Are you there, Serotonin? It’s me, Suzanne.

[Trigger warning for suicide ideation, depression, mental illness, stigmatization]

I am a proud member of Prozac nation.

I refuse to solve my problems and deal with unpleasant emotions. I don’t treat my depression with good ‘ol hard work and bootstraps. I take the easy way out. I medicate. My moods are chemical, my personality is a façade created by neurotransmitters.

Ah, manufactured happiness.

***

All jokes aside, I love it when I’m told that treating depression with medication is the “easy way out.” Nearly forty thousand people commit suicide every year in the United States, and approximately 60% of those people suffered from major depression. Moreover, 15% of the population will suffer from clinical depression at least once in their lifetime, and 30% of clinically depressed people attempt suicide.

I’m sorry, what, exactly, is  the problem with using an “easy way out” of depression?

The idea that antidepressants are a lesser treatment is rooted in the narrative that depression is a personal failure rather than a disease. If depression is a personal failure, then you can correct it through hard work. Taking a pill to “solve” your mistake is a cheat, an unfair shortcut to redemption.

One of the consequences of ableism is our collective distaste for vulnerability, whether of the body or of the mind. We want to believe our bodies are under our own control. We especially want to believe that our minds are under our control. The idea that our brains could suddenly get sick, and we wouldn’t be able to switch them back to healthy is, frankly, terrifying.

So we lie to ourselves. We tell ourselves that depression doesn’t exist, that it’s an invented disease, that it’s just people complaining too much about bad moods, laziness or hard times. It’s easier than confronting the reality – than realizing that yeah, there are mental, and we can’t magically control them with the flip of a mental switch.

Unfortunately, the “make loud noises and hope the problem goes away” tactic isn’t exactly helping. In a 2011 study on why people with depression don’t seek treatment, sixteen percent said they perceived treatment as ineffective, while ten percent cited stigma. 21.2% of the people who drop out of treatment do so because of stigma, and 21.1% do it because of perceived ineffectiveness.

So yeah, when you start denying that antidepressants work at all, or when you say that depression is a made-up disease and the people who have it are weak… there are consequences to that.

***

This discussion isn’t theoretical for me. When I started taking antidepressants, I, like many people, didn’t believe they worked. I thought the “hard work” of therapy would fix my depression, not the “quick fix” of medication. Thus, when the antidepressants did nothing, I didn’t bother to alert my doctor.

It took a long courtship to reunite me with antidepressants. Our reunification took a the form of a classic, 19th century marriage plot:  we had to go through misunderstandings, affronts, passions, separations and despair before we finally found each other.

Pride and Prejudice, Elizabeth Bennett, Mr. Darcy, Ball scene,

1. Misunderstandings: Fluoxetine, part 1

It was my first year in college. I hadn’t wanted to go to my university – McGill – because I thought the school was too big and I would be isolated and alone.

And, since  17-year-old me was quite prescient, I was precisely right! I did feel isolated and alone.

I did have one small ray of light: I was in a play! Whooo! Unfortunately, the play had an end date. And on the aforementioned end date, I went back to my dorm, fell asleep, and didn’t come out for three months.

Okay, so I’m glossing over some details. I did leave to get food and go to the bathroom. But I didn’t go to class. I didn’t go outside. I stopped reading. I stopped contacting the outside world. I spent my days lying in bed, listening to music, and watching every single episode of America’s Next Top Model.

I wasn’t sad. I wasn’t filled with angst. I wasn’t even anxious – which, if you know me at all, is pretty rare. I was just numb. Numb, numb, numb, numb, numb. WHEEEEEEE, numb.

Hyperbole and a half, Allie Brosh.

Hyperbole-and-a-half, characterizing me exactly (http://hyperboleandahalf.blogspot.com/2013/05/depression-part-two.html)

Sure, I was failing all my classes, ruining my academic career, spending my days in bed and doing absolutely nothing. But I wasn’t worried!

I wasn’t anything at all.

To me, nothing was wrong. I was just incredibly lazy. That was the problem. Any day now, I would snap out of my incredible laziness and start working again. Bootstraps! Yes sirree. (This strategy did not work)

Three months in, I finally told my mother that I might be a “little depressed.” Because my mother knows that I have an *incredible* gift for understatement, she interpreted this correctly as “I might be really really depressed, oh god help.”

