In the six years I worked for The Mail on Sunday, I’ve recovered from an eating disorder, suffered several bouts of severe anxiety, moved house twice and gotten married. I am now in the process of getting divorced.
However, I hadn’t taken a single day off for mental health reasons until late last year, and I had nothing to do with any of this.
In fact, my breakdown was caused by the pills I was taking to help me cope with the stress of it all.
It happened in September, two weeks after starting the antidepressant Prozac, also known by its generic name, fluoxetine.
I decided to continue the medication when my anxiety symptoms (heart racing, tightness in my chest, knots in my stomach) began to make daily life difficult.
My breakdown was caused by the pills I was taking to help me cope with the stress of the above, writes Mail on Sunday deputy health editor Eve Simmons.
Like eight million others in the UK, I have suffered from intermittent bouts of anxiety for most of my 31 years, usually triggered by stress. I was prescribed Prozac, one of the most commonly prescribed antidepressants, twice before, during my teens and in my early 20s, to treat anxiety. But this last time something felt different. Fifteen days after starting the treatment, I began to feel… a little bad.
I was at a friend’s birthday barbecue. It was a lovely day (warm weather, pots of gravy, and three kinds of sausages), but I began to feel as if someone had started a fire in my chest, or how I imagine it would feel at gunpoint. My body was rigid, anxious thoughts racing.
I came home afterwards and collapsed on the couch, cried, and then spent two hours googling things like ‘How can you turn off your thoughts?’ and ‘How do you know if you have schizophrenia?’
Most alarmingly, I developed the feeling of dissociation, a feeling that the body is separate from the mind. Basically, I thought I was going crazy.
After getting minimal sleep, the next morning I called my colleagues at MoS Health and admitted for the first time that I was not well.
I’m not ashamed to talk about my mental health, but my work has always been a kind of sanctuary from my troubled mind.
This time I couldn’t do anything: write, read or understand. The information just wasn’t coming in.
My editor insisted that I take as much time off as I needed.
What followed was a desperate call to the doctor, who prescribed me a low dose of the sedative diazepam and told me to call back in a couple of days. “It’s very common for fluoxetine to make you feel worse at first,” he told me, “but the side effects usually go away in a month or two.”
Could I feel like this for two months? He wasn’t sure he could survive the next day.
In light of all this, it may surprise you that, to this day, I remain a staunch supporter of Prozac and all antidepressants. I’m still taking the pills.
The GP was right. The side effects subsided after about a month and the treatment has kept me afloat during a turbulent time in my life. But as a health journalist who has written prolifically on the benefits of antidepressants, my problem baffled me.
In November, I received a series of flak after writing on these pages that my childhood GP had first prescribed Prozac to me when I was just 15, to treat severe anxiety. On Twitter, some accused me of promoting powerful drugs to teens that were known for their side effects, such as suicidal thoughts.
According to official guidance, antidepressants should only be prescribed by a psychiatrist for children under 18, and only in severe cases. I immediately responded, arguing that the evidence showed that, in general, antidepressants do more good than harm, and even for adolescents, they can save lives. But had my own recent experience proved me wrong?
The most commonly prescribed antidepressants in the UK are selective serotonin reuptake inhibitors or SSRIs.
Several reviews, looking at hundreds of studies, found that, on average, about 40 to 50 percent of people with depression and anxiety who take SSRIs see an overall improvement in mental health. About half of the patients will experience at least one side effect. For one in ten, these problems are so severe that they stop taking them.
Side effects differ between medications, but are mostly fatigue, nausea, dizziness, upset stomach, sexual problems, and severe agitation/anxiety. About four percent of patients experience suicidal thoughts, according to the American Medical Association.
But there is little clear information about how long these problems last. Guidance from the UK’s drug watchdog, the National Institute for Health and Care Excellence (NICE), mentions vaguely that the pills should take effect within four weeks, while some side effects “may persist throughout the treatment”. But GPs I’ve spoken to say they’ve noticed a clear trend.
