Antidepressants: a nearly 100 day update

Nearly 100 days in, it’s probably time to reflect on some of the ways that being back on SSRIs has affected my life. Continuing the theme of practising what I preach with respect to tackling mental health stigma, I’ll try to walk the tight-rope of Emotional Honesty without falling into the shark-infested waters of Too Much Information; as always, though, I may well fail. Please don’t hold it against me. All the standard caveats apply: this is only my own experience, people with mental illness all experience them in unique ways, please don’t take this as representative of everyone else’s experiences.

Over the last three months, I’ve had my dosage upped twice. I started on 50mg of sertraline per day, which is the same dose they give to little old ladies. I’m a 6’4″, 23-year old man weighing just under 90kg, so I’m not too concerned about having to go up a bit. I was moved up to 100mg pretty quickly, and then 150mg just under two weeks ago. As the dose has gone up, so has the therapeutic effect, but the side effects have followed along with it.

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Emotional Blunting

I think this is the thing that bothers me the most. It’s quite hard to understand if you’ve never experienced it, but I’ll give it a try. Start with the common conception of depression as feeling ‘sad all the time’. That’s an inaccurate depiction, as pretty much any depressive will tell you. (On a side note, isn’t ‘depression’ a rubbish way of describing it? A depression is just this temporary dip in the land, something shallow and gentle. Depression isn’t that. It’s rough and raw and grating. It’s a deep sense of unease within yourself, a gnawing sadness and emptiness which holds you in its grip and refuses to let you get out of bed. It’s a pair of hands holding your eyelids open and fixing your gaze upon the space on the wall, stopping you from looking anywhere but there, stopping you from thinking about anything but the utter emptiness and meaninglessness of your own existence. Melancholia is a much better word. Depression is a misnomer.) There’s sadness, but most of it is emptiness. You just can’t find the impetus to engage with the world. You’d rather stay asleep than have to cope with the drudgery of life – if you’re able to sleep, that is. It’s a painful nothingness that demands to be felt.

Anti-depressants, for me at least, allow me to live in spite of that emptiness. It would be a lie to say that they get rid of it. I’ve written before about the way that they allow you to bounce back more easily from your lows: they let your brain divert from the broken railway track that leads into the canyon below and onto the siding of relative comfort. But that doesn’t mean they make you happy. They facilitate you living in a way that allows you to achieve happiness by other means. You can drag yourself from your cave of self-pity to the gym and harvest those delicious endorphins. You can make yourself go to work and produce things which provide some degree of contentment. You can put on your Normal Functioning Human Adult face and grin and trick your brain into thinking it’s entirely unforced.

There’s a trade off, though. You lose the intensity of emotion you get with depression: whilst you had to live with gnawing guilt at how appalling a human being you were, at least you had that feeling. It might sound ludicrous to say that being able to feel negative emotions is a positive: who wants guilt, anxiety, sadness, anger? Surely we’d be so much better off without them. The problem is that SSRIs seem to erase your capacity to feel those emotions, at least to the extent that you’re used to. But when they’re gone, they’re not just replaced with happiness and sunshine and rainbows and visions of ambrosia. Instead, in situations where you know you should feel those things, you’re left confused.

A thing happened the other day that should have made me intensely sad. I wanted to cry. I couldn’t cry. I knew that I should be sad, but nothing was coming. I was emotional foie gras. People talk about being emotionally constipated, but I don’t think I’ve ever really understood exactly what it could mean. It’s like a phantom limb which still wants to be felt: you know there should be something there, but it’s just a ghost of what it was. The object is gone and now all that’s left is the shadow and a series of increasingly tenuous metaphors and similes. It’s frustrating because sometimes you need to feel an emotion in order to exorcise it, and it leaves you unable to console your conscience in the way you’re used to.

I used to be wracked with guilt. All of my teenage years were characterised by a constant nagging feeling that I was wrong, that the things I was feeling and doing and experiencing were incorrect and out of sync with what I should be feeling and doing and experiencing. It got a bit better as I approached my twenties – I think there comes a time when you begin to realise that you’re not the only one who feels that way, and there’s a certain comfort in that – but now I can’t really feel it at all. I used to constantly worry about the effects of my actions on others; the empathy I felt was painful in its intensity. It’s not that I don’t care, now. I still think about it a lot. It’s just that now I have to force myself to remember what it was like to be that empathetic, to care so much about how others perceived me and to make sure that I’m as kind to others as I can be. Perhaps I overcompensate, but I’d still rather that than hurt people through callousness. I’m an ancient fridge with a jaunty sign scrawled on the front. The light is broken, but I still work.