The mental health clinic at my school had a three-week waiting list for an appointment, and my health care coverage in Quebec was crap, so my parents flew me back to the United States to see a doctor. I took the two-page test medical practitioners give you when they think you’re depressed (some of you know exactly what I’m talking about) and my doctor took one at it before he said: “Uh… yeah, you’re pretty fucking depressed.”

Except he didn’t use the word “fucking,” and he did use the phrase “major medical disorder.”

Then the Doctor recommended that I take a medical leave from school (before I failed allllll my classes) take antidepressants, and start therapy. I was worried that therapists wouldn’t think I was depressed enough to take a medical leave (remember, I still thought I was just a “little” depressed), but the two therapists I saw back home couldn’t sign the “This student should really take a medical leave of absence” sheet fast enough.

Meanwhile, my doctor put me on one of the most common antidepressants: Prozac, AKA Fluoxetine.

Fluoxetine is an SSRI – a Serotonin Selective Reuptake Inhibitor. The way SSRI’s work is by inhibiting the reuptake/ reabsorption of serotonin, a neurotransmitter that regulates mood. Because your brain isn’t “reuptaking” the serotonin, there’s more of it around, which leads to more ‘happiness.’  At least, that’s the theory.

serotonin

My buddy Serotonin!

I took a medical leave from McGill. I came home. I took antidepressants. I started therapy. Therapy was good. Not being in school was good. Being home was good.

Fluoxetine… was not so good.

“It works pretty fast,” people told me. “It was pretty instant when I took it.”

Well… I wasn’t feeling anything. Not after two weeks. Not after six weeks. Not after two months. Therapy and lack-of-school were making me feel better, but I didn’t feel like the numbness – the nothingness – was gone.

Hyperbole and a half, Allie Brosh

Hyperbole-and-a-half again, encapsulating the feeling perfectly.

Then again, I’d never taken antidepressants before – and frankly, I didn’t really think they “worked.” Maybe the effect was really subtle. So I never brought the “not working” part up to my doctor.

When I went back to McGill at the end of the summer, I fell straight back into depression.

So much for fluoxetine!

Mr. Darcy, Pride and Prejudice, Marriage Plot, Elizabeth Darcy

Told you. It’s a complicated courtship.

***
This time I made it through the semester – somehow. It was a pretty terrible semester.

During the winter break, I found a new, less stressful, living situation. I decided to take only classes I thought I’d enjoy. And I stopped taking fluoxetine. I did not consult a doctor – I was in Montreal, and I didn’t have any medical authority to turn to. I just knew that the fluoxetine wasn’t doing anything. So I stopped.

Things got better. I lived in a good place; I went to interesting classes; I started making friends. By the end of the semester, I was in recovery.

***
So hey! you might be thinking. Doesn’t this story prove that antidepressants don’t really work, while therapy and changing your life circumstances does? You took antidepressants and things got worse, you stopped them and things got better. Case closed, right?

Not exactly.

Here’s the thing about depression: we haven’t quite figured out how the fuck it works. Some of it has to do with brain chemistry, but some of it is definitely due to environmental or psychological factors. And we’re not sure how those three interact, or which ones to “treat” first.

Let’s look at those factors in the case of my depression.

1. Environmental: I was in a university I hated. I had no support system. I had no community. I had no friends. There was nothing to be happy about.

2. Psychological: Without getting into a ridiculous amount of details, one of my parents was emotionally abusive (or, to quote my first therapist: “your parent is a real bully, huh?”), and the emotional abuse caused me to adopt some pretty maladaptive lines of thought. Like blaming everything on myself; thinking I was worthless, hating myself etc. The usual.

So these environmental and psychological factors were definitely fueling my depression. And then we get to:

3. Weird brain chemistry stuff.

Hey, look! This is what depression looks like.

We know that depression changes a person’s brain (see above). We think it might have something to do with the neurotransmitters that regulate mood, like serotonin and dopamine. It’s not entirely clear whether your brain chemistry gets weird, so you get depression, or whether you get depression, and then your brain chemistry becomes weird. Maybe it’s both. Maybe it’s different for different people. Probably it’s different for different people.

