"I know it’s not ideal… you take medication to get yourself out of a dark hole but you end up in a display home on an empty street," says comedian/ actress Hannah Gadsby in the award-winning comedy drama Please Like Me. The person she’s talking to (Rose) is complaining about the side-effects of her antidepressants, telling Hannah: "I don’t want to spend the rest of my life feeling the same way at a friend’s wedding as I do at their funeral." To which Hannah replies: "I just took myself off my medication and I’m fucked, it’s bad. But I’m taking my meds again, I’ll be beige inside soon enough. It just really hurts to know that I need to take pills simply to function."
While the stigma of antidepressants is lifting, and that’s great, stigma is just one of many side-effects that the record number of people taking antidepressants in England this year (estimated to be one in 10) have to deal with. It’s easy to assume that antidepressants fix the problem, job done, but there are long lists of side-effects that can affect a person’s quality of life, such as: emotional blunting (the 'beige' feeling Hannah and Rose describe above), weight loss or gain, constipation or diarrhoea, insomnia or drowsiness, excessive sweating, dry mouth, low sex drive/ difficulty reaching orgasm, and plenty more. Several of the side-effects listed on the NHS website under antidepressants are also listed as symptoms of depression: weight loss or gain, constipation, low sex drive, disturbed sleep. Antidepressants are effective in treating depression and other common mental health disorders such as anxiety, OCD and PTSD – that’s not up for debate; but it’s also not the end of the story.
The weight gain was annoying but I always said my mental health was more important
The department of psychiatry at Oxford University published a study late last year which found that nearly half of depressed patients on antidepressants experienced emotional blunting. Katie, 25, recently came off citalopram, one of the most commonly prescribed SSRI antidepressants in the UK, which she took for a period of 18 months. She reported "a dullness/ evened-out mood that meant I physically couldn't cry (and I'm a crier)" while on the drug, as well as low sex drive and weight gain. She says she felt "pissed off" at the side-effects: "The sex drive thing was a nightmare. Luckily I have a long-term boyfriend who was very understanding and patient. The weight gain was annoying but I always said my mental health was more important. And mood dullness was weird – I didn’t feel quite like a zombie but I didn't feel I had the capacity to experience emotions as much as I do when off them – which I think is sad because what is life without the highs and lows?"
Since coming off the drug, she says she does feel better. "After a few weeks, I didn't feel like I needed to go back on them. I was elated to feel things again – Tears! Laughter! Sex! – and although I've had bad days and stressful weeks, I feel more resilient. I'm in the same job, have the same friends, am the same person, but something's shifted that makes me feel like I can handle life."
As Dr. Steven, a GP in South London with a special interest in mental health tells me, this shift that Katie reports after coming off antidepressants means the drugs have worked. "The recommendation for the duration of treatment for an antidepressant is six months from the point at which your depressed or anxious symptoms are under control. So once your symptoms are better or controlled, you continue the drug for six months. And after that time, if the person is still feeling well, I start to reduce their dose, and they can get rebound effects as the dose is reduced, but that should pass after a couple of weeks. The theory then is that you have overcome your episode of depression and your brain has learned that it needs to produce more of that chemical that you were giving it – ie. the brain adapts. In theory, the symptoms should remain under control." Dr. Steven is quick to point out, though, that depression is a variable illness and people who suffer from chronic depression or chronic anxiety, rather than episodes of it, should take the medication long-term. "Some people will experience a depressive episode and then overcome it; they may not be depressed again for several years. But other people experience chronic depression and they rely on a drug to increase their levels because they are naturally low producers of serotonin." As far as he is aware, there are no increased side-effects or issues with taking antidepressants for life if you are a person who suffers with chronic mental ill health.
