The discourse around mental health has picked up speed, but it remains an underserved topic. If you’re curious about SSRIs, or know someone who is, we’re resharing the below meditation and guide on antidepressants, originally published in 2016, in case it’s what you need to read today.
hen I was 12 my grandmother died, and suddenly I saw death everywhere. I’d been an anxious kid before that, with baby-sized panic attacks that had me hallucinating slow, booming voices and strange objects that ballooned into my frame of vision.
Later, I’d sit up at night to guard against what felt inevitable: our house burning down, a murderer crawling in a window. Imperceptible rejections could propel week-long crying jags, gentle self-harmings (digging my nails into my palms, slamming my head into the side of a bathroom stall) felt better than living inside my brain. One thought became eight thoughts became an endless, tangled river of possibilities, inadequacies, shortcomings, failures. In bad times, I would go weeks without eating a real meal, feeding myself on the crumbs of my dramas and the odd croissant.
Despite this, I believed myself to be generally fine. I didn’t consider therapy until the age of 27, when my partner of eight years left me; I continued sporadically once I moved to New York, a city that both blurs and amplifies feelings. Then I got a bully of a boss, and then I got fired, and then I tried to get a dear, damaged friend to love me back, and then I stopped being able to climb stairs without pausing for breath, or sleep for more than a few fitful hours at a time, or eat without wanting to vomit. It was a true angel of a nurse practitioner who finally suggested — after thyroid and dietary and allergy tests — that I might consider medication.
In 2015, 11% of Americans reported taking a selective serotonin reuptake inhibitor, or SSRI. They are the second-most prescribed class of meds in the U.S., used to treat conditions ranging from depression to premature ejaculation. My prescription (Lexapro, 10mg, nice to meet you) is for generalized anxiety disorder; which, according to the Anxiety and Depression Association of America (ADAA), “is characterized by persistent, excessive, and unrealistic worry about everyday things.” Anxiety can cause insomnia, muscle tension and headaches. It affects 3.1% of the U.S. population, and women are twice as likely to be diagnosed. On the other side of this fun coin is depression, or “a feeling of disinterest or discouragement lasting more than two weeks” that makes daily activities — the work of living — feel impossible, or pointless. It is one of the most common mental disorders in the U.S., with 6.7% of Americans having experienced a major depressive episode.
Gemma, 32, had her first encounter with depression in seventh grade. “At my school, seventh grade was high school. I was just so, so anxious and upset. Just devastated about growing up. I went the first day and then stayed in bed the rest of that week.”
Despite periods of “fineness,” her depression became debilitating in her third year of college. “I’d leave my bed to go to class, and then crawl right back to it. As I walked around campus, I envisioned myself collapsing and laying down on the sidewalk. I was crying all the time. I don’t remember what the impetus was, but I finally went to student health. Through that, I met with a therapist and a psychiatrist who prescribed me my first SSRI. It changed everything.”
This slow slump into treatment is a common narrative for many suffering from anxiety or depression. There is a wide spectrum of how we, as human beings, interact with the world. As women, we are told our feelings make us female: our anxieties about our bodies and sexuality are part and parcel of our womanhood, and our willingness and ability to ride the tide of our emotions (many hormone-driven) is one of the trophies of the female experience. I spent many years convinced my anxiety was merely a sign that I was (lol) an “artist.” I assumed that not being suicidal meant I wasn’t really ill: there’s a wild gulf between fearing death and wishing it on yourself.
That’s why anxiety is particularly nefarious, even more so when it rears up in response to circumstance (a breakup; a move; the election of a racist, xenophobic, misogynistic president). In being hard to name, it becomes hard to take seriously. And mental illness is still stigmatized, especially in lower income and rural areas. Therapy can be prohibitively expensive: I pay $10 for a month of generic escitalopram, whereas the therapist I was seeing at the time of my diagnosis charged $250 an hour, and didn’t accept insurance. The idea of medication only became normalized to me after years of talk therapy, and luckily coincided with an uptick in friends willing to share their experiences and an increase in cultural consciousness.
“There’s more awareness that there’s something wrong with being anxious or depressed,” says D.C.-based psychotherapist Dr. Beth Salcedo of the increase in the use of SSRIs. She always recommends her patients first try therapy or other lifestyle changes to address anxiety or depression: “If the stressor is fixable, fix the stressor; if not, treat the person. Even just the act of entering into therapy can be helpful. And then things like exercise, good sleep, quality nutrition — meditation is one of the easiest things to implement, and it’s so highly effective for anxiety. I recommend relaxation techniques like progressive muscle relaxation, or apps like Calm and Headspace.”