But right now, science is still a bit baffled. Yes, we’ve got antidepressants, but no one’s quite sure how they work, or why they work. We know they’re doing something, because they help a lot of people. But they’re also totally useless for a lot of other people. Some people respond terribly to one antidepressant, but do great on another one.  And nobody’s sure why! But we’re dealing with a pretty terrible illness, and if a tool works, we’re going to use it, even if we’re not sure exactly what it’s doing.

(This is, obviously, a massive oversimplification of the current state of depression studies)

So, to recap: since environmental and psychological factors were a big part of my depression, changing them – finding a better living situation, going through talk therapy, surviving the hell of my second semester – made a big difference. Enough of a difference that I went into depression-recovery even though the meds I was taking to target my brain chemistry weren’t working.

Here’s the flip-side: it took me over a year-and-a-half for me to recover from my first depression without the help of medication. And it was not a fun year.

Still, you think: all the medication and neurotransmitter stuff  I just talked about? That’s all theoretical. The proof is in the pudding. You got better without antidepressants!

Just wait. You’ll see: there’s more to this story.

***
 Affronts – Fluoxetine, part 2:

The next two years went pretty well. I switched my major, fell back in love with school, made friends, participated in a play, found my community. When I had the time and resources, I went to therapy.

And then: the migraines.

My migraines have always been problem, but in my junior year at McGill, they became a plague. I got them almost every day: blinding pain in the back of my skull, accompanied by dizziness and aching muscles.

I decided that the solution to my migraines was to overhaul my diet. Protein, I thought, was the key. Cut out all those carbs and sugars, and eat miles of protein instead. Oh, and I should start an exercise program. An hour at the gym every day.

I told myself these changes – the diet, the exercise – were for my migraines. But deep inside, I knew the truth: convinced I was too fat, I wanted to lose weight.

The migraines got a lot worse. Shockingly worse. Before I started going to the gym, my migraines would always go away with a good night’s sleep. Now, I would come out of the gym and have migraines that lasted for days. Nothing made them budge – not medication, not sleep, nothing.

And even though I knew the exercise was causing the migraines, and the diet was making it worse… I kept going.

That’s when the shit hit the fan: my migraines became light-sensitive.

I would go to school feeling fine, and after an hour under fluorescent lights, I would have a migraine bad enough that I’d need to go home immediately. I couldn’t handle any light – I closed all my shades, turned off all the lights, switched my computer off – and spent the day in the dark. I couldn’t do anything. When I tried, the pain would be so bad that I would start throwing up.

Not surprisingly, these circumstances took a psychological toll. Combine the pain from the migraines with the fact that I couldn’t do anything and you’ve got a recipe for a very unhappy Suzanne. Before I even realized what was happening, I’d landed back in the middle of the town of Total Numbington.

Once I stopped going to the gym, started eating better and kept spending all my time in the dark the migraines got better subsided. My residency in the town of Numbington, however, was far more permanent.

In a repeat of my first depression, I spent most of my time in bed, reading piles upon piles of X-Men: First Class fanfic. Fortunately, this depression didn’t seem as severe as my first, so I was still able to go to class and do work. My grades held steady.

I did not see a doctor in Montreal.

When I finally came home to Wisconsin, my parent had switched health insurance plans, and I could not longer access my long-term therapist or doctor. My new doctor asked me almost no questions before diagnosing me with depression again. Then she asked me if fluoxetine had given me any side effects when I’d first taken it.

“None that I noticed.”
“And did it help?”
“I’m not sure. I didn’t feel anything, but maybe it was subtle.”

She started me on fluoxetine again.….I am not a good advocate for myself in health situations. At all. Because I should have stopped her there and said “no, fluoxetine didn’t work, we need to try something else.” But since I still didn’t realize that you’re actually supposed to * feel * the effects of antidepressant, I just acquiesced to the fluoxetine. Again: telling people that antidepressants don’t work HAS CONSEQUENCES.

The doctor, of course, wins a gold medal in “wut” medicine for translating my “I’m not sure fluoxetine did anything” response into “let’s just throw more fluoxetine at the problem.” (In a shocking twist of events, fluoxetine did absolutely nothing. Who could have predicted that result, huh?)

Some good things did happen that summer. I found a great new therapist. I started a fairly effective migraine treatment. The lack of school-related stress from school also helped. I certainly wasn’t as depressed at the end of the summer as I was at the beginning.

Eventually, I saw another doctor. I brought up the fact that fluoxetine (still) wasn’t doing anything. She decided not to switch my medication since I was about to move back to Montreal.

