This post is a second draft. The first draft was so self-indulgent that I deleted it out of spite. If the first one was deemed too much and this one has achieved a glowing acceptable, just imagine how much too much the first try was.
Dearest friends, relatives, and that one guy who likes everything I post immediately, making me sure he’s never actually read a blog of mine but just gets off on giving me a little bump of serotonin (big up),
Here it is, the next instalment in the series of very long and very depressing posts I intermittently use to curse your feeds. Today we’re gonna be discussing
and how much they can help and hinder in one’s journey to mental healthiness.
I wanted the word antidepressants to be glittery on a rainbow background but I don’t think that WordPress has developed that functionality yet.
First, though, a couple of notices:
If you hate the jokes I try to make (and who can blame you!) but love reading about how much I despise the inside of my eyelids, this link will take you to an archive of everything I’ve put on here about Living With Depression.
This post will contain references to depression, anxiety, suicidal ideation and self harm. There are currently no graphic sex references, but I may add some erotica or a tasteful nude later to undercut the misery.
I don’t think many people read this blog who don’t know me personally, so that trigger warning might be a bit pointless. Even so, I’m trying to get into the habit of posting warnings more consistently. I read something a few weeks ago that contained a graphic self harm reference and it really knocked me over – I wouldn’t like to do that to anyone.
When I wrote a very long post about depression a few months ago (this boy), I specifically avoided talking in detail about medication. I mentioned that I’d been taking Citalopram since I was a teenager, but I didn’t talk about its effects very much. As the post clocked in at an eye-numbing five-thousand-and-something words, it strikes me as an act of kindness that I refrained from adding even more blah.
That probably sounds disingenuous, and it is: when have I ever shied away from giving you, my beloved readerate, too much information to comfortably digest? There’s a reason my average sentence is sixty words long, and it’s not because I’m a genius. I had a couple of explanations as to why I decided not to spend much time talking about my relationship with medication, aside from the above lie about not wanting to bore you.
Firstly, I didn’t have much experience with meds and it felt wrong to disseminate information that could potentially be wrong. I still don’t have much knowledge outside of a few hours’ Googling and personal experience, but now that I’ve tried two different antidepressant prescriptions, I think that I have something slightly more interesting to say.
Even so, I’d like to underline that I don’t have any medical knowledge and that my experiences with antidepressants are certainly not universal or representative. In fact, one of the things I’ve learnt from my Googling and conversations with doctors is that people’s reactions to antidepressants and other neuroactive drugs are hard to anticipate. (More on that later.)
Please don’t take my perspective as universal, especially if you’re considering starting antidepressants.
Secondly – and I’m on the fence about whether theorising about your own neuroses counts as armchair psychology (a punishable crime) – I think I was afraid to specify what antidepressants I was taking. On a subconscious level, I was worried that defining my medication and dosage would quantify my mental illness and that people would look down on me for not having severe enough depression. I sometimes have a similar feeling when people see my self harm cuts/scars/marks – I worry that they’re thinking: All that fuss over that?
I told this to my flatmate once when we were having a semi-drunken heart-to-heart in our living room. He said, “That’s backwards,” which I think is the best response to something that’s so blatantly nonsense. “Yeah, that is backwards!” I said. Now when I catch myself thinking along those lines, I think “That’s BaCkWaRdS,” as loudly as possible. (Thanks, Aaron.)
Those are the two things that have prevented from writing about antidepressants in the past. I’ve been thinking about doing a post like this for a while now, especially over the last couple of weeks, when the effects of Sertraline have started to become more noticeable, and, in some cases, invasive. The transition from one kind of SSRI to another has given me a slightly different perspective on the whole sorry mess*, and what do we do when we have something to figure out? We write a very long blog about it!
*whole sorry mess is code for Ro Daniels’ mindstate
My relationship with antidepressants is quite long, which you would expect from someone who was diagnosed with depression checks watch five years ago. It was when I first started self harming that my mum took me to see the GP. My memory of that time, like my memory of most of the worst times of my life, is very hazy, but I remember that I was firmly against the idea of being treated for a mental illness. I think Mum had to all but carry me to the car, but I imagine that she had to all but carry me to lots of places, because I was limp and lifeless most of the time.
