My first memories of depression and anxiety are from the time I started kindergarten. My parents had recently divorced. I was leaving preschool for a whole new life, with new teachers, classrooms, and friends. I survived the transition, but the anxiety stayed with me: a horrible burning sensation in my chest that wouldn't go away for hours or even days at a time. Within a few years, I found myself constantly worried, sometimes unable to sleep or eat. Eventually, I was diagnosed with generalized anxiety disorder and dysthymia, a moderate but chronic form of depression.
I didn't seriously begin to address my condition until after I graduated from college. In late 2011, I began attending weekly therapy sessions. But nearly three years into weekly therapy with excellent counselors, I still wasn't reaching my mental health goals.
It wasn't that I wanted to be happy all the time; I just wanted to feel like happiness was possible. I wanted to only be worried if I had something specific to be worried about, and only feel blue if something upsetting had happened. I wanted to feel what I thought of as "normal," my default state neutral instead of panicked. My therapist suggested SSRIs —selective serotonin reuptake inhibitors, common antidepressants that work by balancing the levels of serotonin in the brain. He told me they had been very beneficial for other clients with similar backgrounds. But I stubbornly resisted. I didn't want to take SSRIs, I told myself, because I was determined to conquer my mental health issues "on my own."
But I couldn't manage my mental illnesses with therapy and willpower alone. I was working hard in therapy (years of spilling my guts, doing "therapy homework" like brainstorming things that might make feel good, exposing every part of my psyche until I had no secrets left from my therapist), but I was still experiencing terrible symptoms, especially from anxiety. I became desperate to feel better. Eventually I didn't care how much I didn't want to explore medication; I was willing to do whatever it took to feel better. I relented. I got a recommendation for a psychiatrist from a friend, made an appointment, and tried to keep an open mind.
I left my psychiatrist's office with a prescription for Lexapro and filled it at the pharmacy the same day. I swallowed my first dose the minute I got home.
I sat there for a second, tilting my head and focusing my hearing as if I'd be able to sense the medicine's effects right away. Nothing happened, of course: It can take as long as six weeks to know if an SSRI is working. Eventually, mine did.
Today I've reached nearly a year of treatment on two antidepressants, Lexapro and Wellbutrin, and the results I've experienced were unimaginable to me before I started taking medication. Prior to taking meds, I struggled to make small decisions, like exactly what time I should go to bed or how to phrase even mundane text messages to friends or my significant other. Every move I made was the result of laboriously playing out myriad scenarios and then choosing the option that felt the safest. Now I am able to make thoughtful decisions that are based not on avoidance of fear, but rather what is going to propel me forward each day. I'm free to pursue goals, seek empowerment, and generally be content.
I was resistant to medication for so long because I didn't understand what taking medication meant. I had bad information and bad assumptions. Here's what I wish everybody understood about SSRIs: the good, the bad, and the anorgasmic.
1) It can take a little while to feel SSRIs working, but when they do, you'll know right away
I was cautiously hopeful when I started the meds. I wanted them to work more than anything in the world, and each day when I woke up, I wondered if this would be the day that I started feeling something different. For days, I thought it might be happening: My daily mood felt better, but it was hard to tell — what if I was just unusually hopeful, or experiencing some kind of placebo effect?
Then I had a fight with my boyfriend. It wasn't our first, and typically these fights sent me into a tailspin: Regardless of the scale, I would be inconsolable for days, wondering if I'd ruined everything, or what would have happened if only I'd phrased my protestations differently. I'd fall asleep able to feel my pounding heart vibrating on the surface of my mattress. But this time, I felt fine. Not good: I was frustrated for an hour or so. But fine. The fight deescalated, and I went to sleep easily. This is what SSRIs gave me: Situations that once had resulted in intense and painful panic now seemed manageable, a dream come true after decades of near-constant distress.
My troubles weren't over, of course. My psychiatrist warned me during my first appointment that it can take as long as a year for some patients to find the right mix of SSRIs. Antidepressant medication is not like antibiotics: The same pills won't cure the same disease in nearly everyone. We tinkered with my dosage of Lexapro and with combining Wellbutrin over the course of several months. But I was improving, and after seeing what one medication could do for me, I was eager to discover what was possible as my doctor and I fine-tuned my treatment.
2) SSRIs do not turn you into a zombie
When I told friends about my decision to try SSRIs, I heard something I call the "zombie warning" more than once. That's when somebody — usually somebody who has never been on an antidepressant, or someone who never found one that worked — tells you that the medication will, permanently and without exception, render you dead inside.
I get to be my own person, not the person my anxiety dictated I must be
While not everyone benefits from SSRIs, the zombie effect just isn't universal, or even particularly common. It certainly wasn't true for me. When they work, SSRIs do for your brain what a healthy brain would be able to do on its own: regulate healthy levels of serotonin in the brain so that you aren't depressed or anxious by default. After six months on medication, I didn't feel empty inside at all: I felt excited, nervous, and, yes, still sad sometimes — just like anyone with a healthy brain does. The difference now is that when I experience feelings of anxiety and depression, they no longer control my mood and my thoughts. SSRIs have made me feel like my emotions belong to me, instead of like forces completely outside my control.
SSRI treatment has helped me become myself. Before treatment, my personality was dominated by anxiety and dysthymia. Nearly everything I did was a reaction to these negative thoughts and feelings. If I was running five minutes late to work on the train, I'd wring my hands for a few stops, then frantically run out to the street to try to catch a cab. I've probably spent hundreds of dollars in cab rides over the past few years just so I could walk into work at 8:59 am instead of 9:04.