“We don’t want too many changes at once.”

pride and prejudice, introduction

Fuck you, antidepressants!

I was pretty much on the “FUCK ALL ANTIDEPRESSANTS FOREVER” train by this point.

Passion, or Wellbutrin Part 1

I returned to school, still on fluoxetine. Though the fluoxetine remained useless, my depression was under control.

It was a good semester. I found a low-cost therapist. I started dating the Feminist Philosopher. I worked on my honors thesis, I enjoyed my classes, I wrote some popular blog posts.

But even in those good moments, part of me was still stuck in Numbington. And I was sick of it.

The next time I went to Wisconsin, I made an appointment with a new doctor. This was the third primary care doctor I’d seen in less than a year, and I was not optimistic.

But this time, I did my research. I wrote a list of concerns. I found a website with lots of information about antidepressants (Crazy Meds), and I read the relevant information. I knew enough that I could advocate for myself.

And this time, the doctor actually listened to me. Our appointment was supposed to be fifteen minutes long, but she spent an hour with me. We went through my list of concerns, discussing the various things that could be contributing to my mood, making a plan. She asked my opinion on various medications.

I walk out with a list of concrete suggestions and a prescription for Wellbutrin.

***
Wellbutrin, otherwise known as Bupropion, is not an SSRI. And it’s not… entirely clear how it works (you may have noticed a trend here).  Our best guess is that it inhibits the reuptake of dopamine and norepinephrine, two neurotransmitters that, like serotonin, work as mood regulators. Since I hadn’t responded well to an SSRI (fluoxetine), my doctor bet that targeting dopamine and norepinephrine would work better than moving on to another SSRI.

Ignore the last one; I couldn’t get rid of it.

Wellbutrin works quite well with depression. It also has very few of antidepressants most infamous side effects: it doesn’t (usually) cause sexual dysfunction, weight gain or somnolence (feeling tired all the time). It occasionally leads to weight loss – which some people may feel is a plus, but which could be a problem for others.

Crucially, Wellbutrin works particularly well with people whose depression is coupled with social anxiety (*raises hand*) and people whose depression manifests through anhedonia – an inability to take pleasure from activities you usually enjoy (*raises hand*).

Wellbutrin, in other words, was an ideal antidepressant for me. It wasn’t an SSRI, it had few side effects, and it tended to work well for people whose depressions were similar to mine.

I felt so much better when I walked out of the doctor’s office, in large part because I wasn’t just taking a pill on faith. The doctor had explained her reasoning, and I felt that she was addressing my specific needs, rather than giving me a one-size-fits-all medication.

Thus, armed with a new antidepressant and a whole lot of hope, I returned to Montreal’s cold embrace.

***
Reader, Wellbutrin worked.

pride and prejudice, gif, Elizabeth Bennet, Mr. Darcy

Two and a half weeks after I’d started the pills, I woke up at nine, lounged in bed for less than five minutes, got up and started making breakfast.

Wait. Pause. If there was something I’d never been able to do during my depressions, it was actually waking up. What the hell was going on?

It kept going. I started getting out of bed with energy in the morning. I was motivated to do things. I was procrastinating less. I’d finally started outlining my honors thesis. My appetite was back. My insomnia was gone. I planned for meals and sleep. And my anxiety, the electric beast perching on the back of my head day and night, seemed to have gone to sleep. I only felt occasional prickles.

Then, reader, I had to have a bit of a sit-down. Because if a medication could make my depression better so quickly and so radically, then maybe I wasn’t the problem.

Maybe I actually did have fucked-up brain chemistry.

Elizabeth bennett, gif

You think I would have figured this out earlier. But even though I believed that depression was a disease, not a personal failure, and even though I knew the mechanics of depression, and even though I knew I couldn’t just “snap out of it – subconsciously? I was pretty sure it was my fault. I bought into the “depression as personal failure” model.

Wellbutrin knocked a couple legs off that theory.

 Part 4: Separation, or Wellbutrin, part 2

A few weeks after Wellbutrin started working, I started fainting. Plus, I had a noxious combination of dizziness, nausea, constant-never-ending hunger and hypoglycemia.

… side effects.

