A Personal Guide to SSRI Antidepressants

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Anyone claiming to have the definitive understanding or guide to antidepressants is not being honest. They have a different effect on everyone because everyone’s brain, body and lifestyle is different. However, I’m hoping that this article will offer a nuanced explanation of how antidepressants can impact you based on my own experiences and personal research. I’m not a medical professional, I’m not trying to persuade you one way or the other about whether taking medication is right for you. In the face of a lot of negativity and misrepresentation about the impact of taking medication for your mental health, particularly SSRI antidepressants, I think it’s worth offering a balanced guide to some things you might expect to experience, how to deal with them, and a brief overview of how the medication works

This article is intended to be a resource for people who have been prescribed SSRIs or are considering asking for them from their doctor. If that’s you I would recommend doing some reading around and being open with your GP about what it is you’re hoping they’ll help with.

The Science

Selective serotonin reuptake inhibitors or SSRIs are one type of antidepressant medication. They can also be used to treat generalised anxiety disorder, obsessive compulsive disorder, panic disorder, sever phobias, bulimia and post-traumatic stress disorder. That’s not a comprehensive list of the situations SSRIs might be offered to you as a treatment, but it show that they can be used to treat a variety of mental health conditions. According to NHS.uk SSRIs work by ‘increasing serotonin levels in the brain’. If you want a more complex explanation of how that works I’d recommend reading the NHS guide to SSRIs. It’s important to note that altering your serotonin levels is not itself considered to be a fix, but the improve in mood that should come with this may make you more responsive to other forms of treatment such as therapy. When I first went on SSRIs I remember being told that I should consider it like a bandage on a wound that will still need further treatment but the bandage being in place should make it more possible to treat the wound itself. This is not going to be true of everyone who takes SSRIs for their mental health, but if this is your first time taking them I think it’s worth taking them while also getting some other kind of treatment such as a form of therapy (this is of course limited by the fact that in the UK it can be very difficult to get therapy because of waiting lists, but it’s something I would personally recommend doing if it feels right for you and if you are able to).

Starting Your Meds

If you have been prescribed antidepressants by your doctor you will probably be aware that there are several kinds available. The 3 most commonly prescribed for mental health conditions are citalopram, fluoxetine and sertraline although there are other kinds available too. Your doctor will likely explain to you that it may be the first kind you try isn’t the right one for you and that your dose may change depending on how well it’s working for you.

The first 2-4 weeks are a ‘settling in’ period. You won’t feel a benefit necessarily, although I’ve personally found that I get a bit of a placebo effect when I start taking meds for the first time. I think that’s because it makes me feel more in control of my mental health, which is no bad thing because any lift in my mood when I’m feeling bad is welcome!

There will be side-effects, you should read the leaflet that comes with your medication to understand the ones you’re most likely to get, but any side-effects you get in the beginning may settle down or change as you adjust.

Things To Know and Tips

-        Be patient: it takes 2-4 weeks for you to feel the benefit and it’s recommended that you take antidepressants for at least 6 months to feel the benefit but…

-        It might not be right for you: it may be that the side-effects are too strong for you or that you’ve tried a few different types and it’s just not helping. If that’s the case it’s ok to stop taking them, they aren’t for everyone or it might just not be the right time for you (but please ensure you decrease your dose gradually under medical supervision - the side-effects of stopping cold-turkey are not fun)

-        If it is right for you, don’t let anyone else tell you otherwise: there is so much scaremongering and negativity around the use of antidepressants and certainly they’re not a quick fix or cure-all but if they help you then you should feel no shame. I’ve had it suggested to me that being on meds means you’re not getting the most of your life or that it’s pointless because I’ll just go back to feeling bad when I stop taking them, or even that I’m limiting my own creative potential (to which I reply that depression does the same thing anyway). Both of those things are untrue but you don’t owe anyone an explanation on how you manage your own health.

-        You might not get it right first time: as I mentioned earlier, there are a few kinds of SSRIs out there and it may be that it takes you a few goes to find one that works for you. You might also have to try a few different levels out before you find the dose that works for you.