Now if I'm running late to a meeting or appointment, I accept that I'm going to be late from time to time, and give myself a pass. On SSRIs, I can make decisions, not just react to the world. It might seem like a small difference, but the ability to thoughtfully respond to everyday situations makes me feel more emotionally free and aware. I get to be my own person, not the person my anxiety dictated I must be.
3) SSRIs are not a way to cheat your way to happiness
For a long time, I believed that taking antidepressants would be cheating my way out of my problems. I told myself to suck it up and continued to trudge through weekly therapy, convinced that talking alone would heal me.
Friends and family backed me up: They said I would never truly be happy if I took medication, because the medication would let me avoid the "real" causes of my unhappiness. Even today, friends tell me that they would never try medication because they want to "really work" on their problems. One of my closest friends told me she didn't want "fake success."
Despite starting SSRIs, I'm still proud of the work I've done in therapy. I haven't quit: Those sessions are essential for coping with depression and anxiety. But I embraced SSRIs in part when I accepted that not all of my emotional troubles were the result of situational stress. Yes, having an uncertain love life, financial worries, and concerns about the future exacerbated my mental health issues. But they weren't the root trouble. The "real cause" of unhappiness in depression and anxiety is often a chemical imbalance in the brain, something that can't be talked out of existence any more than a headache.
4) SSRIs might profoundly impact your sex life, and not in a good way
When I started taking Lexapro, I couldn't have an orgasm. At all.
With time, the anorgasmia faded and I was able to get off again, but by that point, my sex drive was down the drain. I could have an orgasm, but I didn't really care if I did or didn't. This was the first and biggest downside to my treatment, and one I wasn't content to put up with for any great length of time.
I made another appointment with my psychiatrist. I told him that it wasn't acceptable for me not to have a sex drive while on meds. I was a little nervous to bring it up: I didn't want him to dismiss my concerns as frivolous or, worse, dirty.
Thankfully, he completely understood and prescribed me a second antidepressant — Wellbutrin — to help alleviate the sexual side effects. I was lucky: The combination worked well for me, and today my sex drive is more or less back to its pre-medication state.
If your psychiatrist is any good, then she'll be more than happy to work with you to mitigate the side effects — sexual or otherwise — that come with treatment. Don't be afraid to bring up these issues. If an active sex is important to your quality of life, you're entitled to maintain it even if you're on SSRIs.
5) You may or may not be on SSRIs forever
When I began taking SSRIs, my psychiatrist told me that while some patients require medication for only a few months or a few years, others are in it for "the long haul." He told me there isn't a good way to predict how long a patient will need SSRIs, so I have no idea how long I may need to take mine. That worries me: What if I need to take my meds every single day until the day I die?
The medicine that works best for a particular patient might not line up with what works best for her bank account
Long-term care for a mental illness can be incredibly expensive. Mental illness, like chronic physical conditions, isn't a temporary affair. I don't need to shell out for a single course of antibiotics, or even figure out how to afford a few pricey surgeries — I've got to budget for this for life.
According to a recent Consumer Report on antidepressants, some antidepressants cost as little as $25 for a month's supply, but others can cost more than $500 (certain dosages of Prozac can be very costly, for example). Unfortunately, the medicine that works best for a particular patient might not line up with what works best for her bank account.
At the moment, I receive insurance under the Affordable Care Act — helpful, no doubt, but not ideal. Even with some help from my insurance, the cost of the medication and trips to my psychiatrist add up. Every trip to my psychiatrist costs $30. For generic medication, I pay $42.39 per month after insurance.
This past month, however, my insurance lapsed, and I had to cough up $224.98 for both prescriptions. That wasn't easy, but steep costs are the reality for many without insurance, or for those whose insurance plans do not cover psychiatric care.
I'm glad to march down to the pharmacy every month to pick up my prescriptions, but I'm not thrilled about the idea of paying for them every month of my life. Despite my newfound enthusiasm for SSRIs, I know that covering the costs of care could present a greater challenge in the future than it does now, and that scares me sometimes.
6) Fear of medical treatment might be a symptom of depression or anxiety
Before I began treatment, I came up with a lot of reasons to avoid antidepressants. Some of these concerns are warranted: SSRIs don't work for everyone. Not everybody needs them. There's always the possibility of winding up with an unethical psychiatrist who uses the medication to dull ordinary emotions. But it's also important to recognize that these kinds of fears are precisely the kinds that dominate the mind when you're anxious or depressed.
Now that I'm on the other side of the wall and can compare how much calmer and in control I feel, it seems obvious that my initial hesitation was largely caused by the sense of hopelessness brought on by depression. It wasn't the only thing I convinced myself I couldn't fix. Looking back, I realize that depression made me abandon ambitions in my career, my love life, my finances, and elsewhere — almost every area of my life.
When you're in the worst throes of depression, it's easy to believe that you have no chance of feeling better. Hopelessness, extreme nervousness, and feelings of shame are all classic symptoms of depression and anxiety. Before giving up on the idea of SSRIs, consider whether the very fears holding you back might be allayed by the treatment itself.
I know what it's like for life to hurt, and what it's like to feel doomed. I know the pain of crying in front of a therapist, admitting that you're desperate to feel better, and I know the embarrassment and nervousness of telling a psychiatrist you've only met a few times that you can't have an orgasm and that can't go on. But I also know what it's like to suddenly feel like yourself again, to no longer feel controlled by chaos and pain. For many of us with chronic mental illness, taking the plunge and trying medication is the best single step we've taken for ourselves. It was for me.
If you even suspect that medication might help you live a fuller and healthier life, discuss it with a doctor. There's no shame in trying. Even if the medication doesn't work at first, or never works at all, you owe it to yourself to fight for your happiness in any way you can, and that's the best chance any of us has to make it through.