So Long, Sertraline
I gaze long and hard at myself in the mirror, straining to reach the girl behind the face. I’m in there somewhere and it’s both liberating and terrifying to think that the person before my eyes is now the ‘real’, emotional, non-medicated version of my being.
It’s been 14 days since Elvis left the building – Elvis being a small, white pill called sertraline, the building being my mind and body – which means that I am now the fully paid-up owner of my mental faculties. But getting here has been a journey of Stygian character.
As there is little in the way of practical medical advice, because the sub-conscious is subjective and we all react differently to drugs, I was forced to trawl the internet’s anxiety-amping corridors – aka Reddit – for some idea as to how I would feel immediately after coming off my anti-depressant.
Would I have to hit pause on life for the next few weeks?
Cue: potential lysergic visions, night sweats, blackouts and paralysis. “My skin felt like it was crawling all over my body and I ached. It wasn’t bad enough to knock me off my feet, but it was a miserable couple of weeks,” wrote one Redditor, imgoingalittlenuts2. “Saturday night she had some pretty vivid hallucinations, thinking that there were old men all around her, pretty scary stuff!” said another, Se7enOne. “Yesterday I woke up with nausea and vertigo, as well as ice cold/numb hands and face, and I collapsed on my way to the bathroom.” – [deleted]
Their words hit me in the face like a shower of bullets. I envisioned myself beating off phantasmagorical septuagenarians on the Victoria line at 8am, before collapsing on a terrified commuter.
But, turns out, it wasn’t quite as bad as that.
For three and a half years, I popped 50mg a day of one of the most commonly used SSRIs – selective serotonin reuptake inhibitors – to help lift me through life. However, in recent months, the quagmire of daily existence had become more navigable terrain *touch wood* and I felt ready to kick away the crutch and go it alone.
When I visited my GP, he told me to phase the drug out of my system by talking half a tablet every other day for as long as “felt right,” and warned me that things may “feel a little strange” for “a while.” So, I dutifully whittled down my pill to a powdery whisper of its former self, at first knocking back a half, then a quarter a day, before eventually waving off that perky, dependable, comforting little lover I had relied on for so long and vouched to (probably, hopefully, sadly) never see again.
It’s excruciatingly hard to give up something you need, and love, and withdrawing from sertraline for my depression has felt like one of those break-ups where you still love each other, but you both know that one of you needs to be on their own to work out whatever it is they need to work out.
I just felt the time was right to stand on my own two feet and learn to love the non-chemically enhanced me. Because, to quote RuPaul, “If you don’t love yourself, how in the hell you gonna love somebody else?” And I didn’t want to be alone forever, despite appearing to revel in its opposite.
During the course of this parliament, the NHS budget for mental health services has been slashed by £600m, with three quarters of trusts admitting they had to freeze or cut their budgets between 2013/14 and 2014/15. Mental health currently receives 13% of NHS funding and yet suicide remains the primary cause of death for men under 35 in England and Wales. Waiting lists for talking therapy can be as long as a year and under Cameron’s premiership, things are only going to get worse.
I first sought medical help for depression and anxiety in 2008. I remember the moment well; I had broken down in tears on the staircase at home and felt my skin and bones twist and crumple into a jelly-like mass, before my dad scooped me up and told me everything would be OK. That was the first time we had ever really addressed what was going on with my mental health. I was 23. Up until that point, my illness had manifested in varying, secretive forms – diary writing, self-harm, cripplingly bad self-esteem, daily tears. But the day my dad told me we could do something about it really was the beginning of the rest of my life, however mawkish that may sound.
We booked the next available GP appointment and I waited about four weeks before I was given a course of Cognitive Behavioural Therapy on the NHS. I was sent to the Priory in Roehampton, south-west London, because it happened to be the nearest CBT centre to where I grew up. Every week, I would make my way over to the eating disorders ward where my counsellor’s office was based and I would try my hardest not to gawp at all the painfully stick-thin girls and boys sprawled out on the sofas and chairs around me.
I remember going into my first day of CBT thinking how spoilt and privileged I was and that this kind of potentially life-changing treatment should be reserved for people with real problems, like these girls and boys, whose lives were palpably ebbing away. But, at that point, mine kind of was, too and as I refused to go on medication, this seemed like the only viable solution. After a few months spent mind-mapping my thought processes and practising visualisation exercises – what is essentially now ‘mindfulness’ – I felt cured of the crippling social anxiety, inferiority complex and obsessive thoughts I had been enduring for some years.
But old habits die hard and it wasn’t long before I slipped back into the negative thought cycles that resulted in episodes of irrational behaviour and self-loathing, running the gamut from irresponsible sexual encounters, excessive spending and drinking, to full-on emotional breakdowns. I wasn’t helping myself, I knew that, but I didn’t care enough about what happened to me to do anything about it.