“It can take anywhere from three weeks to a month before you feel normal again,” said The Mail on Sunday general medicine columnist Dr Ellie Cannon, adding that she also experienced short-lived side effects from taking SSRIs. “They have made me feel very sick for the first few weeks, and if I adjust the dose it can seem like I’m going crazy.”
Like eight million others in the UK, I have suffered from intermittent bouts of anxiety for most of my 31 years, usually triggered by stress. I was prescribed Prozac (pictured), one of the most commonly prescribed antidepressants, twice before, during my teens and when I was in my 20s, to treat anxiety.
Dr Clare Gerada, a psychiatrist and president of the Royal College of GPs, said: “Patients feel absolutely worse in the first three weeks. They tend to have very severe anxiety symptoms. I sometimes prescribe a sleeping pill in the first week to help patients cope with increased panic at night.
“But if they stick with the antidepressants, things usually get better.”
Dr. Penny Ward, visiting professor of pharmaceutical medicine at King’s College London, says there are several possible explanations. “The chemical combination of some SSRIs has a ripple effect on other compounds in the brain and the rest of the body,” she says.
SSRIs turn off the body’s ability to buffer serotonin (a neurotransmitter that carries messages between nerve cells in the brain and the rest of the body).
This could have an impact on the central nervous system, which controls our natural response to fear and could, in theory, exacerbate anxiety. But once serotonin reaches a mood-enhancing level, anxiety becomes less bothersome.
Few studies control for the duration of specific side effects, but many report that many patients stop taking the pills because of side effects and when.
In a study of more than 600 patients, only 15 percent said serious side effects led them to stop taking the pills in the first three months, although 60 percent had serious side effects in the first week. Another US trial of 400 patients found that 40 percent suffered from sleepiness, 30 percent had sexual problems (such as erectile dysfunction), 22 percent had insomnia, and 19 percent suffered from anxiety.
In about two-thirds of the cases, symptoms were a problem only for the first two weeks.
But some SSRIs are associated with more early side effects than others, and fluoxetine seems to be one of the worst offenders.
“I would always prefer not to prescribe fluoxetine,” says Dr. Gerada. ‘You see a lot more anxiety with it, compared to other SSRIs.
‘For starters, you have a feeling of irritability and restlessness, because it has a slight stimulating effect.’
Several doctors I’ve talked to over the years have told me that patients often find that antidepressants don’t work because they come off too soon. Studies show that about 60 percent of people see benefits after three months, compared to 40 percent after one month.
The message is, if you can, try to stick with it. “Have a loved one watch you closely for the first few weeks,” says Dr. Cannon.
And if not, try something else. In 2008, experts at the University of Pittsburgh found that 40 percent of a group of 334 depressed patients saw an improvement in their mental health after switching SSRIs.
But doctors say that these drugs are not the be all and end all. There are classes of drugs that work with different chemicals in the brain to improve mood and relieve anxiety.
For example, SNRIs, which affect another mood-related brain chemical called norepinephrine, may be effective in those who don’t get along with SSRIs, particularly venlafaxine. There are also older classes of antidepressants such as tricyclics, including amitriptyline and nortriptyline, although they are associated with side effects such as drowsiness and falls.
A 2018 review by researchers at the University of Oxford compared clinical trial dropout rates (the percentage of patients who stop taking a treatment before the study ends) and the efficacy of 21 different antidepressants.
Interestingly, the ones that stood out were atypical antidepressants, including agomelatine, which increases production of the hormone melatonin, mirtazapine, and a tricyclic antidepressant called clomipramine. But all the drugs studied, including SSRIs, were found to be effective.
I’ve been taking Prozac for six months, which is about how long the doctors suggest stopping if you feel better. And though I feel much less deranged, with a challenging year ahead of me, I’d rather not risk letting my brain marinate in its natural juices.
I am aware that there is a possibility that I could be with them for the next two, three, or even five years, but as long as I get out of bed in the morning, I honestly don’t care.