Jo, 32, tried sertraline and citalopram (the two most commonly prescribed antidepressants by GPs) before being prescribed duloxetine by a psychiatrist. If she forgets to take a pill, she gets "these weird electrical ticks in my body, they’re horrible, but also a good way of training me to never forget to take my meds! It's like Pavlov's Dogs brain training but with punishment rather than reward." Other side-effects Jo experiences include night sweats and finding it difficult "though not impossible" to reach orgasm during sex. The tablets also make her constipated – "but that one is actually great because I used to get terrible IBS from anxiety, so now I’m actually on a normal poo schedule!" Jo says her doctors have "always been helpful" when she’s asked about the side-effects of antidepressants, but haven’t given "much info upfront".
Katie also felt she wasn’t given accurate information about side-effects by her doctor at the time of prescription. "I didn’t get any advice on side-effects," she says. "I was told I might feel more depressed and anxious initially but I heard nothing from my GP about the other side-effects. In the same way I didn’t get told about the side-effects of birth control…"
You can lose the battle before you’ve even begun if you fixate too much on the side-effects
Dr. Steven says he always mentions side-effects when prescribing antidepressants, but he stresses their positives much more than their negatives. "I wouldn’t prescribe these types of drugs in mild cases of anxiety or depression, so if I think it’s appropriate to start them on the drug, I am going to try to convince them that it’s the right thing to do, so while I mention the side-effects, I make it clear that I feel the benefit of this drug way outweighs the side-effects. Particularly with anxiety, when people are naturally sceptical or cautious of taking a drug and they’re going to be very sensitive to any side-effect of the drug, you can lose the battle before you’ve even begun if you fixate too much on the side-effects."
"Every drug has side-effects and it’s unrealistic to start any long-term medication and think you’re not going to have a single side-effect," he continues. "Too many people come to their GP because they’ve been feeling depressed for two or three weeks and they want a very quick fix. They think antidepressants are going to make them feel better – they’ll take them for a month and then they’ll stop taking them – but that’s completely inappropriate. If you’re going to take an antidepressant you have to prepare yourself for taking it for a minimum of six months and be willing to accept some side-effects (within reason of course)."
Rachael, 36, has been taking duloxetine for the last three years following a suicide attempt (read her story here). The side-effects she notes include "passing urine a lot more frequently at night – and I sweat a lot more, which can be embarrassing." Rachael tried taking the tablets at night instead and that made the sweating better but made her too tired to function at work the next day (another side-effect), so she’s gone back to taking them in the morning. "I also felt some nausea at first, but I think that went away after a short period. When I started taking duloxetine, I was severely depressed, so the side-effects were nothing really when compared to the positive effects of the drug. I do feel much better on them."
Jo agrees that the positive benefits far outweigh the negative: "I’d live with much worse side-effects than these before I went back to taking no drugs at all."
Personally, my side-effects from five years on antidepressants included dry mouth (like cotton wool), mental fog (feeling hungover when you’re not), and emotional blunting. But the worst side-effect, if you can call it that, was the stigma I carried myself about being on antidepressants in the first place. Hannah Gadsby’s comment in Please Like Me – "It just really hurts to know that I need to take pills simply to function" – was the thing that plagued me, and I must admit that I felt like a failure. But since media coverage has increased, and people are sharing their experiences, I feel completely differently about taking meds, and talking about them. "People still carry stigma themselves," agrees Dr. Steven. "I hear people saying 'I don’t want an antidepressant because it’s a sign that I can’t cope' or 'I don’t want to have to rely on something because my natural coping mechanisms are inadequate' or 'I’m a weak person'. I tell them depression is an illness like diabetes is an illness and you wouldn’t feel bad about taking medication if it was prescribed for you for diabetes, so why do you feel bad about taking medication for depression. There’s also family stigma with people not wanting to tell their parents or partners that they are taking antidepressants, and cultural variations in mental health understanding."
As a society, we are coming around to the idea of talking about our mental health in the same way as we would our physical health, and if you’re struggling with side-effects from antidepressants, that should be a part of the conversation. It might be embarrassing to admit that you sweat more now as a result of your medication, or that your sex drive has disappeared, but the more people who realise how common these side-effects are, the easier they will be to cope with in everyday life.