At 28, I finally succumbed to the allure of medication, despite worrying that I may suffer from one or more of the following side effects: overactive reflexes, tremors, nausea, vomiting, diarrhoea, loss of appetite, feeling unsteady, loss of coordination, SSRI-induced mania, xerostomia (dry mouth syndrome), grinding of teeth, weight gain, sexual dysfunction. But when you’re that bloody miserable, you don’t care about potentially losing your teeth or piling on the pounds, you just want to be able to wake up without that proverbial cloud hanging over you.
And after a few months, the clouds did start to clear. After six months, I was practically leaping out of bed every morning, itching to start work and dedicating any spare time to the causes, issues and interests I had always cared for but never quite had the motivation or focus to pursue, because I was so consumed by my own thoughts. I became pro-active and my head felt noticeably calmer – I wasn’t fixating on stuff as much as I used to. I do remember experiencing a kind of wading through water sensation, and would often find myself blankly staring off into space while people were talking to me, but it was nothing I couldn’t handle. Pretty soon, my head felt less cluttered, I began plotting a new life plan and I felt increasingly ready to tackle reality on my own. I stopped crying every day, which was weird. But never once did I feel devoid of emotion – often the main concern when starting meds. I don’t believe anything has the power to stem my emotional outpourings.
Three and a half years later, I decided to kick the ‘cleaning up’ process into gear. It should theoretically take up to six days for sertraline to leave your system, but of course everyone is different, and with me, the weirdness ended up lingering for some time after that.
I first began to feel the effects of the withdrawal on day two – nothing quite as severe what those Redditors may have experienced, but it was bad enough to make my work and social activity grind to a halt. I had to ask for extensions on deadlines and stay in bed because I felt too sick and dizzy to do anything else. By day three, I was so irritable that I couldn’t stand to be around anyone. I ventured out to the shop but was not fit for public consumption. Case in point: during said trip, I encountered an annoying girl shouting to her boyfriend about what kind of bread they should buy and I kept fantasising about clobbering her with one of the stupid, overpriced loaves. Also, the shop assistant was way too enthusiastic, so after listening to her explaining the many varieties of tofu they had on offer, at length, I ended up buying chicken kievs and a Peperami just to spite her. She was only trying to be kind and helpful. When I got home, I burst into tears in front of my housemate, before necking a massive glass of red wine, which made me feel as woozy as hell. Drinking while coming off sertraline, I quickly realised, was a recipe for disaster.
By day four, I was completely zapped of energy and felt totally nihilistic. I consumed half a tub of prawn cocktail Pringles for lunch because I was ‘working from home’ (i.e. in bed, trying to put everything off) and didn’t have it in me to leave the warm cocoon. When you’re trying so hard to hold it all together, to keep up the good work you have been honing for years, to meet that 4pm deadline without asking for more time, but you’re at rock bottom, that half tub of Pringles is like a hot pink mirage in a dismal, grey landscape.
Day six was by far the worst. I had to leave work early and spent two days in bed. By day eight, I felt just about well enough to leave the house and socialise. The next morning I cried in the shower, but noticed that the dizziness had finally gone. However, it had been replaced with a relentless torrent of internal questioning, including: Will my mind go back to how it was before, now? Will I ever be ‘normal’? What even is ‘normal’? Who wants to be ‘normal’? Will I ever be able to cope without meds? Will anyone ever love the ‘real me’? Who even is the ‘real me’? ARGHGHHGHGHGH. I got back into bed.
Because it is important to appreciate that anti-depressants do not necessarily work alone, you are advised to make healthy lifestyle choices, as well as engaging in some kind of ‘talking therapy’ in your quest for a clean bill of mental health. As I mentioned before, these kinds of psychological therapies are nowhere near as readily available on the NHS as they should be. The Chief Executive of Mind, Paul Farmer, says 28 days of referral is the optimum, but in cases of moderate mental health issues, it is a notoriously long wait; for me, at this point, it’s been five months and counting.
I approached the twelfth day with an intense feeling of positivity, one that I had genuinely feared I would never regain. It’s been two weeks now and I actually feel…OK. I don’t regret my decision to come off medication and I know that I am incredibly lucky, because for many people out there, taking anti-depressants is the only way they can function. I will still try and get on that second course of CBT, although I have considered forking out for some kind of private therapy (which I can’t really afford). However, most importantly, it’s up to me now to build on all the good work I achieved with the drugs as my crutch, and I will always be grateful to them for that.
But for now – so long, sertraline. Let’s hope we need not meet again (for a while, at least).
Illustration by James Burgess