A Beginner's Guide to Antidepressants

(I submitted this guide to starting antidepressants to Rookie. Unsurprisingly, it was rejected. I didn't want to waste all my hard work, so here it is for my hoards of blog readers to enjoy.)

My panic attacks all begin the same way.

I feel a slight pressure in the middle of my chest. I inhale deeply. I exhale forcefully. My thoughts start to slip out of control.

“Am I suffocating? If I black out, where’s the nearest emergency room? I think there’s one a few blocks south of here…”

I begin to hyperventilate, inducing yawns to ensure I get a full breath. Breathe in, breathe out.

Breathe in, breathe out.

Hyperventilating is making my blood flow irregularly. My shaking hands start to feel tingly. They’re not working like they’re supposed to.

My chest pressure is suddenly coupled with a sharp pain. I try to breathe, but it’s getting harder. My heart starts pounding and the room begins to spin.

“I’m dying. This is the end. This is the panic attack that finally kills me. I can feel it.”

I’ve battled mental illness for half of my life. Over the past ten years, I’ve struggled with various degrees of depression. My worst period was during high school. During this time, I saw a counselor weekly and met occasionally with a psychiatrist. I was prescribed antidepressants when I was 15, but made a joint decision with my dad not to take them. I tried to manage my depression without the help of medication, and it worked for a while.

My sophomore year of college, my mental health took a turn for the worse. I was working 40 hours a week and going to school full time. This led to an overwhelming amount of stress that triggered frequent panic attacks. They could be caused by certain events or come completely out of nowhere. I had no way of knowing when they would happen.

I suffered from severe anxiety for almost a year before I couldn’t handle it anymore. Living in a constant state of dread was starting to take its toll. I ended up taking a year off of school to get my mental health under control. I could barely sleep or make it through a shift without an anxiety-related episode.

I finally decided to make an appointment with my doctor. I explained my nervous, panicky thoughts and the physical symptoms that accompanied them. I broke down crying in her office almost immediately. She read me a checklist of anxiety symptoms, trying to verify the ones I’d experienced. I was prescribed escitalopram (name brand: Lexapro), an SSRI used to treat depression and generalized anxiety disorder.

Mental illness among young people is more common than you might think.

It’s very easy to feel singled out with your mental illness, especially if you don’t know anyone personally who shares your struggle. We are the most mentally ill generation in history, with one in four teenagers suffering from a diagnosable mental illness. In 2013, a survey conducted by the ACHA found that 57% of college aged women experienced “episodes of overwhelming anxiety”. Additionally, 33% of college aged women reported depressive episodes that impacted their ability to function daily. More than 11% of college students have been diagnosed or treated for anxiety in the past year.

You aren’t alone.

It's okay to be nervous.

Karen, age 20, was hesitant to start her prescription. “My psychologist's recommendations were no longer working for me,” she explains. “I was finally recommended medication. I’ve always had a fear of taking wrongly-prescribed medication, especially ones that would alter my brain.”

I was very nervous about starting antidepressants, too. I didn't actually take a single pill until about six weeks after my prescription started. Naturally, I had anxiety about taking medication for my anxiety! I was the first of my friends to be prescribed an SSRI. I didn't have anyone close to console me or share their experiences. I felt like I was taking a shot in the dark.

I obsessively Googled things like “starting escitalopram”, "escitalopram side effects", and "escitalopram success stories". I read countless anonymous mental health internet forums. I didn't find this information very reassuring, but I needed some kind of answer. It took a lot of encouragement from my friends and family to persuade me into starting them. I knew they wanted me to help myself, but my anxiety was preventing me.

...but you don't always have to be.

In hindsight, I wish I would have taken my medication as soon as it was prescribed to me. I had to do a lot of self-reassuring in the beginning. I repeatedly compared my antidepressants to long term medications that are prescribed for physical illnesses. It took me a long time to understand that doctors prescribe medications for a reason. I didn't ask to be mentally ill, just like people don’t ask for broken legs or diabetes. It was something out of my control.

The side effects can be unpleasant at first, but you'll make it through.

I'll be honest with you guys. Initially, the side effects can be pretty uncomfortable. I had some of the most painful stomach aches of my life the first week I took my pills. My sleep schedule was irregular for over a month. I couldn't sleep at night, and was tired all day. I could have fallen asleep almost anywhere ...except in my bed! There can also be sexual side effects, like not being able to orgasm. Talk to your doctor about the potential side effects so you know what to expect. (I didn’t.)