I was in Canada, and I had no way to pop down to my doctor’s office in Wisconsin to figure out if Wellbutrin was indeed causing these symptoms. They weren’t on the list of common side-effects, but there weren’t a lot of competing explanations. At some point, my doctor stopped responding to my emails. I was cut off of medical advice. Any doctor I could have seen in Canada would have cost a whole lot of money, and would have zero knowledge of my medical history.

And meanwhile, I was dizzy/fainting/hungry/nauseated/ freaking out.

I stopped taking Wellbutrin. Cold turkey, no titrating. It seemed like the best option at the time.

Pride and Prejudice, Mirror scene, Elizabeth Darcy

I stopped fainting. The dizziness went away. And the depression, temporarily banished to the outer atmosphere, fell straight back home. With a vengeance.

Going from “doing good!” to “severely depressed” in a week was viciously painfulI spent a lot of the month of February and March curled up in bed, watching Elementary and drawing pictures of naked women (don’t ask).

But I did return to functionality. Depressed functionality, true, but functionality. All of my assignments got turned in on time. I missed minimal classes. I finished my honors thesis with time to spare. I graduated with first class honors. I made some big life decisions; I moved apartments; I dealt with bed bugs. I started playing video games.

Three people are now rolling on the ground, laughing at this Dragon Age joke. Credit: http://falseteethcyborg.deviantart.com/art/Shale-DESTROY-ALL-PIGEONS-198074293

I was depressed, but I was okay.

Part 5: Despair

Then I stopped being okay.

It was summer. I was no longer in school. I was facing a really massive change in my life: the end of college, the beginning of my adult life, a move to a terrifying new city etc. etc. etc.

And I was now entering year two of an untreated depression.

My depressions were usually characterized by numbness, exhaustion and lack of interest in the world. I did have moments of overwhelming sadness, but they were moments. They lasted twenty minutes to an hour at the most.

Now they lasted days. My numbness now translated into constant sadness and despair. I took frequent breaks during the day to lie in bed and cry. I cried myself to sleep most nights.

And then, for the first time in my near-five years of experience with depression, I experienced suicide ideation.

Feeling suicidal is Not Fun. Especially when it’s happening 2-3 times a week, and you’re too terrified by the feeling to tell anyone. I’d always been able to handle my depression. I didn’t know how to handle this. I didn’t know how to handle the overwhelming sadness and shame and guilt that made me want to die. I’d always felt like a burden; now I felt like so much of a burden that I just wanted to disappear, to make everyone’s life easier.

Hyperbole and a half

Yes, I wanted to live; I wanted to live desperately. I had so much to live for. But I also wanted desperately not to feel, to stop the pain of living, to end my constant guilt. In those moments, I felt trapped – I couldn’t see a stopping point to the pain. I didn’t believe there would be a stopping point. I just wanted it to end.

It never got bad enough that I started planning, or even considering options. But the “not bad enough” was more than bad enough for me.

I was so scared.

A friend and I were talking over facebook around this point, and she said, “I don’t understand. You have the Feminist Philosopher. You two seem so happy together. And you’re moving to NYC, and there’ll be lots of opportunities there. Why are you depressed?”

See,  that’s what’s so terrifying about depression. It’s not necessarily a response to something. It can be caused by psychological and environmental factors, but it doesn’t need to be. It’s an illness.

It doesn’t need to be caused by anything.

Which, when you’re lying in bed thinking about death, is horrifying. Because if it isn’t caused by anything, how are you going to make it go away?

Reunification, or Paxil

Paxil!

To cut a long story short: I found a way to get back to Wisconsin (for a ridiculous amount of money). I saw my doctor and left her office with a prescription for a new antidepressant: Paxil, AKA Paroxetine

Even today, I have zero idea why I was prescribed Paxil. It’s one of the more prescribed antidepressants, but it’s not one of the most effective ones – in a lot of trials, it’s not even as effective as fluoxetine, which we’d established didn’t work for me at all. It’s also one of the worst, if not the worst, antidepressant for side effects – especially for sexual side effects.

I… was not happy about that. I really like sex. Sex was one of the things that remained wonderful despite the depression.

And, on top of the horrible side effects, Paxil has a notorious discontinuation syndrome. If Paxil didn’t work, not only would I have to find a new antidepressant, I might also have to deal with withdrawal.

At the same time… Wellbutrin was supposed to work great and cause zero side effects. But it didn’t. So maybe I wouldn’t know how Paxil would work for me until I tried it.

