Note: This post contains discussion of depression, self-harm and suicide.
I went back on antidepressants just under a month ago. This is the third time I’ve been on them. When I was first diagnosed in 2012 I was put straight on venlafaxine, which is a heavy duty SNRI*. I never found it hugely helpful. It blunted my mood, making me unable to feel the kinds of highs I’m used to, and made my self-harming behaviour worse. I can’t quite remember what it did to the kinds of suicidal ideations I used to have, but I’m fairly certain it didn’t make them go away. I ended up taking myself off them. Then, in the first half of 2013, I went on citalopram, which is an SSRI and is usually more of a first-line antidepressant**. Again, it wasn’t a panacea, and I ended up taking myself off them in the summer.
Now, a solid three and a half years later, I’m back on. Why? I can’t sleep for shit. I wake up about five times a night because my brain, like some kind of bizarro headmaster tasked with planning the school day, doesn’t seem to understand that time exists in increments other than ninety minute blocks. Then, when I do wake up in the morning, I can’t get out of bed. Unless there’s something that I need to do, somewhere I need to be, I just stay there. It doesn’t matter how motivated I was the previous evening, how determined I was to launch myself into the next day screaming the lyrics to Eye of the Tiger. When I wake up, it’s genuinely like a different person has taken control of my body and won’t let me out of bed. Morning Tim doesn’t think that life is worth living. As the sort of wanker who likes to go to far-flung places and argue with strangers at the weekend, I often find myself saying ‘non-existence is utility neutral’. We usually take for granted that getting out of bed and doing the things we do is a net positive. Morning Tim doesn’t believe that’s true. He’d rather sleep forever, because unconsciousness is a blissful reprieve from having to get up and fucking live.
I thought it might just be the winter. I’ve recently moved up to Edinburgh and, whilst we’re on the same latitude as a lot of Scandinavia, we don’t seem to have nearly the same level of cultural understanding of seasonal depression and similar conditions. I thought the lack of light (and the cold and the rain and the wind and the difficulty making new friends) could be the issue, and that it would all get better when spring came.
No such luck. When I started self-harming again I knew it was probably time to go back to the doctor. He was very nice (and quite concerned when he saw the marks on my torso, because it looks a little bit like I’ve been using my stomach as a makeshift tally chart, as though I’m doing a zero-budget remake of Memento). He put me on 50mg of sertraline per day and prescribed me some zopiclone, a sleeping pill. I went back a week later and he gave me temazepam, a stronger sleeping pill, because I was still waking up in the middle of the night like a rooster with performance anxiety.
I thought that, in an attempt to navigate the thin line between useful stigma-reducing writing that helps to normalise the use of antidepressants, and cringe-inducing oversharing, I would post something about my experiences with SSRIs over the past few weeks. ‘Eight Things you Won’t BELIEVE Antidepressants do to your Mind and Body’, if you will. (‘Number seven will SHOCK you!’).
Obviously these experiences are deeply personal, and they certainly won’t reflect the myriad lived experiences of other people living with depression and other forms of mental illness. But it’s a start. If this is helpful for people who might not understand what antidepressants do or why people take them, or for people who’ve been on/are currently on them themselves, then I’ll chalk it up as a success.
1. The first weeks are difficult (who knew?)
When you first go on antidepressants, you’re often told that they may take a little time to have an effect. For some people, this two to three week wait is agonising: you’ve taken all the action you can take, and now all you can do is sit back and hope that it works – that the fog in your mind clears and that you’ll be able to function like a normal human being again.
One of the deepest frustrations of depression is the disconnect between your desires and your ability to act on them. At a really deep level, you wish you could be happy (or at least feel something other than gnawing emptiness), and you sometimes even know the kinds of action you should take if you want to be happy. But the bridge between those desires and the ability to make your mind in-the-moment act upon them is gone. It’s been burned. The hope of SSRIs is that you can start to rebuild that bridge, and that even if it’s never going to support a six-lane motorway (, either cut this comma or put another one or put another one between ‘that’ and ‘even’ to make it a subordinate clause) you might at least be able to get some foot traffic passing over it. But that rebuilding takes time, and in the meantime you’re left wondering: is what I’m experiencing right now just what I would be experiencing without the drugs? Have the drugs started working already? Am I only experiencing this because I expect to feel something?
2. Expectations are a bastard
The struggle with the placebo effect is compounded by mental illness. If you expect to feel better, and then you do feel better, it’s entirely possible to then roll back all or some of those effects if you start to think that the reason that you’re feeling better is because you expect to. It’s a circular clusterfuck of meta-expectations and reflexivity, like an entirely mental Human Centipede.
This means that it’s incredibly difficult to separate out the provenance of your feelings and any side effects you might have. This gets particularly tricky when it comes to alcohol and sex, two areas where expectations and anxieties already temper our experiences in a variety of fun and deeply frustrating ways. We’ll get on to that.
3. Bouncing back is easier
One of the things I’ve noticed about antidepressants is that they put a floor under how low your feelings can go, or at the very least they elasticate those feelings: even if you go low, you end up bouncing back up far more easily than you would under ‘normal’ circumstances.
