I want to start this post with a disclaimer: SSRI’s can be wonderful, medically necessary, life-saving tools. They should absolutely be covered by insurance, prescribed when needed, and used without shame or stigma. And the doctors who do prescribe them should properly educate patients about the vast range and variety of medications available, the potential side effects, and the fact that if one goes horribly, that doesn’t mean there are no others out there.
I also believe that therapy in some form (talk therapy, meditation, making therapeutic lifestyle changes, etc.) is crucial to being the best and happiest version of yourself, regardless of whether you have mental health diagnoses or need SSRIs. Oh, and cognitive behavioral therapy (CBT) is my personal favorite ;-)
All that aside, I have experienced challenging transitions onto -- and off of -- SSRI’s. Several years ago, back when “just anxiety” was the only diagnosed explanation for my constant health problems, I was advised by my PCP to try Lexapro. I have always reacted strangely to medications (thanks MCAS) and was very hesitant to try such a significant one. But, I was also desperate, and decided to trust my doctor. She prescribed it, saying if I should give it a try for a few weeks and if I had any issues I should give her a call and we’d figure it out. She did not go over any side-effects.
What followed was some of the worst symptoms of my life up to that point. I was up all night with nausea, vomiting at work, being criticized by my (not so compassionate) supervisor for not being committed enough to our work, had terrible brain fog, and overall felt awful. After a month or so (I think? It’s all somewhat blurry…), I called my doctor to say it was horrible and I didn’t know what to do. I was told that she couldn’t see me anytime in the near future, and that if I felt it was an emergency I could see someone else. So, desperate, I came in to see a stranger who agreed I should probably go off the meds. No mention of weaning off (at least that I can remember -- again I was very foggy), or that other SSRI’s may be a good option. Unaware of the consequences, I went off cold-turkey. It was awful. I had horrible shakes and chills, had to periodically crawl into my office to lie down on the disgusting floor, etc. A coworker finally asked me what was up, and we had a long talk about their experiences on SSRI’s in which I learned more than any doctor visit. (Note: around this time my mom -- a physician -- figured out what was going on, freaked out that I’d gone off all at once, and helped me to wean off appropriately).
After that experience, you can understand why I was hesitant a couple years ago when again it was suggested I try medication, this time Sertraline. I felt more informed, however, and Sertraline was a drug that multiple family members had responded well to. After struggling with the decision for quite some time, I finally went on it. My therapist at the time shared her concern that my emotional capacity was a wonderful aspect of who I am, and she wanted to make sure I didn’t feel pressured into a drug that might damper it.
All things said, though, it went quite well. It took the edge off in a way that helped me retrain some of my tendencies that just weren’t being fixed in therapy. Before Sertraline, my reaction time to stressors was so sudden and my fight/flight response would be so elevated that it was near impossible to make calculated decisions about how I wanted to respond to anything. It was so frustrating to go through all the work, the therapy, the intentional planning and conversations, just for it all to go out the window as soon as my traumatized brain got triggered.
I was able to create some patterns that I hope will last for many years to come and allow me to feel in control of myself. I want to always be kind to myself and others, and it can be challenging when your lizard-brain is in charge.
I am hoping to have children in the near future, and Sertraline is not great for pregnancy. I thus decided (many months ago) that in April of 2020, I would wean off. I chose April because it would allow me to transition at a time when my mood is usually its highest, when the weather is lovely and hope is ample. Womp womp.
When Vermont closed up due to COVID-19, my four jobs all changed drastically overnight, and my personal safety became highly at-risk all at once, the thought of medication changes was completely extinguished. But by May, I was starting to feel stable enough to wonder if it was possible. I gave it a try. I weaned off ssssuuuuuuupppppeeeeerrrrr slowly. Now, in July, I am finally down to a half dose every 3 days.
