When the Antidepressants Are Worse Than the Depression

When I was 17 years old, my father died unexpectedly. He wasn't really sick, he wasn't very old, but one day he was alive and the next day he was not. I was, understandably, a mess. Despite unending support from friends and family, I was suddenly pitched forward into a dark cave of uncharted territory. I still went to school but I didn't really absorb anything. I still hung out with friends but I didn't really care what we did or talked about. At night, I made my boyfriend spend hours on the phone with me so I didn't have to be alone. My therapist told me I was depressed.

Counselling didn't really help my depression. My therapist believed strongly in Freudian theory, and it quickly became tiresome to avoid talking about anything that could possibly be interpreted as a physical or metaphorical phallus. I went to my family doctor to get a referral to a new counsellor, and in the meantime, he prescribed me a new type of antidepressant called a Selective Serotonin Reuptake Inhibitor (SSRI).

I never really found a therapist I connected with so I mostly relied on the SSRI for relief. I loved my SSRI. I was doing well in school, I had a social life, I felt really good, and all it took was a pill before bed. My good mood went on for a decade.

When I was 27, I decided I was ready to go off antidepressants. I talked to my doctor and she agreed. I had been on the lowest possible dose for the majority of my twenties, I was finished with school, and I was in a stable relationship. I was finally okay.

The first day I "stepped down" my dose was a nightmare. There was no warning at the time of prescription or at the time of discontinuation that there were any ill effects of stopping the SSRI: I was simply informed to step down my dose until my prescription had run out. I immediately felt the effects of stepping down even though it had just been hours since my dosage change, not to mention the dosage change was tiny, literally removing one bead from almost twenty in a capsule I had taken apart.

Every day after the first step down was a struggle to get out of bed. I was often nauseated and I suffered from constant "brain zaps" whenever I moved my head, a phenomenon described by people withdrawing from SSRIs as an electric buzz or a shock. I couldn't pay attention at work and cancelled any social interaction in favour of sleeping. It was almost like being depressed again but worse, because short of going back on the antidepressants and delaying the inevitable, there was nothing I could do to control the withdrawal symptoms.

SSRI Discontinuation Syndrome, or SDS, also sometimes called SSRI Withdrawal Syndrome, was first discussed in the late 90s. The prevalence of SDS varies wildly from 20 to 86 percent of SSRI users, depending on the study and the specific SSRI (popular brand names include Prozac, Zoloft, Paxil, and Lexapro). Initially, SSRI withdrawal was thought of as something that was preventable, easy to treat, with mostly mild symptoms. However, a recent review of SSRI withdrawal studies from researchers in Italy and the US show that SDS is more serious than originally imagined.

The review showed that SDS can happen regardless of the type of SSRI. Furthermore, gradually weaning off the drug doesn't diminish the chances of discontinuation syndrome. Symptoms, which include nausea, rapid heart rate, and hallucinations, usually last a few weeks but can persist up to a year.

Maybe describing SSRIs as addictive isn't totally off the mark. A 2012 study by Danish researchers noted that SSRI withdrawal was similar in nature to benzodiazapine withdrawal (benzos also go by the brand names of Valium and Xanax), so similar that using terms like "dependence" to refer to benzodiazapines but not SSRIs is nonsensical.

SSRIs boost the transmission of serotonin, a neurotransmitter thought to be behind happiness. Neurotransmitters like serotonin are sent from neuron to neuron in the brain, like little messages in an old-school pneumatic tube system. But instead of all the tubes being connected, there are little gaps, called synapses. When the first neuron sends its shipment of serotonin, not all of it will get through and bind to the second neuron; some of it gets reabsorbed into the sending neuron in a process called reuptake. SSRIs increase the level of serotonin in the synapse, giving the serotonin more of a chance of binding with the receiving neuron by blocking its reuptake by the sending neuron.

The physiological reasons for withdrawal are unclear. Some researchers think it's from a sudden decrease in serotonin in the brain, while others think it could be a stress response due to genetics or from tolerance. There are no studies that provide a definitive answer.

The symptoms I experienced when I was withdrawing from my SSRI lasted over a month, though it felt a lot longer. I started to feel hopeless, frantically googling "brain zaps when stop" and wondering if I should go back on the SSRI instead of just waiting it out when I started to feel okay again. I was able to start doing work again and flip my hair without feeling like my brain was in an underwater toaster.

Despite the effects of SDS, I still don't regret taking SSRIs. At the time, I didn't feel like I had a lot of other options and the SSRI enabled me to do things I wouldn't have been able to do otherwise, such as graduate university, maintain employment, and dye my hair a horrifying shade of blonde only carefree twenty-somethings are brave/dumb enough to attempt.

I wish there had been more dialogue surrounding SSRI withdrawal so I had known what to expect, however. At no time did the doctor who put me on the SSRI discuss possible withdrawal symptoms, nor did the doctor who took me off the SSRI. Without that full disclosure, I was totally blindsided by the withdrawal symptoms, the severity of which is potentially dangerous for a person with previous mental health issues. If I didn't have such a strong support system and even stronger Google skills to figure out what was going on, I would have likely assumed SDS was just what real life was like after SSRIs and either resumed SSRIs indefinitely or fallen back into my old withdrawn, anhedonic habits.

For others, experiencing the unexpected effects of SDS after years of stability on SSRIs could be devastating. Recently, I was able to find a good therapist and I finally have the support to work through my grief and various issues in a non-Freudian context—no SSRI needed.

Lit Up is a series about drugs and drug-like substances and practices. Follow along here.