So I tried it! Very unhappily, but I did!

tumblr_li9vljpWlo1qcrza7o1_500

I really wasn’t expecting much.

But taking Paxil, my friends, was a good life choice, because two-and-a-half weeks later, the fog just – lifted.

I know this whole “fog-lifting” thing sounds like a figure of speech, but it did not feel that way at the time. It was as though every color in my brain had reset to a brighter setting. Two weeks.

Pride and Prejudice, Mr. Darcy, sunrise scene

Antidepressants rising

I stopped feeling suicidal. I haven’t had a single episode of suicide ideation since I started taking Paxil. All my random crying jags ended. I mean, I still cry, but there’s always a reason – I’ve had a bad day, I’ve dropped a stack of books on my foot, I’m watching Catching Fire and I can’t handle the flashbacks to RUUUUUEEEE.

My moods made sense. I wasn’t randomly desperate or unhappy or mad. If I was sad, it was because something sad had happened. And my default was no longer “numb/sad,” it was “fairly happy.”

Yeah, when antidepressants work, they can really work.

A few weeks later, I moved to a new city – New York City, in fact. Unlike my first major move (to Montreal), this one did not provoke a new depression. In fact, I was pretty thrilled. I found a great job. I found a second job as a freelance book reviewer (!!!). I made friends. I explored the city. I spent lots of time with my boyfriend.

When people say that antidepressants squash creativity, I laugh and laugh. Sometimes I can stop laughing before they start talking about calming drinks.

Prior to Paxil, I was basically incapable of reading, much less writing. When I got to New York, I started writing again. I managed to publish a few blog posts – those had essentially disappeared during the Major Depressive Summer. I began writing fiction again for the first time in years. I taught myself how to spin yarn using a drop spindle. I started painting my nails. I took the GREs, I applied to graduate school, I got a 750 on the GRE in Literature. The three people who have taken that test are now suitably impressed.

I started volunteering.

tumblr_mayaoxQWRA1rrghlso1_500

Dear Paxil:

… yeah, I’m pretty sure the antidepressants aren’t destroying my personality.

Okay, let’s talk about the bad news – the side effects.

I’ve got a couple. The usual vivid dreams – serotonin is notorious for this one – but vivid dreams don’t really bother me. I’m sleepier, although I can’t tell whether this comes from the paxil, or from all the migraines I’ve been getting. I now shake my leg when I’m working at my desk – again, I can’t tell if this is a side effect from paxil, or if I’ve just picked it up in the last few months.

I haven’t had any sexual side effects, which is BLOODY FANTASTIC. My sex life is great, thanks for asking!

I have gained a lot of weight. Side-effect fatty over here! Obviously, it is possible that this is an unrelated weight-gain, but the evidence seems to indicate that it stems from the Paxil. I’ve also been eating less and exercising more since I started Paxil (it’s amazing how not being depressed can help you get out of the house/cook food). And I gained weight on my other SSRI, fluoxetine, which I lost it when I stopped taking the drug.

I think I’ve gone up a couple dress sizes. Am I super-happy about this? Nope!

I am a product of our society, and although intellectually, I don’t think there’s anything wrong with being fat(ter), I struggle with a shit-ton of body issues. Plus, you know, having to buy new clothes sucks.

At the same time, I’d rather be bigger and happier than thinner and depressed. At least when I’m in recovery, I have the emotional resources to deal with body-image issues. When I’m depressed and thinner, I still hate my body, but I have no capacity to deal with it.

So. On balance, I’m quite pleased with Paxil. It took three medications, but I’ve finally found one that puts me in recovery, and where the side effect are tolerable.

Part 7: The end of the courtship

Having been through the whole courtship and marriage plot shindig, let me tell you, I’ve learned a lot about antidepressants. I know how to make a relationship with serotonin and other neurotransmitters work.

Let me share my secrets.

1. If you don’t feel antidepressants working, they’re not working

I wasted an incredible amount of time taking fluoxetine because I thought it might be working even though I didn’t feel any different. Now I know better: if you don’t feel an antidepressant working within six weeks, it’s not doing anything.

