Picture this — floating lazily on a canal boat in Amsterdam on a beautiful summer day with my teenage children, on our way to the Van Gogh museum. We’d been cycling around the Vondelpark in the sun, and would later see a Banksy exhibition. A perfect day. Except I was pulsing with anxiety, and trying to hide it from my kids.
orse than anxiety — actual dread, waves of it breaking over me like an electric current. There was no external reason — I’m not an anxious person and hadn’t experienced existential anxiety before. Yet I was having to breathe deeply just to stop myself from actually freaking out. Maybe it was menopause — I’d recently undergone surgery to remove my ovaries after a cancer scare, which had turned out to be a false alarm. Wasn’t anxiety a symptom of menopause?
Back home, my GP suggested I go back on the antidepressants I’d recently come off, at a higher dose. A consultant gynaecologist suggested the same. Almost immediately, my anxiety dissipated, and I felt normal again.
This was five years ago, and I stayed on them —SSRIs, selective serotonin reuptake inhibitors, the standard prescription used by millions to treat depression and anxiety, the most famous one being Prozac. My menopause symptoms, initially ferocious, eased and plateaued. Was it because I was still on antidepressants, or was it the HRT, yoga, wholefoods, and all the other things I did to manage it?
Last October I read an Economist article which suggested most people on anti-depressants don’t need them, and that only 15pc of users were getting any substantial benefit beyond that of a placebo. Maybe it was time to wean off them again, this time for good.
I’d been on Prozac for 12 years by then, minus a few months around that trip to Amsterdam. Before I began using them, despite removing any obvious external depressants from my life — crucially, alcohol — there had still been days when I’d struggled to get out of bed, days when the idea of doing the washing up felt like climbing Everest. I felt irritable a lot, which was horrible.
My knowledge of depression was narrow – didn’t it mean sitting alone in a darkened room listening to The Cure? I’d read Elizabeth Wurtzel’s 1994 memoir Prozac Nation and hadn’t related to all the breakdowns and suicide attempts. And because my former husband had died from untreated depression in 2006, I had always associated the condition with its worst, most irreversible outcome.
It wasn’t until hearing people talking about depression in 12 Step meetings, in far less dramatic terms, that I realised they were describing how I was feeling. Anger, stress, irritability, indecision, overwhelm — I had no idea these were part of depression. And like many others, I’d been self-medicating with booze to alleviate it.
After a standard GP assessment showed I was indeed on the depression spectrum, the doctor offered antidepressants. Although I’d already spent years doing tons of therapy, and had psychologically unpacked just about everything there was to unpack, I’d never used any prescription medication before. I was 42, sober, and my life was stable and content. Why couldn’t I fix this myself, with exercise and diet, and more talking therapy if necessary? Wasn’t medicating myself a cop out? But I took them anyway, after someone reminded me that if I were diabetic, I would take insulin, or if I were asthmatic, I’d use an inhaler, so why should meds to help with mental health be any different?
Two weeks later, at a stressy supermarket check-out with my kids, I felt something shifting — like clouds clearing and sunlight shining through. As though my mind was exhaling. It was extraordinary, happening in an exact, tangible moment. This, I realised, was what ‘normal’ felt like. It felt like an enormous breakthrough.
Antidepressants are an important contributor to mental wellbeing for many. Photo: Getty Images/iStockphoto
Depression, as we all know, is the common cold of the mind, affecting 12pc of the Irish adult population in 2022, according to research undertaken by Maynooth University, Trinity College Dublin and the National College of Ireland in a study involving 1,100 participants. A further 7pc identified as having anxiety. (In the UK, according the Office of National Statistics, the figure was 17pc in the summer of 2021, in the US it’s around 10pc of the overall population, and globally, according to the WHO, it’s around 5pc — the lower figure could reflect cultural reluctances to identify as depressed). The good news is that both depression and anxiety are eminently treatable, via meds and therapy. But does that mean you have to stay on antidepressants forever?
“The suggested length of time used to be 6-12 months to take them, which has been expanded to two years,” says consultant psychiatrist Ivan Murray, medical director of Dublin’s Neuromed Clinic. “But people stay on them for far longer than that.” This, he adds, is not harmful. You can’t get antidepressant poisoning.
But did I still need to be on them? I decided that I didn’t, and gradually tapered my daily dose over a period of weeks, to avoid withdrawals – if you have ever accidentally gone on holiday without your Prozac, you’ll know it can feel a bit unpleasant: brain zaps, general feelings of vacancy, headaches, sleep disruption. I followed medical guidelines and did it properly, reducing by small increments, rather than rushing it.
According to Harvard Health, the medication takes around 25 days to leave your system.
A few weeks after that, I started feeling not great. Irritable, stressed, overwhelmed. Snappy. Crying on my yoga mat during Savasana. Feeling like Chicken Licken, that the sky was about to fall in. Admittedly, there were external stressors going on — mortgage rates going crazy, causing financial insecurity, and the death of my elderly father — but my response seemed disproportionate. I felt like I was drowning. I toughed it out. I was determined to not need antidepressants anymore.
Until my daughter said one day, “For god’s sake Mum, what is the matter with you — why are you doing this to yourself?” I think I’d been shouting at the dog. (I never shout at the dog. I love the dog.)
“Life is hard enough,” says Ivan Murray. “Getting well involves using all the pieces, whatever works. I’d always argue ‘yes’ to coming off antidepressants, because that is how you find out if you need them or not.
“Your own experience is unique to you — you apply what works to yourself. They are only meds, not cures, which is why sometimes psychiatry falls foul by overselling them as cures. There is no brain chemistry in these pills. But SSRIs are efficacious, as they turn off the symptoms of depression. Being well is like making a cake — there are several ingredients needed. Medication, therapy, and lifestyle — not just diet and exercise, but social factors too.”
Meds are not entirely foolproof. A friend who also uses standard SSRIs tells me how hers suddenly stopped working for her after several years. She experienced a dip in mood she couldn’t explain and wouldn’t go away, which unnerved her and impacted her ability to function properly, until her doctor referred her to a psychiatrist, who changed her meds. She was soon back to normal.
“This is called tachyphylaxis, when antidepressants sometimes stop working for no apparent reason,” says Dr Murray. “Its causes are unknown, and it can be distressing — but it can be addressed by changing the dosage or changing to another antidepressant.”
Meanwhile, I carry on. Maybe I’ll have another review at a later stage, but for now, I am delighted that antidepressants exist and that I have access to them. When it comes to mental health, pragmatism is key. Why suffer?
Safe withdrawal tips
Psychiatrist Dr Ivan Murray says: “Have a rationale for coming off meds. Maybe they’re not working, or you want to switch to another kind. The most important thing is to do it slowly, and under medical supervision. Withdrawal can be serious if done willy-nilly. I would suggest a tapering-off period of at least six to eight weeks.
“Otherwise your original symptoms may come back, but plus-plus — so if you were using anti-depressants for anxiety, if you rush coming off them, your anxiety could be even worse. It can be extraordinarily unpleasant. If you are on, say 40mg of fluoxetine [aka Prozac], go down to 20mg for a few weeks and see how you get on. If you feel alright with that, go down to 20mg every other day, and again, see how you feel. This process would be absolute minimum one month, probably longer.
“And if you don’t feel good, go back a step. Keep the anti-depressants in your treatment arsenal. There are no set rules.”
Consult your GP before you make any changes to your medication. See aware.ie for more information on depression