We went into the GP’s office together when my full name flashed up on the announcement thing. She wanted me to have a sense of ownership over my health so Mum sat down discreetly by the door and let me try to tell the doctor what was wrong. I could barely get through a
“Things have been really hard recently,”
before I started crying. To be fair, that is to this day the exact phrasing I use to describe the periods of time when I want to pull my skeleton out of my body, and it seemed to do the trick. Mum took over explaining what I meant by that while the doctor gave me some tissues and made me a cup of tea and got out a pack of leaflets about crisis hotlines and so on. That wad of leaflets is very familiar to me now – I get given one whenever I get a new GP or therapist or similar – but that was probably the first time I’d ever seen Samaritans’ branding.
Like loads of people, I had been very resistant to the idea of antidepressants. My mindset was causing me and everyone around me lots of pain, but it seemed wrong to chemically change the way I perceived the world. After all, I thought, this was what I was honestly experiencing, and I thought that taking antidepressants would put a filter over what I naturally understood, that it would distort the truth – I was sure that the things I experienced without medication were fundamentally more real than things I would experience with the help of artificial serotonin.
I told this to a friend of my Mum, who paused, and said, “No, it’s what the depression is telling you that isn’t true. The medication will allow you to see what’s real.” Now I understand that she’s absolutely right – that depression is a distortion, and my outlook on life when depressed is not more truthful because it occurs naturally. At the time, I was worried that people were trying to force me to see the world in an unrealistic way.
My trepidation wasn’t helped by the fact that no one seemed to know how antidepressants worked. I thought this was because the people I was talking to were inherently lazy and didn’t care enough to do research about the drugs they were pushing on me; however, having tried to do some research about drugs on my own, and having spoken to even more GPs/therapists/misc. mental health professionals, I now understand that very little is actually known about neuroactive medication.
I don’t feel like I made the choice, when I was 18, to start taking antidepressants. I was by no means convinced that they worked. Still, we left the GP that day with a prescription for 10mg/day of citalopram and a bundle of leaflets about what to do if you wanted to commit suicide. (As in, leaflets about who to call, not tips.)
I stayed on citalopram from when I was first prescribed it when I was 18 until three months ago. We started at the lowest possible dose, 10mg, before increasing to 20mg and then 40mg a day. For a short period of time we lowered the dose back to 20mg to see if it would help make me less drowsy, but the reduction coincided with a more difficult period so we raised it to 30mg and then all the way back to 40mg.
Citalopram is an SSRI or Selective Serotonin Reuptake Inhibitor. It’s among the antidepressants GPs are most confident prescribing because it has relatively few side effects and seems to work well for most people. I had a look at the NHS page about SSRIs to make sure I’m not spouting bullshit, and it seems to confirm that no one really knows why they’re effective:
It’s thought that SSRIs work by increasing serotonin levels in the brain.
The page goes on to say that increasing the levels of serotonin in the brain has been observed to correspond with a reduction in the symptoms of depression.
My experiences with citalopram were mixed. On the one hand, I do think it helped level me out and mitigated some low mood. Another positive is that I experienced very few adverse side effects on citalopram, apart from drowsiness. On the other hand, it didn’t prevent me from feeling shatteringly awful at times, and the consequences of missing even one pill were brutal.
That sounds unbalanced against citalopram, but when you’ve been depressed for a while, being levelled out is meaningful. When the dosage was first increased to 40mg, which was the level that helped me the most, I remember waking up one morning and lying absolutely still in bed, enjoying the sensation of being OK. All of the fuzzy background noise and itchy thoughts and aching emptiness had cleared out of my skull and ribs and I felt luxuriously empty. I felt able to experience the world around me in a more rich way than I had for ages.
The euphoria at feeling OK didn’t last all that long – I quickly started to take it for granted. Citalopram raised my base level from dreadful to alright, which allowed me to participate in society and to do things. It definitely changed my life, but it didn’t eliminate my symptoms of depression or prevent me from experiencing suicidal thoughts on a regular basis and the compulsion to self harm almost constantly.
Forgetting to take a dose of citalopram could be quite serious, even if I missed a single one. I don’t know how much of this was placebo, but my mood would plummet, leaving me too low to put on socks. I also regularly experienced something my doctor called “brain zaps”, the sensation of electric shocks in your body and head. Again, we don’t know what causes these, but they suck. They’re uncomfortable, and if you associate them with being depressed, they make it hard to distract yourself from feeling down. I’d occasionally get brain zaps at the end of a long or stressful day – my pet theory is they’re a symptom of all the extra serotonin runnin’ around my brain being used up.