After about six weeks, my body finally adjusted to the medication. My stomach aches stopped, my sleeping pattern returned to normal, and I could orgasm again (woo!). The adjustment period can feel excruciating and never-ending, but I promise it will get better.

Like all medications, not every antidepressant works the same way for everyone. Emily, 22 says, “My side effects were very minimal and tolerable. It was very much worth it for me to power through those first few weeks. Even after the adjustment period, I continued to have freakishly vivid dreams. They’re amazing.”

They can take some getting used to.

Remembering to take a pill every day can be challenging. Antidepressants were the first daily medication I'd ever been prescribed. I’ve forgotten to take them a few times. Fortunately, most antidepressants have a fairly long half-life, so you won't be affected too much if you miss a day. (The longer you take your pills, the longer their half-life will be.) Set an alarm for your medication if you're forgetful, or take it along with another daily medication like birth control, allergy pills, etc.

Generally, antidepressants aren't effective immediately. Just like your body needs time to adjust, so does your brain! Your anxiety or depression could potentially worsen before it gets better. If this persists, talk to your doctor and discuss what changes need to be made to your prescription. Starting antidepressants can be a long process, and so can finding the medication that fits you best.

You may need to experiment with different brands and dosages to find what's right for you.

I was very fortunate with my prescription. My dosage and brand worked very well for me, and I’ve had minimal problems with them so far. However, this isn’t always the case.

Kelly, age 20, tried a few brands and dosages before finding her best prescription. “I didn’t tell my therapist about my eating disorder when I was first prescribed antidepressants,” she explains. “I began taking 10 mg escitalopram. My dosage was raised to 20 mg after I confessed my eating disorder. I went back to my doctor and told her I was still bingeing, purging, and having depressive episodes daily. I was then switched to 10 mg fluoxetine (name brand: Prozac). I finally wasn’t thinking about food every minute of the day. This, in turn, made me feel much less anxious. I didn’t have any trouble switching [medications] because I was going right from one to another.”

Your doctor and pharmacist are there to help you.

The morning after I took my first pill, I woke up with an unusual headache. I called my pharmacist immediately. She reassured me that this was normal and not to worry. It's also important to make regular appointments with your doctor for med-checks. Discuss with your doctor how effective the medication feels and the side-effects you are experiencing. 

If you see a therapist or psychiatrist, they can be great resources too! Even though I see a therapist bi-weekly, my primary physician is the person who prescribed the medication. Medical professionals want to help you, and most of them are only a phone call away.

Antidepressants aren't a magic cure…

Antidepressants don't eliminate anxiety or depression completely; they exist to make mental illness easier to manage. I have my share of days where I still feel depressed or anxious. There are times when I feel a panic attack is coming on. These feelings are not nearly as destructive as they once were, but they still happen.

Karen has been taking her prescription for a while, but she occasionally battles her old symptoms. “I notice a tiny bit of anxiety when I'm by myself. However, it's nothing compared to what I experienced before taking the medication. When I acknowledge this kind of anxiety, I’m able to listen to myself when I say that it's nothing to worry about. I'm able to move on and do something to manage it.

…but they can be extremely beneficial if you have a prescription.

With the help of my prescription, I’ve been able to get my mental illness under control. I no longer have daily panic attacks, and for the most part, my overall mood has improved significantly. They’ve eased my lifelong shyness, which often fueled by my anxiety. My self-esteem is higher and I feel motivated to succeed.

“I no longer felt the need to cry. I am motivated to go out with friends and to work again. I no longer have the thoughts that I will never be happy again,” explains Karen. “I’m confident in myself again. I don’t have crippling anxiety when I’m alone.” 

Emily’s medication positively impacted her life, too. “My prescription has calmed me down immensely. My mental state is clear and calm, whereas before it was like a hurricane of colors and pain. I can be myself and not feel afraid or anxious. I’ve noticed that I care more about friendships and relationships than before. I feel better than I have in years.”

If you have any other questions about your prescription, do not hesitate to contact your doctor. I am not a medical professional of any kind. These are my personal experiences that I wanted to share with other young people starting to take prescribed antidepressants.