More of us than ever are on antidepressants. Doctors in England wrote out more than 64 million prescriptions for them last year, and use of antidepressants is now seven times higher than 25 years ago, in 1991. The most widely used antidepressants are [selective serotonin reuptake inhibitors (SSRIs) ](/wp-admin/(http:/www.nhs.uk/conditions/SSRIs-(selective-serotonin-reuptake-inhibitors)/Pages/Introduction.aspx)like fluoxetine (aka Prozac), sertraline and citalopram, which act on your levels of mood stabilising neurotransmitter serotonin.
Some people need antidepressants and anyone who has a problem with that should get over it, stat. There is no shame in taking antidepressants and for many people, they are life-changing. There is no 'one-size fits all' treatment when it comes to depression. But, with so many of us taking these pills as part of our normal daily routine, it's worth asking whether there can be life after SSRIs, in which it's possible not just to survive, but to actually thrive? We spoke to three women who've been there, plus Dr Mark Salter from the Royal College of Psychiatrists and mindset coach Ebonie Allard, to find out.
First up, how do SSRIs actually work? Well, like anything else, they're not a magic bullet, can take a week or two to kick in, and don't have the same effect on everyone. 'People vary widely in the way they respond to anti-depressants. What they don't do is lift mood; they usually remove the obstacles to feeling happy or functioning effectively in the first place,' explains Dr Salter.
'For me it was really gradual, but it just took the bottom out of situations,' says 25-year-old Lauren, who was prescribed sertraline during a rough period of depression and anxiety last year. 'Things that had been a big deal to me, suddenly didn't seem so bad. I still felt sad – that wasn't gone – it just wasn't so extreme. From there, I was able to learn how to deal with my emotions, so that I could feel prepared for when I wanted to come off.'
Whether or not anti-depressants help depends on the person and their diagnosis. What works for you might not work for the person sitting next to you in the GP surgery waiting room. For 27-year-old Rach, SSRIs have never made much difference – despite having tried several over the years. 'Because of my Borderline Personality Disorder (BPD) diagnosis, they don't really do much for me,' she says. 'I came off the last lot of antidepressants partly because it wasn't doing much but also because I was in a better place at the time.'
While only you and your doctor can judge the right time to come off, NHS guidelines suggest a typical course of treatment should last six months to two years. However long you've been on them though, Dr Salter says there's no point coming off unless you've made necessary changes to other aspects of your life.
'You must never, ever use an SSRI in isolation. You have to look at exercise, psychological treatments, changes in family, work, alcohol, body weight, eating, and so on because depression is so complex and intertwined with the life of the patient,' he says. 'If someone has been on an SSRI with great benefit, and there've been significant changes in their life, the odds are they probably can stop taking it successfully.'
34-year-old Debbie recently came off sertraline after two years, after 'realising that things were a lot more settled'. She was first prescribed anti-depressants at 18, and then again several years later, but says she's been lucky to avoid any real side effects both times.
'Coming off was more difficult the first time because I didn't know what to expect. I'd heard that coming off antidepressants was really difficult, so I had a bit of anxiety around that. I felt more ready to come off them the second time too, whereas the first time I wasn't entirely sure,' she explains.
Antidepressant withdrawal is usually done gradually by decreasing the dosage over a number of weeks or months, and side effects can include agitation, sleep disturbances, changes in your appetite and sex drive, and irregular periods or bowel habits. Personally, the first and only time I tried to come off fluoxetine - after a year or so - I had a horrendous breakout of stress acne, which affected my mood, and ended up going back on it to clear my skin up. I've felt slightly held hostage ever since.
Similarly, the first time Lauren tried to come off sertraline, she says, 'it was absolute hell. It was like I was right there back at before I'd even taken them, having the same kind of attacks and crazy emotional down spirals.' However, at her second attempt, Lauren had virtually no side effects at all. 'I would get really sleepy at weird times of the day, which was bizarre, but otherwise nothing,' she says.
For all of these women, life after SSRIs has had its ups and downs, but both Debbie and Lauren say the techniques they learned during therapy have helped them get through the toughest days without antidepressants. 'My advice to anyone coming off SSRIs would be to make sure you have good people around you so they can keep an eye on you,' says Debbie. 'And, trust yourself, trust your GP. Trust yourself more than anything, because you know how you feel. Listen to your instincts and what your mind is telling you,' she adds. 'Life is never always great, it's never always terrible, it's just about making sure you have those coping strategies in place and know what works for you.'
For mindset coach Ebonie Allard, this kind of self-awareness and community support has been really key for both herself and her clients in learning to thrive after SSRIs. 'Being on antidepressants gave me the mental energy I needed to take control of my life and my mind, and to make some really big changes in my life,' she says.
'I'm now actively involved in a community where the culture is to regularly talk about how you're feeling. I actively campaign around mental health and help others acknowledge where they're at, and I've changed a lot in my views around vulnerability and strength,' Ebonie adds. 'It can be uncomfortable to have to make big life change and challenge your unhealthy thought processes. But it's about looking at whether actually your job is too stressful, or the culture of your friendship group is creating an unhealthy comparison feeling.'
Although she's personally been off SSRIs for five years now, Ebonie says she still believes they're worth taking when you need that extra help. 'I really do recommend SSRIs to people when they're not coping, because they're there for a reason and they work,' she says.
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This article originally appeared on The Debrief.