You definitely want to give it six weeks (although many doctors will want you to check in after three weeks to see if they should up the dose) because some antidepressants take time to work. But if you’re not feeling anything, or if what you’re feeling is so subtle that it’s meaningless, you have the right to bring it up. There’s nothing wrong with you because a treatment didn’t work. And you are not obliged to keep quiet about it to make the doctors feel better or to avoid inconveniencing anyone.

Moreover, just because one dosage of one antidepressant doesn’t work does not mean that antidepressants are wrong for you, full stop. After using fluoxetine, I was pretty sure antidepressants did nothing for me. Five years later, I can say with certainty that some antidepressants do a whole lot for me.

Is it a pain in the ass to deal with the trial-and-error of finding the right medication? Absolutely. Just like it’s a pain in the ass to do the trial-and-error of finding a new therapist.

But one experience with antidepressants does not seal your fate with psychiatric medications.

2. Doing your own research is a good idea.

Understanding how antidepressants work and having my own internal database of medications, their side effects and their efficacity went a long way to reconciling me to the idea of psychiatric medications after my bad experience with fluoxetine.

Obviously, it’s important to remember that what you find in your research doesn’t determine how you’ll react to any given antidepressant. See: my experience with Paxil. But it can help demystify the process and allow you to advocate for yourself in the doctor’s office.

You can also get an idea of what side effects are unacceptable to you. Heightened anxiety? Cognitive problems? Somnolence? Loss of libido? If you give doctors an idea of what you don’t want, they can try to tailor their prescription.

At the very least, if you’ve done your research, when your doctor says something you know is false, you can run. 

(I’m personally a big fan of the irreverent and comprehensive website Crazymeds. It’s got a ridiculous amount of information on various psychiatric medications (not just antidepressants). It’s also run by crazy people, for crazy people, which I find reassuring))

3. Advocating for yourself is important, but is also paradoxically the hardest thing to do while depressed.

Finding the right antidepressant involved a whole of lot of me standing up for myself, demanding that doctors help me and refusing to believe that it was all my fault.

In other words, it took a lot of investing in myself.

But there’s a reason it took me five years to get to that point. Because when you’re depressed, you have nothing to invest in yourself. Your resources are gone.

And depression, meanwhile, is actively convincing you that there’s no problem at all… except you. You’re the problem. You’re not sick, you’re just lazy/stupid/etc.

Which is why:

4. Getting good treatment involves supportive, continuous healthcare.

 You know when I started getting good treatment? When my doctor started listening to me. That’s how I got prescribed Wellbutrin. That’s how I got prescribed Paxil. Before then, I’d been through two separate doctors who either hadn’t listened to my problems, or hadn’t inquired further about my experience with antidepressants when I said they weren’t doing much. That… was not okay.

Mental illnesses are a chronic problem, and they need continuous care. A prescription is not the end. Often, problems will arise, the dosage will need to be adjusted, side effects will appear, or the medication won’t work at all. Healthcare here needs to be seen as a long-term process, both by the patients, and by the doctors. My biggest problem with recovery has been my lack of continuous healthcare. Even when I found medications that worked for me, I couldn’t go see my doctor for a regular check-in, because I was in Canada and she… wasn’t. I probably would have found the right antidepressant a whole lot faster if I were able to access healthcare more often.

But unfortunately, access to healthcare was geographically and economically impossible for much of my college life. (It’s still economically impossible for me at this point, which… is great! (not))

5. Who gives a shit if Antidepressants Are the Easy Way Out?

So, are antidepressants the easy way out?

Time for a rant: The idea that antidepressants are an “easy solution” to depression is such bullshit. The flip side of that coin – that therapy, exercise, diet change etc. and tackling the “root psychological problem” – are the “correct” way to solve depression is also pure BS.

Both these ideas are rooted in the narrative that depression is a personal failure, a mistake you can “correct.” Some people choose the “easy” way out and just take pills, which means they never “correct” their personal failures. Others pull themselves up by their own bootstraps by doing therapy and running 30 miles a day. Those people are actually “correcting” their personal failure by doing the hard work of personal redemption.

Yo, depression isn’t a tragic flaw in a shakespearian tragedy. It’s a disease that fundamentally changes the way your brain works. You do not “deserve” to be depressed. You aren’t depressed because you took the wrong path in childhood. You aren’t depressed because you’re lazy. You aren’t depressed because you’re weak. You’re depressed because you have an illness.