-        There will be side-effects: it is different for everyone but there will be some kind of side-effect. It might be very small, barely noticeable and it might be a lot bigger and harder to deal with. It’s up to you whether you feel the benefit outweighs any side-effects, but I would recommend being patient and not making quick decisions as these things work slowly.

-        You can’t mix grapefruit juice and SSRIs or take ibuprofen if you’re on SSRIs: just something to remember! Grapefruit can interfere with how you metabolize your medication and be potentially dangerous and you can’t take any NSAIDs (e.g. ibuprofen) while taking SSRIs as they can cause serotonin syndrome or bleeding.

-        Get a routine with collecting your prescription: you will probably be expected to have an appointment with your GP every month to collect your prescription (obviously this varies depending on location etc). This can be difficult to fit in so it may be worth talking to your doctor about whether there’s any flexibility within that, or if you can maybe make a phone appointment with the doctor and have your prescription either posted to you or sent electronically to the pharmacy. The worst thing to do when you’re taking SSRIs is to let yourself run out of meds and slip into withdrawal because you will not feel good, so make sure you make time to get your meds.

Managing side-effects

This is just a bit of advice on how to handle the side-effects I’ve personally experienced. NHS.uk lists the main potential side-effects as:

-        feeling agitated, shaky or anxious

-        feeling or being sick

-        dizziness

-        blurred vision

-        low sex drive

-        difficulty achieving orgasm during sex or masturbation

-        in men, difficulty obtaining or maintaining an erection (erectile dysfunction)

I’ve found personally that some kinds of SSRIs make me more anxious and shaky than others. It can feel difficult because this is one of the things they’re supposed to be treating but if your medication is making you very anxious definitely speak to your doctor about it and they may recommend changing dose or type.

The side-effect I find hardest personally is the tiredness. This is not going to be the same for everyone, but if it’s something you’re struggling with too, make sure you’re prioritising your sleep – you need it. Try and practice good sleep hygiene, make time for yourself to be tired, don’t be angry at yourself if you can’t do as much as you used to. 

I also struggle with my short-term memory when on SSRIs. It makes my brain feel kind of ‘slippy’. I manage this at work by always carrying a notepad with me and keep notes on what’s happening even in informal meetings so that if I find it difficult to recall something that happened a few minutes ago I have a way to look it back up (plus it makes me look really serious and hard-working). If this is something you’re finding difficult and are able to, it may be worth confiding in your manager or relevant colleague as there are probably small changes they can make that will make it easier for you to keep on top of things. But remember that these things will feel a lot stronger and more noticeable for you than for those around you.

If you’re struggling with side-effects, consider the benefits of the medication too. Does it help you handle difficult emotions? Do you find yourself feeling more evened out? I’ve come off SSRIs because I found the side-effects too difficult in the past, but there have also been times when I’ve understood that the trade-off is worth it, I can handle feeling bad in these ways if it makes me feel better or more manageable in other ways.

If for whatever reason, you’ve come off your medication instantly without gradually decreasing the dose you are going to have some unusual side-effects. I’ve personally found brain zaps to be the most surprising and they can even be a little scary if you don’t know what’s the cause – if this does happen to you I’d recommend taking the time to read up on what side-effects are likely to happen as then you’ll know why it’s happening and that it’s only temporary during the withdrawal period.

Ultimately, remember to look after yourself. Don’t let the opinions of others make you feel ashamed or ‘reliant’ on medication. It can be very hard to reach out and acknowledge you need help, it’s not a sign of weakness to need or want to be on medication for your mental health. 

Resources

All the science and facts for this article are taken from NHS.uk - https://www.nhs.uk/conditions/ssri-antidepressants/

Information an all kinds of antidepressants - https://www.nhs.uk/conditions/antidepressants/

Information on sertraline - https://beta.nhs.uk/medicines/sertraline/

Information on citalopram - https://beta.nhs.uk/medicines/citalopram/

Information on fluoxetine (Prozac) - https://beta.nhs.uk/medicines/fluoxetine

Mind guide to antidepressants - https://www.mind.org.uk/information-support/drugs-and-treatments/antidepressants/

‘Antidepressants work so why do we shame people for taking them? - https://www.theguardian.com/commentisfree/2017/sep/01/antidepressants-work-shame-people-ssri

[Mel Reeve]