I’ve been journaling (both before and during the wean) and paying close attention to my mood, physical symptoms, stress response, sleep, energy levels, etc. What I’ve noticed has been fascinating -- I do not seem to have any tangible change. My sleep is still great, which for me is saying a lot. I’m able to focus well. My body feels the same as it has since quarantine hit (so, good but not great). As for my moods, I do not feel that they are any different than they were in March through May. Most days I am happy and feel very grateful. I have periods of anxiety, fear, grief, guilt, and deep crushing sorrow at the state of the world around me. But you know what? Each emotion has felt 100% justified. Not only justified -- HEALTHY.
Pain and fear and brokenness are REAL right now. Anyone who doesn’t feel it isn’t paying attention, or has worked really hard to stay numb.
Our society values impassive, stoic, docile strength. I have felt my entire life that crying is admitting weakness, that by feeling and expressing the depth of my emotions is fulfilling the stereotype that women are too emotional, not rational.
We know that we need more emotional expression. We hear it from Brene Brown and see it in The Mask You Live In. We witness its evidence in our relationships. We notice it in the powerful leaders, without whose passion and pain we would never have the change they have gifted us. We would not have had the Stonewall riots or “I Have a Dream” or the Women’s March. It’s the intense emotions -- fear, anger, hope, determination, connection -- that drive the most important aspects of our life.
Yet this month, when I’m feeling something especially potent, I immediately wonder if I should go back on medication. I can feel, in that back part of my brain that I like to ignore, the stares of everyone who has ever mocked or judged me for being “too emotional” or “intense.” I hear the gendered messages that have been reinforced my entire life, the reality that I often will be taken less seriously if I let out the deluge of what I truly feel.
I was on an SSRI to be healthy. I am going off of it because it is now the healthy choice. None of this decision should be influenced by whether or not society will discount my opinions or my strengths. And I haven’t even noticed an increase in emotions off of Sertraline. It’s literally just “what if” and worrying that others will see my tears and ask “should you be taking your Zoloft again?”
I am writing to you as a way to remind myself that this conflict is real, and is worth expressing. I also hope that someone else may see this and feel respite in knowing they are not alone. I saw this facebook post from a friend today, and it made me smile:
Absolutely. All of my relationships have benefited from my emotions and vulnerability. I frequently have friends say how much they appreciate my openness, that it creates room for them to be honest and unfiltered. I had a voicemail from a friend just this week that started with “I loved your last message, how you named your discomfort. This is what I love about you, your honesty and bravery.” I would not have my writing job if not for my raw authenticity in this blog. I would not have such incredible, loving communities without first being vulnerable. I would not be able to connect nearly as well with the teens I teach.
As I finish my last weeks on Sertraline, I keep remembering walking through Yad Vashem, Israel’s Holocaust museum, with a bunch of 20-something near-strangers. I was doing everything in my power to not sob my whole way through the powerful museum. The people I was with were keeping it together, perhaps a single tear here or there, so why couldn’t I? I finally decided that in this of all places, I -- a granddaughter of Holocaust survivors -- should not be stoic. It felt insulting to the suffering I was there to bear witness to.
It’s not healthy to walk through Yad Vashem dry-eyed. It’s not reasonable to experience today’s death and suffering without intense emotions. Not when we have access to the statistics of who is being claimed by COVID, the stories of families unable to say goodbye due to risking exposure, the videos of young men being killed in the streets, the insensitive and dangerous statements by leaders… Sure, sometimes we need to cope by numbing or distracting, and I continue my therapy and meditation and art and exercise as healthy outlets. But don’t tell me that I need to medicate those feelings away. People like me, who are emotionally strong enough, and socially brave enough to share our fear and anger and anguish with the world, are helping keep the rest of the world grounded. Movements die without these emotions. People are left to suffer. Apathy breeds resentment for the restrictions that keep us safe. Empathy keeps us wearing our masks.
Whether my physical health is better or worse on SSRI’s is a consideration, but it is MY consideration to make. What is unhelpful are the voices of society, coworkers, family members, acquaintances, the judgemental stares of strangers… hell, the voices in the back of my own head, telling those of us who do feel deeply to hide it or medicate ourselves unnecessarily.
Now that I’ve processed those tougher feelings… time to go enjoy the positive emotions that are just as strong :-)