And since depression is an illness, not a character flaw, it responds to treatments like an illness. Which means that everyone’s depression will respond differently to therapies and treatments. No treatment is inherently better or worse than another. If therapy helps you, that’s great. If antidepressants help you, that’s great. If a combination of the two is an optimal solution, that’s fantastic.

Important side note: since depression is an illness that no one really understands, you won’t know what works for your depression until you’ve found it. There’s no great way to guess what’ll work for someone, which is why we shouldn’t assume that one treatment is better than another for any particular person (unless, obviously, there are allergies/side effect issues/other health factors).

Finally:  Who the fuck cares about whether something is “easy” or not when you’re severely depressed? Seriously, this is life we’re dealing with, not an endurance contest. There is no prize at the end for the person who Worked The Hardest To Solve Their Brain Chemistry Problems.

***

Disclaimer: This was my long, long, long post about my personal experience with antidepressants. As a reminder, it’s… my experience, not anyone else’s. And there are a shit-ton of problems with antidepressants beyond the fake issues people invent. Hey, it’s harder for people of color to get correctly diagnosed! Doctors make all kinds of terrible mistakes based on stigma! We don’t have the healthcare structure necessary to make sure that people who need treatment *get* continuous treatment!

Tons of problems.
Antidepressants being “easy” isn’t one of them.


9 Comments on “Are you there, Serotonin? It’s me, Suzanne.”

  1. dawnofthenerds says:

    This past year I’ve gradually realized that I’m dealing with depression, generalized anxiety disorder, and agoraphobia (crowds). I’m ‘lucky’ enough that my symptoms balance each other in a way that makes me functional. My anxiety means I need to get things done in a reasonable time frame. My depression means I need to take breaks and not run myself into the ground. All in all, the dishes get done, I’m getting good grades in grad school, and it could be worse. I’m just rarely happy. About the only emotions that come through clearly are shitty ass anxiety spirals and rage. Less than ideal. Fortunately, I’m done school in two months, and then I can move back home. And it always gets much better when I’m back home. I’ve been muddling along without medication so far, and it’d be kinda pointless to start trying to find the right one when my major environmental stressor will be gone soon. But if things don’t get better this summer, I’m definitely coming back to this. Wellbutrin sounds like a good one for me, and that’s way more than I knew before. I also reeeeaaaally suck at advocating for myself, and being depressed makes it that much harder to even begin doing the research necessary to do that. So, thank you very very much. I’m really glad that you’re doing better now.

    Also, assuming that McGill is similar to the U of T, the psychologists there may not have helped much anyway. I got an appointment here at the U of T, and the psychiatrist was just going to write me a scrip for something or other without a) telling me what it was and b) asking if I was already on any medications. Accutane has serious side effects and contraindications. She was an incredibly self absorbed and dismissive person. Here, all they want to do is write a scrip and get rid of you. A bunch of my friends have had similar experiences with U of T psychologists. (What does it say about my program that over half of the people I know in it have struggled with mental illnesses)

  2. Eileen Young says:

    I’m glad you were able to share this – and even more glad that you’re in an enough better place that it was possible to write it. And – and I’m contributing this not to in any way diminish what you said, but because I come from different disciplines and therefore have a different vocabulary – the Just World Fallacy contributes a lot to people’s ideas of bootstrapping their way out of depression. It’s a cognitive bias that a lot of people share that pre-disposes people to thinking that aimless and terrible misery is going to be in some way their fault, because bad things don’t happen without reason.

    Brains are dumb and beautiful and terrible.

  3. […] Are you there, Serotonin? It’s me, Suzanne. […]

  4. […] Are you there, Serotonin? It’s me, Suzanne. […]

  5. rimonim says:

    Thanks for this very thorough post! I wrote a rather similar post recently on my blog. The prevailing attitudes about antidepressants are frustrating, ignorant, and abilist. Glad to hear you found a treatment that works for you!

  6. emmawolf says:

    Thanks for this. I think you said a lot of things that I needed to hear.

  7. Khai says:

    OMFG THANK YOU THANK YOU THANK YOU

  8. Khai says:

    Reblogged this on Duffel Bag And A Dream and commented:
    I rarely reblog, but this is very much worth a read. Get a cup of tea, and READ IT.

  9. Lacey Sutton says:

    Just this morning I was hoping that you would post a blog soon. And this one is so dead-on what I needed to hear today. Thank you!


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