It’s probably natural that I most often forgot my antidepressants when I was feeling great, but this somehow felt especially unfair. My joyful moments felt far and few between, and were often marred by a comedown that you’d be unlucky to get after a serious night of partying, as well as the proverbial electric chair.
After I had my infamous new years’ 2019 mental breakdown, I spent more than the usual amount of time opposite a doctor or mental health professional. I think that part of the reason I had such a crash last year is because I’d been horribly ill for a few days and hadn’t been able to keep down water, let alone citalopram. However, medical professionals, my mother, and I were all disappointed to note that my mental health didn’t return to its pre-breakdown levels even after citalopram had been back in my system for a long time – even though I had started psychotherapy. This was a concerning sign that citalopram was no longer working for me – if it ever had.
Mental illness is tricky because it’s hard to define a metric by which to measure how someone’s feeling. When the GP prescribed me citalopram back in 2014, she* said that in four to six weeks I should be feeling more positive. I definitely did feel more positive. But did I feel enough more positive to suggest that citalopram was the ideal drug for me? It’s hard to say. It’s also tricky for people who’ve suffered from depression for their whole adult lives, because it’s hard to know what constitutes a healthy experience – so how do you know what you’re aiming for?
*that’s right, the GP was a woman all along.
After talking to my GP, a therapist, and my brother, it seemed like it was time to try a different drug. The process of changing from one antidepressant to another is not straightforward. For one thing, the GP can’t know which antidepressant you’re going to respond better to, so it’s a gamble that you’ll feel any better than on your current medication. For another, you can’t just stop taking one kind of drug and start another; my experiences with brain zaps after missing a single dose proved that. If I cut citalopram out in one fell swoop, I risked being zapped to oblivion. For a third thing (if a third thing were needed), antidepressants typically take a few weeks to be effective, meaning you can experience a relatively long time of not being medicated to the ideal level – first when you reduce the dose of your original medication, and then when you begin your new one. It did not promise to be an easy time.
We decided to wait until I moved back to Sheffield to start this process. Although I’d be dealing with the not-insignificant stress of moving country, starting uni, and meeting lots of new people, I would be much closer to a support network that could intervene if things began to look too zappy. Accessing help would be easier than in Prague: my mum lives an hour away – the university provides a lot of pastoral care – they speak English at A&E.
Not necessarily the best time to switch meds, but certainly the least worst time.
The alternative we plumped for was sertraline, the next in the family of SSRIs. I asked the GP whether it was useful to try a drug that was in the same family as the one we were rejecting, but she said that some people react differently to similar medications. We don’t know why.
I had to continue taking a reduced dose of citalopram for a week, and then begin taking sertraline alongside citalopram for a week, and then switch to just sertraline.
This is a very complicated system and I am a renowned idiot.
It’s no surprise, then, that I instantly fucked up and started taking double the dose of sertraline I was supposed to – I had it in my head that I was supposed to be taking two pills: first two 10mg citalopram pills, then a 10mg citalopram and a 50mg sertraline, and then two 50mg sertraline tablets. In actual fact I was meant to stay on one 50mg sertraline a pill a day.
Inadvertently doubling my dosage of sertraline really did hit home for me how important it is to listen to your doctor carefully and write down everything she says*.
*or “he says”. It’s 2019. Men can be doctors, too.
I only realised my mistake when I gulped down the last two pills in a strip, reached for the next one to put by my bed, and saw that the box was empty. Panicky, imagining having to deal with withdrawal symptoms from sertraline as well as my scheduled withdrawal symptoms from citalopram, I got an emergency appointment with a doctor I didn’t know and was given a new prescription and an understanding smile.
In the few weeks I’d been illegally taking 100mg of sertraline, I’d been shocked by how quickly I’d felt its effects. They hit me suddenly. One day I came home from uni and felt so exhausted that I lay down on the rug downstairs without taking my shoes or backpack off. I’d been feeling drowsy all day, but this was something else. I felt physically numb all over and a little high. “Holy shit, it’s working!” I said out loud. “What?” said my flatmate, who was sitting with his headphones in. I couldn’t feel my toes. I crawled (literally) to my bedroom and slept for hours. When I woke up, my mind felt like a smooth flat stone. My body was heavy and tired, but I didn’t mind: I was so relieved not to feel depressed.
My whole life, even when I was little, I’ve had a recurring fantasy that one day I would sneeze blood or something and have to be taken to the doctor’s, and that the doctor would scan my brain and see, like, a worm or a bug or a gnome living there fucking shit up.
