What the doctor might not mention ...

I fought against taking medications for mental illness for a long time and now I have been contentedly taking them every morning for a long time.

I had resisted them because I was a big believer in psychology. And the ability of cognitive techniques to get me through. I also felt there was something genuine and authentic about my strong emotions, even if they were tortured and despairing. I had always identified as someone who “thought too much” and approached the world very critically, so something about this sustained sadness felt very much like me.

I did wonder – and I still do – if by going on medication, I’d be denying a part of my true self. I thought that perhaps bouts of paralysing depression and anxiety were just part of the human condition, and something didn’t feel right about ‘curing’ it with medication.

But part of the human condition is also about having some sort of desire to keep living. And that’s what I got back when I went down the antidepressant path. My sleeping patterns changed and my motivation wakened. I got a bit of my spark back.

There’s a lot of misconceptions about antidepressants out there. And I held some of them.  Here’s some of the things that a doctor might not let you know.

The beginning part is really pretty shit.

Chances are, you’ll probably feel a lot worse initially.

I have been fortunate enough to have been in a hospital each time I have started on a new medication. Otherwise, I just don’t know if I would have had the patience to stick with it.

The initial period felt like I wasn’t even a part of the world – electric currents surging through the body, pounding headaches, nausea, crippling anxiety, dizziness and light headedness, total exhaustion. Not the most pleasant experience.

Depending on the type of antidepressant, it can take anywhere between two and eight weeks to feel the effects. Immediate results are not key here. Some medications, like Venlafaxine, can induce some bizarre sensations, like brain zaps or muscle spasms. You might experience nausea or headaches, so most medical professionals advise that you don't go on them during a period where you really can't afford to take time off.

The other key thing to note is that often with these medications they will start to relieve the physical symptoms of the psychological disorder before the mental or emotional symptoms. As such, we might start to begin to feel more motivated and energetic, but still be experiencing very negative self-talk, feelings of hopelessness and a depressed mood. This combination of factors can increase our suicide risk during the initial phase.

Trial and error is common.

And once you start one medication, you might find out that antidepressant is not the right one for you. And the process needs to start again.

I’ve been really lucky with the medications I’ve tried, but I think I’m an outlier.

There is still so much that we don’t know about mood disorders. Sure, we’re learning more about it every day, but as of right now, we don't have it down so well that we can hear a list of symptoms, prescribe the appropriate medication, and then let the drugs do CPR on our broken rainbow generators.

Certain types of depression require specific types of medication. Couple that with the fact that each person reacts to those chemicals differently, and you basically have to set up a dartboard, prescribe whatever you hit, and see what happens.

I’ve known people who have had to go through months and years of trial and error of medication games trying to find something that might “work”. It’s horrendous. The real trouble starts when the person gets frustrated, not understanding exactly how long it takes for these things to show any sign of working. Couple that with it taking up to six weeks to even know whether or not a medication will work or not. For some, this can be an enormous process that takes massive amounts of time and dedication, and often the person will feel much worse before they feel better.

The side-effects can range from harmless to hellish.

Antidepressants are pretty serious brain drugs. They can also have some pretty serious side effects.

Side effects generally depend on the type of antidepressant and the individual, but common side effects include weight gain or appetite changes and reduced sexual desire.

Most people are aware that antidepressants and anti-anxiety medication can cause impotence in men, but it can also have a severe effect on women's sex drive. Many people on this kind of medication have difficulty achieving orgasm, some only for a few months, and others for as long as they’re on it. I can’t personally comment on this, as I am gloriously single.

The most notable side effects I experience are drowsiness, increased night sweating and blunted emotions.

I’ve always loved to sleep, but now I seem to be somewhat affected by what Dr Matt calls the “Zoloft doze”. The afternoon nap, which is not really a nap, but a solid and very deep sleep and which doesn’t impact my ability to catch the zzz’s at night time.

Because of the drug's effect on REM sleep, there are numerous studies to suggest that they worsen the quality of sleep in depressed patients. Some are activating, while others are sedating, so it's important to know the right match for you. Currently, I could sleep for 12 hours and wake up and hit the snooze button. This is pretty common for individuals using SSRIs and SNRIs.

I sweat more during my sleep. Bit gross, but apparently normal. Up to 22 per cent of patients report excessive sweating after taking antidepressants. Many also encounter intense night sweating.

And my emotions are blunted. My highs aren’t as high as they were. And I don’t cry in Love Actually anymore. Or at funerals.

Withdrawing from them may be atrocious.

Antidepressants are not addictive medications – you don't get cravings for them or need to keep increasing the dose to get the same effect.

However, all psychiatric drugs change your brain and body chemistry, and if you have been taking them for a while, your body will have adjusted to them. This means that you may experience withdrawal symptoms when you stop taking them – especially if you've been taking them for a long time. Withdrawal or discontinuation syndromes from these medications, is something that has only been acknowledged as thing by the pharmaceutical companies in the past ten years or so.

For this reason, it's always advisable to reduce the dose slowly instead of just stopping taking them.

I always knew this, but one time I skipped a couple of doses. I think it was a public holiday and I couldn’t really be bothered finding the after-hours chemist and I thought a couple of days wouldn’t be noticeable. I was wrong.

Pretty quickly I had a runny nose and headache. I was dizzy and had trouble standing up straight and walking. And the ‘brain zaps’ – sort of like electric currents going through my brain – were unpredictable and just weird. Sleep was impossible. Disorientating, weird and awful.

Never again.

Some medications are renowned for causing particularly bad withdrawals, and others have barely any. It also depends on the person.

Your days of taking party drugs may be over. Or you will be.

I am sometimes gobsmacked that psychiatrists and doctors don’t make this clearer. Working in the drug and alcohol services, it never ceases to surprise me the number of people who I see who prescribed SSRIs and are also known to take party regularly, yet have no idea that this combination is potentially fatal.

Because SSRIs block or inhibit the reabsorption of serotonin back into the neurotransmitter it means that there is quite a bit of serotonin swimming around in the brain. This helps lift the cloud of depression. However, some licit and illicit drugs (e.g., MDMA, ecstasy, speed, methamphetamine) also act on the serotonin pathways in the brain causing even bigger amounts of serotonin to be swimming around in the brain. And it’s got nowhere to go – because the SSRI is blocking it’s path.

And here’s the thing, too much serotonin – serotonin toxicity – can be fatal.

They’re not a cure.

Unlike other things we might see doctors for – rashes, broken arms, infections – the prescriptions they give us for our brain, are not on their own enough. Relying solely on pills to treat or manage a mood disorder is usually a massive disappointment; although they do help relieve some of the anxiety and stress caused by depression, they don't address the underlying mental issues. They just help with some of the symptoms.

All the research shows, that psychological treatment (therapy of some sort) is needed in conjunction with the medication for some sort of effect to occur. There are often things outside the realm of a physical chemical imbalance that need to be addressed. Work is too stressful. You're intimidated by large crowds. You have nightmares about geese with guns. Those things need to be talked out and confronted. Pills can't do that for you.

There is stigma around taking them.

And despite these medications being not all that easy to take, they still come with a bit of stigma within the community – Aren’t you just treating the symptoms and not the cause? Have you tried natural remedies? How do you know what you’re like now without them?

The truth is, I don’t know the answer to these questions. And psychiatry hasn’t really figured out how anxiety and depression works. Or how antidepressant medications work. But like most things, my use of medication, is a personal choice that suits me really well right now, despite the allowances I make.

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