It’s 2am and I’m wide awake, scrolling frantically through TikTok for videos posted by strangers about the antidepressant I’m on. I type ‘first two weeks on antidepressants feeling like I’m going mad’ into the search bar, hoping to find someone who’d been through something similar and recovered.
Would I ever feel normal again?
I started taking the pills three weeks prior to this. It followed an episode of acute anxiety – a problem I’ve struggled with at various points in my life. About two-and-a-half weeks in, I started to feel really odd.
The best way I can describe it is a sense of being detached from my body. I struggled to concentrate on anything – even episodes of Love Island, which normally take my mind off the day’s stresses.
Eve Simmons says she takes a pro-pills stance, based on her overall positive experience
I was intermittently consumed by panic and constantly aware of my heartbeat.
As the former deputy health editor of this newspaper, and currently health editor of its sister website MailOnline, I know where to go for trusted medical advice. I know my way around clinical research papers and have some of the world’s top mental health experts on speed dial.
But in this case, I was stumped – no doctor I spoke to and nothing I read seemed to be able to offer tangible advice.
I had little choice but to turn to social media for answers – and, to some extent, I found them. But I couldn’t help think that I shouldn’t be like this.
I thought of this last week when an ongoing row reignited between experts over antidepressant safety.
In one corner there are psychiatrists who claim that disturbing side effects have been hugely underplayed. In the other are those who insist these problems are rare, minor and transient, and that any doctors who disagree are scaremongering.
On Wednesday, some of the anti-antidepressant camp wrote to medical journal The Lancet claiming that withdrawal symptoms – hallucinations, insomnia and worsening anxiety – hit up to half of patients taking the pills. This is vastly more than previous research, published earlier this year, suggested.
I’ve written about my mental health in these pages before – I take a pro-pills stance, based on my overall positive experience.
The best evidence shows that antidepressants improve about half of patients’ symptoms.
And they work for me. I was first prescribed them at 15, when I was suddenly hit by inexplicable, incessant anxiety, but only needed them for less than a year and stopped without any issues.
I took them again in my 20s, and for a third time aged 30, in 2022. It was then that I first suffered negative effects.
Within two weeks I developed the sensation of dissociation – the feeling of the body being separate from the mind. It was so bad, I had to take time off work.
But this mostly evaporated within another week or so, and I carried on taking the tablets.
I believe they left me better equipped to deal with life’s rich tapestry, including an unpleasant divorce. And I said this all publicly. There was backlash, mostly from people who’d suffered side effects and claimed that I was minimising the harms. But I stuck to my guns, even winning an award from the British Association for Psychopharmacology for my pro-medication articles.
I came off the pills after 18 months, again with no issue.
But this summer the anxiety returned – I found myself lying awake at night plagued by terror, struggling to breathe.
I feared that I was teetering on the edge of a psychotic episode, and that I needed medication again. This time, though, I found myself questioning whether I was right to be such an advocate for antidepressants.
I started taking the lowest possible dose of escitalopram, a common antidepressant.
There was a brief period of relief, but by the end of the month I was terrified of everything. The world around me felt unsafe, and my thoughts told me I couldn’t cope with another day of living.
Thankfully, I was already on annual leave from work. I spent the best part of a week moving between my bed and the sofa, scouring the internet for research that would support my suspicion – my desperate hope – that my experience was a temporary side effect and I wasn’t going mad.
But what I came across was universally vague. The drugs can cause ‘anxiety and agitation’ as well as ‘sedation’ in the first few weeks. The NHS simply says antidepressants can ‘cause problems at first, which generally improve’.
I contacted the psychiatrist who’d written the prescription. ‘It is difficult,’ she texted me, along with some confusing instructions to slowly come off the drugs if I continued to feel bad.
This, I felt, raised more questions. If I pushed on, would it pass? Or was it a warning that something was going seriously wrong? If I stopped, would my anxiety return?
I emailed a trusted contact – a world-leading expert in mental health treatment – who said ‘it is complicated’ and suggested I speak to my psychiatrist.
So I did what every health journalist warns readers not to – I turned to TikTok for advice. But what I saw was surprisingly reassuring. Hundreds of people, mostly in America, were talking about similar experiences. They spoke of their brains feeling ‘two steps behind’ their body, or like a ‘f****** zombie’.