And the doctor would say: “What’s that doing there?!” and take it out. And when I woke up from anaesthetic I’d suddenly — be — normal. All of my anxieties, the heaviness in my bones that made it hard to get out of bed, all of the things that made me feel different from other people would be gone. I would be effortlessly OK all the time; I wouldn’t have the barriers to communication I’ve always felt; I wouldn’t be the self-conscious burden who found everything so difficult, even the things everyone else could do easily. And I would think: “Ohhhh, it wasn’t my fault. I had a brain gnome.” And that would explain it. And I’d be fine.
For a couple of weeks, I thought sertraline might be the proverbial gnome-removal-service. I thought I would be normal, OK.
Now that my body has started to get used to sertraline, I can compare it to citalopram better. I think that sertraline helps me feel less depressed than I did on citalopram, but the side effects are pretty gnarly. The initial wave of SSRI-numbness was so lovely that I got my hopes up that that would be what life would be like from now on – but just like with citalopram, that euphoria has been short lived.
I would say that sertraline has improved my mood on a day to day, but it hasn’t prevented occasional very severe bad days – as my family, housemates, and local medical professionals can attest. Maybe this is to be expected when I’m on a relatively low dose – maybe the medication can filter out the slightly-bad-feelings but can’t cope with the very-bad-ones. Maybe that’s how SSRIs work.
The doctor warned me that I would probably feel increased anxiety as I changed medication, and for a while as I was getting used to sertraline. I wasn’t phased by the prospect – I thought I knew what anxiety felt like.
Oh, man. It’s been really shit.
I am so easily stressed that recently I’ve been considering it a success when I can sit in the same room as someone. I’ve always been a little bit socially anxious, but this is next level – I’ve been panicky and overwhelmed at most social events I’ve been to, and it’s hard to resist the temptation to self-medicate, especially when being slightly intoxicated seems to take the edge off.
It’s manageable when I’m with someone I especially trust and feel comfortable with and the environment isn’t too intense, but even then, a very slight thing can make me spiral. When feeling anxious, colours have been sharper, sounds have been louder and hurt my head, and physical contact has felt like an attack. When I’ve met people unexpectedly over the last few weeks, I’ve been so flustered I’ve struggled to speak. Uni has been difficult.
This is a fucking drag. I really like people (usually) and I (usually) enjoy being around them, even if I feel awkward. This is especially true of the people I know in Sheffield, who are all gloriously friendly and (usually) a joy to be around. I feel like I’ve lost my ability to walk, or something.
I should probably just say to people, “Hey! I’m feeling extra anxious. I’m not avoiding you on purpose,” but I don’t want to because thinking about having that conversation makes me want to set myself on fire.
The aftermath of seeing people has been really hard – it feels like something that I have to recover from. Even after relatively successful interactions with people I know and like, I’ve felt compelled to self harm.
Quite a significant exception to this is that last weekend I went to a party and had a really good time for a few hours. I think this was manageable because I was with some of the best people I know and because I’d been drinking, and looking back it was a pretty pretty good accomplishment.
Despite how pleased I am with how that went now, directly after I felt like an incredible failure because I left early; and I lay on my bed and thought through everyone I knew and liked at the party and thought about what they must think of me and how much they must dislike me and what a worm I am. Looking back, I’m ashamed to have thought that way, because these are some of the nicest, most sound people I know, who go out of their way to make me feel welcome and comfortable. Like, genuinely notice when I’m looking nervous and look after me. At the time, though, the idea that I was universally despised (and for good reason) felt very real.
Anxiety aside, I’ve experienced some grim physical side effects with sertraline, like weight gain, reduced ability to orgasm, and sleeplessness. Honestly, I’m most annoyed about the middle one. Who needs to be rested and thin when you can cum?
All of this sounds pretty awful, and these side effects might lead you to wonder why I don’t throw sertraline in the sea and take the SSRI that doesn’t really work rather than the one that makes me actively anxious. Good question!
I went to speak to my doctor about it and she said that it will take a while for my body to get fully used to the new medication, and that side effects often diminish with time. She said we could change now or we could wait a few months and see whether my body and sertraline get their act together and start behaving like grownups.
For now, then, I’m still taking the anxiety pill and trying to develop techniques to deal with the (hopefully) interim effects. Expect updates.
I would definitely recommend antidepressants; despite their flaws and side effects, they have enabled me to do things I wouldn’t have managed without them, like putting on socks.
Love you all,
I am so tired so so tired.