On drugs (and off them)

I came across an interesting piece in the Guardian the other day written by Deborah Orr, who had just taken antidepressants for the first time (with unpleasant consequences). This was followed by an explanatory article by blogger and author Dean Burnett who explains that nobody really knows how anti-depressants work, and why it is not surprising that they can have unexpected side effects. I hope that the articles I mentioned above help make it clearer what is involved being on medication of this sort. These drugs are in widespread use, but ignorance about them is spread even wider.

I remember a while ago, when I was working at the University of Sussex, sitting on a bus in Brighton with two people behind me talking – in a very unhelpful and ill-informed way – about depression, and how anti-depressant drugs were a `soft option’. It made me quite angry listening to some of the comments they made but I didn’t intervene. I toyed with the idea of writing a blog then but I didn’t get round to it, partly because I didn’t really want all the staff and students in the School of which I was Head to know I was taking heavy medication for much of the time I was working there.  I only told a handful of people at the time. Now I am no longer in that job I think it’s safe to be a bit more open, and add a little bit here from my own experience to the articles mentioned above.

The most widespread anti-depressant drugs currently available are called Selective Serotonin Reuptake Inhibitors (the best-known of which, Fluoxetine, is known by the trade name Prozac). Deborah Orr’s article concerned her experience with an SSRI called Citalopram, which I was using about five years years ago. More recently, for much of the time I was at Sussex I was taking Paroxetine (trade name: Seroxat). The latter is not available on the National Health Service through a General Practioner, but must instead be prescribed by a consultant psychiatrist.

Anti-depressants are not only prescribed for the treatment of clinical depression but also for, e.g., anxiety disorder, panic disorder, and post-traumatic stress disorder. Nobody really knows why anti-depressants work against depression (although there is clinical evidence that they do), and there is even less understanding why (and, in some cases, evidence that) they are effective for these other conditions. Like many treatments they seem to have been discovered empirically, by trial and error.

As Dean Burnett explains in his article, SSRIs work by increasing the level of Serotonin (a monoamine neurotransmitter). However, taking an SSRI increases the level of Serotonin almost immediately whereas the effect on depression takes weeks to register. While low Serotonin levels may play a part in depressive illness, they’re clearly not the whole story.

My experience contrasts a bit with Deborah Orr’s, in that I have never experienced significant problems going onto this sort of medication – the worst by far has been when I’ve tried to quit. I had awful problems in the summer of 2012 largely as a result of trying to come off the medication I had been on since the previous autumn. The withdrawal symptoms then included shaking fits, insomnia, visual and auditory hallucinations, nausea, and hypervigilance.

The effect of this extreme collection of withdrawal symptoms was that I didn’t eat or sleep for a couple of weeks, and ended up in a high-dependency unit at a psychiatric hospital under sedation while they figured out what to do with me. Fortunately, I recovered well enough to return to work after a couple of months.

At the end of the summer of 2012, I was offered the job of Head of the School of Mathematical and Physical Sciences at Sussex University. I moved from Cardiff to Brighton in early 2013 to take up this new position. I hadn’t been there for long when my old problem returned. The stress of the job obviously played a role in this, and I soon realised that I couldn’t keep going without help from medication. It was then that I was tried out on Paroxetine, the dose being gradually increased until I was at the maximum recommended level (60mg daily).

While this medication was effective in controlling the panic disorder, it had some unpleasant side-effects, including: digestive problems; dizziness; difficulty in concentrating; fatigue; and the weirdest of all, a thing called depersonalisation. Deborah Orr describes the latter very well in her piece but she seems to have experienced it as soon as she started taking medication, whereas in my case it came on  gradually.

 I found myself living a kind of half-life, functioning reasonably well at work but not having the energy or enthusiasm to do very much else outside of working hours. Eventually I got fed up with it.  I felt I had to choose between staying in my job as Head of School (which meant carrying on taking the drugs indefinitely) or leaving to do something else (which would mean I might be able to quit the drugs). I picked the latter. The desire to come off medication wasn’t the only factor behind my decision to stand down from my job, but it played a big part.

