A beginner’s guide to starting SSRIs for anxiety or depression

WORDS BY EMMA MAIDENS

“Let someone close to you know, so they can support and be part of monitoring your reactions to the medication. It’s not always a smooth process.”

SSRIs (also known as selective serotonin reuptake inhibitors for those lucky enough to be unfamiliar with the acronym) are commonly prescribed antidepressants. Personally, I’ve been familiar with this acronym for three years now, after suffering a major depressive episode and needing more of a helping hand than therapy alone could offer.

If you’ve ever had a doctor or psychiatrist float the idea of SSRIs by you, you’ve likely ended up in the Google black hole that is ‘side effects of SSRIs’. If you haven’t, let me tell you, it’s dire out there. The best you can hope to find is forums of people sharing their experiences.

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Some of these instil hope if you’re in the depths of despair (and if this is you, know that I’m sending all my love) and some recounts do nothing more than scare the hell out of you. From my own experience, these Google searches don’t answer many questions and often leave you with more concerns than ever.

While your doctor will be able to provide the medical advice you need to consider, there’s some practical life advice I can offer that I’ve learned over the years that will hopefully help you on your journey more than Dantheman66 on Reddit. In addition to my personal experiences, Dr Amanda Ferguson, psychologist, author and host of the podcast Psych for Life explains exactly why these survival tips can help you on your SSRI journey.

Treat the week you start taking them as a write-off

You’re about to start taking brain chemical-altering medication. This isn’t the week to convince yourself you’re just popping an extra multivitamin. You’ll likely feel different, and that’s normal – just know that it won’t last forever.

If you live with other people, let them know and give your boss a heads-up. Personally, I would recommend having a couple of days off work, or at the very least opting to work from home. What you’ll feel during these first days will differ from person to person, and be impacted by factors like which SSRI you’re prescribed and your dosage. I felt spacey and nauseous and experienced heightened anxiety I couldn’t attribute to anything in particular.

This increased anxiety during the early stages can be scary but remind yourself, it won’t last. Also, know that your doctor is a phone call away, and if you find your thoughts drifting to negative places, please ask for help.

Dr Ferguson advises to “… Let someone close to you know, so they can support and be part of monitoring your reactions to the medication. It’s not always a smooth process. SSRI medications are basically a trial and error process”.

Pay attention to changes within yourself

My SSRI, Sertraline, makes me tired. Not just a bit sleepy, but so tired that after taking it at lunch I resemble more of a zombie with obnoxiously loud, long yawns instead of an employee. Not cute. I told my doctor, who advised me to switch to taking them at night time. It was a simple and effective measure that improved both my concentration and sleep pattern drastically.

Try keeping a tracker of how you feel in the form of a diary or journal. This doesn’t need to be a detailed essay each day, as this can feel too overwhelming. It could be as simple as a score out of 10 for your mood, or noting down the day’s symptoms (e.g. if you have a headache or feel nauseous).

Dr Ferguson advises possible changes to make note of, including “nausea, dizziness in the early days and then ‘feeling like my old self again’ is a sign that people are probably on the right medication and the right dose”. Know that SSRIs are meant to improve your life, not make it harder and if you notice changes that are having a negative impact speak to your doctor. You know yourself best and small changes in dosage, type of SSRI and the time that you take them can all be adjusted to work better for you.

Understand that it’s not a life-long commitment

There are many feelings that can go hand in hand with beginning these drugs, and I’ve felt them all. A primary one was the fear I’ll become dependent on them forever; a lifetime of one of those chemist boxes with the days of the week printed across the top flashed before my eyes.

Understanding exactly the function SSRIs serve helped a lot with overcoming this fear. “They were originally developed to be prescribed for three-month intervals – to be reassessed at each three-month interval.”

These days, “It depends on what individuals are dealing with in their lives as to how long we anticipate they might reassess their prescription. In some cases, I might say, ‘Let’s look at this again in three months and in other cases in six, 12 or even 24 months’”.

Managing motivation

Something I noticed in myself, and have discussed with others on SSRIs, is a change in motivation. Now if you’ve suffered from depression, you’ll know that a symptom is no motivation. It can be difficult getting out of bed, let alone showering and eating.

