just bury one emotion, it shuts all of them down, leaving the numb feeling often described. What’s most important is to communicate with your doctor about how you feel so you can get better. When talking to one student I approached, Bee, she mentioned that when she switched from one medication to another, the withdrawals were not a good time for her. “Everything felt like it was shutting down. It was the most horrible two weeks of my life.” Bee was grateful that she has a doctor that listens to her concerns and keeps her informed about the side effects of antidepressants. “Some of my friends don’t even know you can’t have grapefruit or it’s dangerous to do shrooms or acid while taking them,” she says.
The biggest issue and the main reason I deal with withdrawals is because of lack of access. I will start to run out of my meds and it is hard to get an appointment at Student Health due to long wait times. And to be honest, the expense of booking an appointment just for a five-minute sit-down answering the same questions with the same answers is tiring and upsetting. Fortunately, I have the luxury of having grown up in Dunedin and of having a GP in Mosgiel, but for many students that is not the case, especially after graduating. Prescription medication is free if you have a Community Service Card or go to Chemist Warehouse (for now) – a plus for those students who do not have much money to spare, but otherwise it’ll set you back $5. When I have withdrawals, it means that I suffer from the brain zaps to an intense degree. For those not in the know, ‘brain zaps’ is a term for a common side effect that feels like it sounds: having a tuning fork struck against you. Often, I would need to grab onto something around me to not fall over. Frustrating, but not as bad as the overwhelming suicidal thoughts that come with it. Even when I do not feel suicidal, the removal of antidepressants means the intrusive thoughts start to kick in. If I did not have the support network that I do have, I would be a lot worse off.
In response to a Critic Instagram story asking for students to share their own experience, one student said they had been taking Escitalopram since they were fifteen. By age seventeen, they were doing a lot better – so they just stopped taking them. “Won’t do that again! Shit idea.” They said it made them “super dizzy” from withdrawal and caused them to lose their appetite completely. They then spent half of first-year without meds before going back on them. “Had a mental breakdown and ended up on Sertraline (so much better I feel like a real person).” They admitted they were “humbled pretty quickly” and noted how you should go to a doctor before cutting yourself off. So I did go to a doctor.
Dr Ryan Ward works for the University of Otago in the Department of Psychology as a lecturer and researcher. I asked Dr Ward questions about why people take drugs and how it affects them, specifically antidepressants and the effects withdrawals have on a person. He explained that SSRIs work by blocking the reuptake of serotonin in the neural synapse: “Essentially, this allows serotonin to remain active for a longer period of time.”
Prescribed by doctors for anxiety, depression and other mood disorders, antidepressants usually take 6-8 weeks to kick in, but sometimes longer. “The reasons for the time lag are unknown, but there is evidence that the brain takes some time to adjust to the changes introduced by SSRIs,” he told me. Some of the side effects of SSRIs go away after a few weeks once the body adjusts. These side effects include nausea, diarrhea or constipation, loss of appetite, headaches, dizziness, drowsiness, insomnia, increased agitation or anxiety, reduced feeling of emotion, restlessness, reduced sex drive and other sexual issues, dry mouth, sweating, and weight gain. It should be noted that these do not impact everyone on medication but are very likely. Yippee.
When withdrawals kick in can depend on which SSRI is being taken. All of them have different half-lives (a rough estimate of how long the drug is active in the blood). Withdrawal can begin as soon as one day after discontinuing use or can take as long as two weeks after – with symptoms fairly similar to those of taking the medication. “There are a number of common withdrawal effects,” Dr Ward explained, including dizziness, headaches, nausea and vomiting, flu-like symptoms, insomnia or vivid dreams, and brain zaps, relapse of anxiety or depression, irritability, mood swings, and confusion.
“Again, not everyone experiences all of the symptoms of withdrawal and they vary in severity depending on the specific SSRI, dosage, and how long the person has been taking it,” Dr Ward reiterated. He explained that there are small things you can do to stop these effects. “Taking pain meds for headaches, staying hydrated, practicing good sleep habits, and practicing relaxation techniques and increased mindfulness can help deal with withdrawal symptoms. Also talking to friends or having some sort of support network is helpful.”
Conclusion: it’s fucking grim. In New Zealand there’s a culture where it is expected that the person struggling needs to reach out, but that responsibility should also be with your friends, family, coworkers, and doctors to make sure you’re okay. It’s a shame that the burden is on the person who's already struggling. I would not be in the position I’m in if I didn’t have friends drag me along to counseling. Dr Ward even said, “At the end of the day it just comes down to the fact that we really don't have a good idea what causes depression and so we really don't know the best ways to treat it.” So for now we’re stuck throwing shit at the wall and seeing what sticks, but at least that’s progress. Psychedelics and ketamine see increasing studies for their potential in easing depression and anxiety symptoms, funding allowing. But until all those kinks are figured out, the best thing you can do is talk to someone you trust or a doctor.