4. I’ve stopped self-harming
This is probably a big one. Of all the stigmatised aspects of depression – not seeing people, not keeping appointments, not being able to work or articulate yourself properly, being overly despondent, staying indoors or in bed all the time – there’s little on the same level as self-harm. I have vivid memories of being immediately shut off from an interview I was giving on BBC London because I wasn’t unequivocally negative about self-harm (it’s obviously not great, but it’s one of a constellation of symptoms of a deeper pain rather than being something which ought to be condemned in and of itself, and it can be a coping mechanism for people who have nothing else).
Most of my scars aren’t too bad, but there are a few situations in which people have noticed them and it’s been a bit awkward (usually for them rather than me – I’m always completely open about how they got there). Even if I’m not getting odd looks in the gym changing room, I still feel somewhat self-conscious about the marks on my abdomen which look like a small child’s attempt at Roman numerals. So the fact that I’ve managed to avoid any further encounters with razor blades is a huge plus. Here’s hoping it continues.
5. It’s totally screwed my alcohol tolerance
Now I’m not saying I’m a heavyweight, but I used to be able to, as it were, bosh a large quantity of pints and be pretty much fine. Two bottles of wine would get me pretty wankered, but I probably wouldn’t have a hangover the next day.
No longer. The week after I restarted SSRIs I went out and had a couple of pints. Lying in bed later on the room was spinning a little bit. A week later I had my first hangover in a long time.
It seems to work both ways: I get drunk more quickly, but sobering up also takes less time. Weirdly though, alcohol also just affects me differently. I’ve only got a sample size of a few occasions but on one night after consuming what wasn’t really a large amount, I just felt weird. I can’t quite place the feeling, but it just felt wrong in a way that I’m not used to.
I’ve noticed previously that alcohol is a bit of an emotional Russian Roulette when I’m on antidepressants. I’m glad that I’m now a really cheap date, but the randomness of the effects is pretty infuriating.
6. My sleep problems haven’t gone away
Sleeping pills, it turns out, might be able to knock you out for a decent period, but they can’t stop me from waking up several times a night. They also only give you a week’s supply at a time, because apparently they’re super addictive, which means that I’m now back to attempting to put my head down and snooze like a normal person. I still wake up constantly, and bizarrely my jaw seems to be clenched the whole time I’m sleeping, and it makes getting up in the morning a (H?)herculean task, because if there’s one thing Morning Tim loves, it’s an excuse to be able to make me sleep longer. “Oh what a shame you woke up and couldn’t get back to sleep last night – guess it’s time for another three hours now 🙂 🙂 :)”.
7. Sex is different
The most common side effect of antidepressants is change in sexual function, so it would probably be remiss of me not to talk about sex at least a little bit (in a further ill-advised exercise in navigating the usefulness/oversharing line).
Once again, it’s really hard to separate out the aetiology of any changes: do they come from the drugs, or my expectations of what the drugs will do? A lot of people have changes in their libido from SSRIs, but then a lot of people’s libido fluctuates naturally over time anyway. It’s not that I don’t want to have sex now, because I still do. It’s just that the desire is kind of tempered a bit, again in a way that I can’t quite articulate yet. SSRIs also make it a bit more difficult to, well, do it – in a variety of ways, but mostly they just desensitise you somewhat. This seems to be a continuation of a general theme: a lot of what antidepressants do for me is stopping me from feeling some of the worst of what I would normally feel. This sits uncomfortably with the fact that a lot of depression stems from feeling nothing at all – but that nothingness isn’t neutral. It’s an aggressive emptiness, a melancholy which yawns and threatens to swallow you whole. The drugs help negate that. If the trade-off is that they make sex different – not worse, per se, just different – then I think I’ll take it, at least for now.
8. It’s not a panacea
Whilst I certainly feel a lot better than I have been – I have relatively normal amounts of energy, my thoughts don’t drift to death and existential emptiness too much more than is natural for a philosophy student, etc – SSRIs certainly aren’t a cure-all. The techniques I learned through counselling a few years back, combined with my own ‘on-the-job’ experience of treating my own depression, have helped me a lot this time around, and without them I doubt that the drugs alone would have done a huge amount. If you’re considering going on antidepressants, probably also think about counselling if that’s an option open to you. I went through four counsellors, and none of them were exceptional, but that doesn’t mean that they aren’t incredibly helpful for other people.
What’s particularly interesting is that the physical side effects of antidepressants serve to reify the mental effects. It’s often really hard to know that they’re doing anything – you just put them in your body once a day and hope, like a multivitamin or a fish oil tablet (except without the aftertaste of Satan’s belly-button lint). When you get side effects, in spite of the fact you know they might only be happening because you expect them to happen, they help you to know that the drugs are doing something. That in turn makes it easier to see the positive effects they’re having upon your mental health. And that, I hope, is mostly a good thing.
*Seratonin Noradrenaline Reuptake Inhibitor – less common than SSRIs, which are Selective Serotonin Reuptake Inhibitors. They do essentially the same thing, but they also hit noradrenaline. We’re not sure exactly why SSRIs work, but their mechanism of action is essentially keeping the levels of serotonin (a neurotransmitter) artificially high by stopping it from being degraded in the junctions between neurones. This means that they keep stimulating electrical impulses in neurones for longer.
**I’m uncertain exactly why I was given the more heavy-duty treatment first. I think it might be in part due to the fact that I presented with reasonably serious symptoms (they balk a little bit when you start chatting suicide, who knew?), and also because I first went to the doctor in Cyprus, where I lived before I started university, and where medical practices aren’t always exactly the same as they are in the UK.