The motivation shift I noticed after beginning antidepressants was different. I can do those things easily now (except on Sunday mornings, because hey, we’re all entitled to a sleep-in). Instead, I began to feel so content within myself, I no longer had the anxiety-fuelled drive to do the things I felt compelled to before. If I’m home on a Friday now, I don’t get FOMO. If I know my friends are all at a bar, I’m content at home.

On the flip side, my drive to achieve, achieve, achieve has also diminished. Depending on your life and job, this can be more or less noticeable. If you find yourself feeling this way, it gives you a great opportunity to a) connect more with yourself and b) figure out your true priorities.

I’ve discovered which friends I can spend time with regardless of whether I’m in a high or low-motivation mood – the ones that understand if I say “maybe”, it’s really a no. I’ve also discovered what pastimes and jobs actually fulfil me because I still have the motivation to turn up every day with a smile on my face. If your lifestyle is being severely impacted by changes to your motivation, Dr Ferguson advises heading back to your GP as “… it’s probably the wrong SSRI or the wrong dose”.

A change in sexual desire

This is something you may or may not notice, and if you feel too much of an effect, know that speaking to your doctor about changes in dosage or medication can help this. If you find yourself going from a healthy sex drive to not desiring sex at all, “it’s probably the wrong SSRI or the wrong dose. But sometimes there is no way around this, and this will hopefully motivate the person to do the psychological work to get off the SSRI”.

Personally, I found little to no change other than a greater understanding within myself of whether I am, or am not, in the mood. My sexual activity is now more considered, and I find myself placing higher importance on my personal pleasure. Solo play is now an important part of self-care for me, and communicating with my partners so that the experience is equally enjoyable for us both takes precedence.

If you do feel affected, it doesn’t have to be a mood killer. Don’t engage in sexual activity if you don’t want to, but if you’re feeling open to it, an increased focus on foreplay and building arousal can enhance the experience for you.

Numbness

There may be a period of time when you feel numb to experiences that used to make you feel the most alive. Yes, it can be scary. While you signed up for losing the deep feelings of sadness and despair that used to cloud your head, you don’t want to sacrifice the sunshine either. Please, believe me, it will return. SSRIs flood your brain with serotonin. This also means you can feel less of a high when you experience other serotonin-inducing activities like exercise and laughing.

Feelings of numbness may indicate that SSRIs alone aren’t enough to help you break out of a depressive episode. “It’s probably an indication the person is either under or overmedicated or not correctly medicated or not needing medication or not responding to it and really needs therapy,” explains Dr Amanda.

Mixing with other drugs

Your doctor will recommend you don’t take other drugs for a host of reasons, but a key one if you’re suffering from depression is the after-effects of stimulants. Many recreational drugs cause a surge of dopamine that results in a depletion over the following days. While the high may be fun, the crash is so much more painful. Mixing non-prescription drugs with SSRIs can have other negative effects too.

“Some people have reported having severe panic attacks when taking SSRIs with marijuana. CBD prevents the body from eliminating the SSRI as quickly as it should and marijuana can raise the amounts of SSRIs in the body. Serotonin syndrome is a potentially lethal illness caused when serotonin levels climb too high due to SSRI use. Serotonin syndrome can happen when someone takes both SSRIs and cocaine together.”

However, I’m still somewhat young. I know that the ‘don’t do drugs’ totalitarian view hammered into us at school doesn’t work. Instead, we’re moving towards a more educational approach. Like pill testing at festivals, if you decide to take recreational drugs, do it as safely as possible and educate yourself on what to look for if something doesn’t feel right.

Don’t stop taking them abruptly and without discussion

Finally, as tempting as it can seem to stop taking your SSRIs once you feel better, please don’t. “[Stopping SSRIs abruptly] is dangerous because of the shock to the body and brain of sudden withdrawal. I would not advise this,” says Dr Amanda.

Instead, speak with your doctor, who will help you decide if it’s the right time for you to stop the medication. If it is, they’ll help devise a plan to slowly reduce your dosage in a way that’s more tolerable for your body.

All said, there’s a strong chance that the right dose and type of SSRI can be a beneficial aid to feeling like your old self again. Dr Ferguson believes in them as one of the steps on the road to recovery. “They are like a glue, holding people together while they – hopefully – seek psychological or psychiatric help to recover from their problems.”

If you or someone you know is struggling with their mental health, you can contact Lifeline on 13 11 14.