Insomnia

In short, I still can’t sleep for shit. I’m no longer waking up like clockwork every 90 minutes, but it’s gotten to the point where I genuinely cannot remember the last time I slept through the night. This morning I was woken up at 5 by someone pretending to be a fucking bird, of all things. I went back to sleep, but then I woke up every half an hour or so until I finally gave up at 8. If you haven’t experienced insomnia, I envy you. I don’t think there’s anything quite so frustrating as going to bed knackered, only for your brain to decide that now is exactly the time to mull over the day’s events and all the things you need to do tomorrow and who you might have upset and whether anyone really loves you. That’s then compounded by the constant waking, such that you don’t even know whether you’ve had a good night’s sleep or not. It’s a self-fulfilling prophecy of shite: you worry that you’ll wake up, so you wake up, and the trench of insomnia is dug deeper and deeper until there’s no path but that one. I have a few temazepam left, and they help a little when you get to breaking point, but it still doesn’t stop the middle-of-the-night waking, and you feel slow as hell the next day.

I wish this would go away. I don’t know if it will. The doctor has suggested using a low dose of a sedative SSRI at night to try and knock me out. We’ll see if that works.

Sex

Obviously, this bit will involve some discussion of my sex life. If you came for this (heh), enjoy, you filthy animal. If you don’t want to ever imagine me in any sort of vaguely carnal scenario, probably skip this bit (Mum and Dad, pls. Also, religious family members, maybe you guys too (soz)). I include it because I hope it might help other people who are struggling with similar problems, or those who might want to understand it better.

So I mentioned the last time I wrote about antidepressants that they make sex take longer. Sexual dysfunction is the most common side effect of SSRIs, and is probably one of the major reasons a lot of people come off of them in the long term. I can imagine that if they make getting an erection difficult or reduce your libido to an unacceptable point, that can be really hard (or not, as it were). It can introduce a significant degree of tension into relationships, make one night stands impossible, force you to out yourself to people you might not necessarily want to talk to about your mental health, or be a source of further depression because sex is – let’s be honest – an extremely important part of a lot of people’s lives.

I’ve noticed that as my dosage has increased, it’s gotten more and more difficult to finish. One tricky thing is trying to separate out the physiological and psychological factors from this. There’s certainly a degree to which it’s in my mind: I worry that I can’t, or won’t, and that acts as a self-fulfilling prophecy. It can induce guilt as well: you don’t want to feel like a burden, or make your partner feel like they’re doing something wrong, or that you’re not enjoying it. The solution, I’ve found, is just to be as communicative as possible. I’ve asked people before about when they tell people they’re dating about their mental illness; I personally find it imperative for me to tell someone before the first time I sleep with them, because it helps to ease my anxieties about this. Obviously there’s an extent to which people don’t tend to mind sex going on for longer, but the difference in your own experience can make you pretty self conscious, and you find yourself apologising a lot and generally just making the whole business a lot more awkward for everyone concerned. Top tip: don’t sleep with people who are shit at communicating or empathy – in life in general, but specifically if you’re having trouble with this kind of thing.

Fortunately I haven’t had the effects on my libido that other people often get, but it’s made drinking on dates quite difficult – I’m not sure how SSRIs combine with alcohol in terms of sexual dysfunction, but it’s not something I’m massively keen to find out, particularly now I’m on 3x the initial dosage.

If anyone wants to talk about this further, I’m pretty open and happy to chat. I don’t think it’s something we ought to keep in the dark (as it were).

Alcohol Tolerance

After a pretty rocky start when I could get the room to spin with nothing more than a couple of pints, this is back to nearly normal, for better or worse. I’m no longer the world’s cheapest date, but at least I can drink without worrying that I’m going to be paralytic after three glasses of wine. What’s also nice is that the changes in tolerance were quite unpredictable: sometimes I could drink like a fish and be fine, other times I’d quickly have to stop. Now there’s a greater degree of consistency to my capacity. Sorry, ladies.

Conclusions

Overall, I’m still very happy to be on the drugs. I haven’t hurt myself since I started taking them, and suicide is now out of the question. I tell myself the latter is for philosophical reasons – I think there’s nothing after death, and as long as life is a net positive then I’d rather have the nothing happen later rather than sooner – but I think my capacity to think in that way is probably facilitated to some extent by these meds. For all the annoying side effects, I’m still not tempted to take myself off them just yet. As always, if anyone wants to chat to me about this, please feel totally free to shoot me a message on facebook or by email.