There are no reliable figures to tell us how many patients suffer early psychiatric problems
For one girl, the medication ‘made the line between reality and a dream-like world very thin’. It all rang true – I wasn’t the only one.
Meanwhile, on website Reddit, hundreds of posts document antidepressant side effects in detail: disabling insomnia; panic attacks; suicidal thoughts; and, as one user put it, ‘feeling like you’re in absolute hell’.
But, reassuringly, the overwhelming majority said these eased within the first three months – and reported an overall improvement in their mental health.
A common theme was shock – no one warned them starting on the drugs would be so hard.
So why aren’t experts talking about this?
‘When you first start taking antidepressants, you get a sudden boost of chemicals [in the brain] which can cause unpleasant symptoms for some people,’ says Dr Sameer Jauhar, a consultant psychiatrist at King’s College London.
‘Over time the brain tends to adapt to this, which reduces these symptoms.’
But just how many suffer from this is unclear.
One 2018 study, based on surveys involving more than 1,000 patients, showed up to half of those taking the most common antidepressant – selective serotonin reuptake inhibitors (SSRIs) –reported feeling suicidal as a result of it. Feeling ‘foggy or detached’ was noted by three quarters, while feeling ‘emotionally numb’ and ‘less happy’ was also mentioned.
‘For some people, the side effects are mild,’ says Prof John Read, psychologist at the University of East London and author of the study. ‘But for lots of people, they aren’t. How can we be prescribing a mental health drug that makes people feel suicidal?
‘Even if it’s only for a few weeks, that is still enough for a person to kill themselves.’
But other experts say Prof Read’s research is not a reliable indicator of the scale of the problem. It is based on patients reporting their own symptoms – which can be difficult to separate between the mental health condition itself and side effects of the drug.
For reasons such as this, ‘self-reported’ data is considered the lowest-quality form of scientific evidence.
However, the highest form – controlled clinical trials conducted by doctors – have not offered answers, either.
There are no reliable figures from this sort of research to tell us how many patients suffer early psychiatric problems. As for what exactly those problems are, researchers seldom elaborate further than ‘severe, mild or non-existent’.
In 2019, health chiefs updated official guidance to acknowledge that withdrawal symptoms after coming off antidepressants may be ‘severe and lengthy’. The change was, in part, sparked by a groundswell of patient reports collected by University College London’s Prof Joanna Moncrieff – a psychiatrist and vocal critic of antidepressants.
To say she has been lambasted by the medical establishment would be an understatement – and, to her credit, she’s stuck to her guns.
The debate has rumbled on with little common ground being found, so where are patients like me supposed to turn for reliable information?
Ideally, your GP would be the first port of call. But one 2019 survey found that only a third felt confident about their knowledge of antidepressant side effects.
When I called my GP to seek help for my meltdown, he said ‘some anxiety’ was to be expected. He prescribed diazepam, also known as Valium, and said he’d call back in a week to check on me, but never did.
Some people, Dr Jauhar says, are at higher risk of side effects from SSRIs due to ‘being more sensitive to fluctuating levels of serotonin’ – the brain chemical linked to mood that the drugs help regulate.
People who suffer bipolar disorder, a type of depression that can cause extreme periods of lows and mania, are prone to this. Extra care needs to be taken if prescribing SSRIs to this group.
Both Prof Read and Dr Jauhar agree on one thing: more in-depth research is needed.
But, thankfully, there is pleasing data on one important detail. In all of the studies I’ve looked at, severe side effects are short-lived for most people.
In one US trial of 400 patients newly on SSRIs, a fifth suffered severe anxiety. For two thirds, this symptom resolved within two weeks. Large-scale reviews have found only around one in ten patients find side effects so unbearable that they have to come off the pills.
What is unequivocal is this: antidepressants are life-saving. A 2013 University College London paper found that, of 81 suicides studied, 75 per cent of victims were unmedicated.
Once again, my period of madness lasted only a fortnight. I still take the pills today. I feel myself again, and far less anxious than before.
So I guess my mantra remains stick with the pills, if you can. If you can’t, don’t just quit – speak to your doctor about alternatives.
- For confidential support, call Samaritans on 116123, visit a Samaritans branch or go to samaritans.org.