But sometimes, still, medication is the best course of action. “I see a lot of young associates in law firms,” Salcedo says, “working 16 hour days, who would love to get better by way of psychotherapy but they don’t have the resources or energy to put into that. Some people have depression because they stay in a terrible relationship, or can’t get the sleep or nutrition they need. If they can’t make changes, medication should be an option. We have to treat [anxiety and depression] the same as any medical illness.”
For Nina, 32, the breaking point was medical school. “I’d gone through a terrible breakup. I was waking up in the middle of the night, early morning — I wasn’t able to sleep through the night. I was taking my first board, and I was panicked that I wouldn’t be able to study if I couldn’t sleep through the night.”
“I think I’ve always had anxiety that I didn’t even recognize, starting in my early teens,” she says. “I managed it pretty well, so I didn’t feel like I needed help. Then the combo of the emotional impact of the situation, as well as having to perform for school, made me look for new options. I remember talking to other women who had gone through these kinds of devastating breakups and they said that being on an SSRI in those initial months had really helped. I was in therapy for managing anxiety, but we didn’t really connect and I needed something that would work quickly. Within three weeks, I was sleeping so much better and able to focus.”
Therapy can take years before you learn how to address the underlying causes of anxiety or depression; medication can be effective in a matter of weeks. Says Gemma of starting Prozac: “It really did just like, part the clouds. I started laughing again. Getting out of bed. Going to the gym. I was still me, and still self-deprecating and felt sad sometimes, but I could function.”
I started with 5mg of Lexapro in the summer of 2013, and increased to 10mg after one month. The first few days I felt nauseous and tired. Following that, the main side effects were a complete eradication of my sex drive for about eight months (helpful, as I was single and nurturing an impressive kernel of dude-facing rage), night sweats, muscle spasms and wild, vivid dreams. None of these are uncommon. Nina, too, struggled with jumpy muscles and stomach pain. Does that sound like a lot? It kinda does, when I write it out, and yet: I would take all of those, all at once, over and over again, to feel this alive and at peace with my thoughts.
“The media has demonized psychiatric medications,” says Dr. Salcedo. “No one thinks about being on birth control for 30 years, but they worry that Zoloft is going to kill them. Mental illness is so abstract because the symptoms are in your brain. It’s not like a blood pressure reading. People feel that they need to do it themselves, that it’s a weakness, that they’re flawed in some way. I’ve seen amazing things with all of the medication I’ve prescribed. There are side effects, and it’s not for everybody, but I wouldn’t want to keep that life-changing experience away from anyone.”
I clearly remember my own quickening. I was eating pasta on my couch, living alone for the first time, a few months after starting medication, watching my cat race around my apartment and a thought suddenly crystallized: I like spending time with myself now. It was such a simple thing, and it brought me to tears.
For 30 years, I believed middling self-loathing was my natural state. Now, I’m able to write without self-censoring; I’m able to be a good partner since I’m not perpetually convinced my boyfriend is about to see my inadequacies and run. Being less consumed with my own inner life means I’m generally a better person — a kinder, more attentive friend, sister, and daughter, with far more time to devote to the well-being of people who are NOT ME. It’s impossible to see when you are in the throes of depression or anxiety, but what feels self-centered — giving yourself the kindness and treatment you deserve — is actually the thing that will allow you to crawl out of your myopic mud cave.
I don’t know if or when I will stop taking my SSRI. Nina, now in a new relationship (“my boyfriend calls my medication my ‘USSR’”), wants to get off before she tries to get pregnant (the risks of taking an SSRI during pregnancy are considered low, but are not entirely known); Gemma tried to replace medication with acupuncture and exercise, but found her depression intensifying, and went back on. Lexapro has also eradicated my vicious migraines. At this point, any thoughts I have about tapering or quitting boil down to a bullish desire to prove I don’t need it.
We currently inhabit what is a very shitty time to be a woman, let alone a person of color, queer, Muslim or gender non-conforming (the list goes on). Our safe spaces are being eroded, and we need to protect our bodies and brains how we can. If you live in a body that no longer feels safe to you, part of defending it is accepting that it is okay to be sick inside it, and to ask for help. Sometimes that help comes in the form of an AirBnB in the woods with good friends; sometimes a paid professional; sometimes a small white pill you dry-swallow each morning, watching your own tired, scared face above the sink. Now, more than ever, we all need our armor.
Photos via iStock.