I knew however that Paroxetine  is associated with notoriously difficult withdrawal symptoms so, mindful of my previous experience in 2012, I followed the medical instructions to the letter, gradually cutting down my dose over a couple of months during the course of the Autumn in 2016. I still had significant withdrawal symptoms, especially the insomnia, but not as bad as five years ago. I’m hoping that my current (part-time) job allows me to manage for the foreseeable future without the need for any medication – apart, perhaps, from the odd glass of fine wine!

So those are my experiences. All I can say that I hope I’ve convinced you that anti-depressants are not a `soft option’!

11 Responses to “On drugs (and off them)”

  1. Astrolori Says:

    My own experience has involved two episodes of medication, first in new Zealand where I made the transition onto medication reasonably ok with some insomnia and extra anxiety, luckily I was observing at jcmt which I think actually helped! The second time was after my daughters birth when I had severe post natal depression and that time getting onto medication was horrific. Nausea, insomnia, suicidal thoughts, anxiety, I stopped eating for weeks. At same time I had a 5 week old baby and a huge hole in my perineum which meant I couldn’t sit and had to have hospital treatment several times a week. Depression is horrific and so many people at hospital suggested just going on medication as a preventive measure without appreciating those 4 weeks of hell as your body adjusts. Happily once they did start working they worked really well and I am now very well, but I’m far too scared to consider stopping again. As with peter my initial problem caused me to leave my academic job as the stress of the job was what made me ill. I guess we all have to consider a lifestyle that we can psychologically live with.

  2. Bryn Jones Says:

    I am very sorry to learn of Telescoper’s health issues and extend my sympathy to him and to anyone else who has been through problems like this.

  3. Thank you for sharing and well aware of the seriousness of antidepressants. A young family member parked her car, walked across a busy road and straight onto the railway tracks in front of train a few weeks off medication. There is history of depression in the family. I believe every case is different and should be monitored very carefully.
    Peter, all the very best on your road to recovery. You are so caring and truly amazing.

  4. Peter,

    Thank you for such an honest portrayal of your own challenges and how you’ve approached them. People like you are so important in changing perceptions around mental health. Long may you continue to be you.

  5. Anton Garrett Says:

    Antidepressants clearly treat symptoms, and the question in mental health remains: what is the cause? In physical health we have found bacteria and viruses. It seems this is far easier than the ontology of mental health. To be clear, I am not criticising antidepressants, for symptom relief is clearly a great help in many cases. I simply wish anybody well who is struggling, or has struggled.

    • telescoper Says:

      Yes, antidepressants are a bit like painkillers in that respect. Alleviating pain is clearly of great benefit in certain circumstances, but pain is an indicator of some deeper problem that must be identified and treated for a full cure.

  6. I was on paroxetine for a while some years ago. Back then, I think GPs could prescribe it, and I don’t think the difficulties of coming off of it were quite so well known. Luckily for me I came off it okay, but I do know someone for whom it was hellish.

    • telescoper Says:

      It just shows how variable these things are from one person to another. When I was first put on medication in the 1980s I was given a tricyclic antidepressant. These are hardly ever prescribed these days, largely because of side-effects which are supposed to be much less severe in the case of SSRIs. Maybe it was because I was younger then, but I don’t remember having have the problems with tricyclics as I have had with SSRIs!

  7. tbell2221yahoocom Says:

    I am currently in the process of trying to get off of Effexor. I have been on 75 mg CR tablets for over 10 years. So far it has been going pretty well as I have tapered very slowly. I tried after about a month to decrease my dose to half and started to experience side effects. I have backed off and am back on about 50 mg. I plan on tapering very slowly. Thanks for sharing your story. Are you off of the Paroxetine now or still tapering?

  8. […] insomnia and I thought I’d comment a bit on it here. This topic has come up before, e.g. here, but I’m very happy to say that sleeplessness is not a problem I’ve had […]

  9. […] This passage struck me very forcibly because it captures what it feels like to experience depersonalisation disorder. I wrote about my own experiences of this about three years ago. […]

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