So you’re thinking of starting antidepressants?
“I used to think it was cheating, now I know it’s just evening out the playing field in my brain.”
If you weren’t depressed before 2020, the seemingly unending list of hellish occurrences this year (between the global pandemic, increasingly fascist governments, a burning planet, the impending threat of murder hornets, etc.), may have just pushed the needle for your mental health. But even if you’ve been in and out of different types of therapy for years, antidepressants can feel like a big jump into the unknown.
Part of this is the fact that everyone seems to have completely different but equally strong opinions about mood medication. Antidepressants don’t work for everybody, and particularly with the broad range of meds available, trying different ones out can feel like the world’s worst pick ‘n’ mix — different people can have wildly divergent responses to the same drug. Sertraline could give you your life back, or a few days of debilitating stomach aches and not much more. But of course, a lot of the negative discourse surrounding this type of treatment comes from the persisting social stigma around having mental health problems in the first place, as well as general sense of chemophobia.
“I initially didn’t want to go on meds fearing that it would make me unable to ‘feel’ emotions,” says Fiona, a 20-year-old college student and teaching assistant. This idea is a common one, often inferred from typical side effects such as reduced sexual libido and, of course, less severe instances of low mood.
Dr Bjorn*, a junior NHS doctor, notes that while “emotional blunting” — feeling like your emotions, both ups and downs, have been dulled — can occur as a possible side effect, it does not in the majority of antidepressant users. Additionally, if you get it in one class of medication, “you won't necessarily get it on another.” He adds, “Your GP will be able to try different types to find one that had less of a side effect profile, or at least a more manageable side effect profile.”
It took Fiona two failed attempts to find escitalopram (Lexapro), the antidepressant that was right for her. “I used to cry every day and have horrible mood swings and suicidal thoughts; it was extremely unpredictable,” she writes, “but the meds have really stabilised that and brought me to a baseline where I can actually take the steps to manage my depression. It honestly is like a lifeboat in the sense that it doesn’t fix everything but it at least stops you from sinking.”
Thinking of the medication as something that can bring you to a baseline is a key idea: you still have to supplement what you’re taking with regular, healthy, non-depressive behaviours. Antidepressants aren’t a fix-all! Yes, unfortunately, just because you don’t feel like a depressed person anymore doesn’t automatically guarantee you won’t act like one.
Most importantly — if you can afford or access them (insert the ‘This Is Fine’ dog here) — it’s generally advised that antidepressants be taken in combination with talking therapies, such as CBT or psychotherapy. According to consultant pharmacist Dr Caroline Parker, “having a healthy diet, maintaining good sleep hygiene and regular exercise” are important supplemental behaviours to practise, which the boost from your meds will hopefully help you to achieve. You should also try to reduce, or at least not increase, “the number of cigarettes smoked and amount of alcohol consumed” as a part of your lifestyle.
Having a strong support system in place around you is vital too, on or off medication, but for Leyla, hers provided essential insights into her antidepressant experience that she wouldn’t have been able to make for herself. “Having people who can keep you on track through those changes was key for me, especially because remembering a depressive episode is very hard when you are doing better, and vice versa when you’re in a bad place,” says the 25-year-old artist from Montreal. “Some days I question whether I need my medication, but on others I’m grateful that something that would have sent me into a tailspin can be stopped before reaching that point.”
One of the most important things to note, Dr Bjorn advises, is the adjustment period before the medication actually begins to take effect: this period is often between a fortnight and a month, but can take up to around six to eight weeks. “Not only do the drugs take a while to work, but some people actually get worse in that initial phase of taking it,” says Dr Bjorn, warning of an unfortunately common side effect where things can feel worse before they feel better. “Without a good support network and adequate warning, the user could end up being at quite a risk.”
Ariel, an illustrator from Boston, MA, found her first three weeks of being on fluoxetine (Prozac) the most challenging. She started taking the meds at 18 years old, after a depressive episode during her first year of college. “As my body was getting used to it, I was so jittery,” she says, “I couldn’t sit still long enough to type an essay; I was shaky and I couldn’t eat much.”
Now 23, Ariel has a markedly different relationship with the drug. “After that period, I noticed such a difference, and I haven’t been off Prozac since. I noticed an improvement in my negative thoughts, my mood swings, and my suicidal thoughts,” she continues. “I recommend antidepressants so much. I used to think it was cheating, now I know it’s just evening out the playing field in my brain.”
The idea of mood medication as a kind of mental health ‘hack’ is an oddly prevalent one. One of the most pernicious myths about antidepressants is that they represent an ‘easy way out’, and that starting a course of mood medication is the beginning of ‘giving up’ when, in reality, it can often be the beginning of properly advocating for your own wellbeing with a more effective treatment plan.
“Millions of people find benefit in taking antidepressants,” says Stephen Buckley, head of information at Mind, a UK-based mental health charity. “It’s important that nobody should feel ashamed or guilty for seeking help for their mental health.” The media’s reporting on pharmacological treatments, says Stephen, has done some damage in shaping public awareness of them. “Sometimes trivialising language such as ‘happy pills’ can cause problems for those taking medication for an often serious and life-changing health problem.”
Medicating such a health problem is, too, life-changing. The fear that antidepressants will alter who you are as a person is one that crops up frequently in discussions and, depending on your perspective, it is not such an unprecedented one. “I think this is a very philosophical question — do you consider someone's personality what they are like off of all substances?” asks Bjorn.
“Who we are as a person is also driven by a culmination of our experiences, so in one sense, yes, if one needs to go on antidepressants then that will shape who they are in the future, as that will be different to who they would be had they not made the choice to start them.” Is your brain exploding yet?
The decision to start antidepressants is a huge one but above all, it should be a decision that you make for yourself. You can listen to a million different anecdotes (and people will tell you them), and still not know if it’s the right choice for you until you try them. If one thing is for sure, there’s as much to fear as there is to gain.
*Some names and identifying details have been changed to protect the privacy of individuals.