The difficult first fortnight

Going on Prozac made me fully mad. But I still wouldn't be without it...

On September 10th last year I went to my best friend’s birthday barbecue. It was delightful: weather warm enough for a cute dress and no bra, pots of dip bigger than my head and three different kinds of sausages. And yet, I spent the entire afternoon feeling like I was dead. Well, half dead, half terrified insect, flinching every time I had a thought. Literally any thought. There is no better way to describe it than this: I was fully mad.

I came home afterwards, collapsed on the sofa, cried, and spent two hours googling ‘disassociative disorder’, ‘how can you turn off your thoughts’ and ‘how do you know if you have schizophrenia’. I was too panicked to work, forced to take what I believe is called a mental health day for the first time in my career.

Two weeks before this, I’d started taking the antidepressant fluoxetine, commonly known as Prozac. The drug is a selective seretonin reuptake inhibitor (SSRI) - the type of psychiatric drug most often given to treat depression and anxiety.

An understanding GP had prescribed the pills for seemingly sudden and unexpected bouts of severe anxiety that had cropped up over the previous few months. (The mystery has since been solved.. but that’s another substack expected March 2024).

Anyway, I called him when my brain went funny and asked wtf was going on. ‘It’s very common for fluoxetine to make you feel worse at first, but the side effects usually wear off within a month to two months.’

TWO MONTHS???

In light of this anecdote, it may surprise you to learn that I, Eve Simmons, bloody love Prozac. In fact, I would go so far as to say the pills are the only reason I am still functioning (mildly) and not opening bottles of Castillo di ablo at 5.30pm every weeknight.

The thing is, the GP was right. In the vast majority of cases, doctors I’ve spoken to say, the nasty side effects dissipate after one to three months. Interestingly, there doesn’t seem to be a lot of scientific evidence on the duration of side effects with SSRIs (or at least it wasn’t easy to find), but the papers I did come across seemed to suggest it’s only sexual problems that are likely to persist after two months.

It’s not entirely clear why your brain gets wobbly for a bit, before calming down. Some scientists guess it is to do with the dysregulation of brain chemicals - although studies have shown cast doubt on the whole ‘antidepressants change your brain chemistry’ theory. Basically, no one really knows how the drugs work, and why side effects happen.

A 2018 review of nine trials found that patients who stuck with antidepressants for more than a month were more likely to see a benefit, compared to those who quit early. Meanwhile, another major review, looking at pretty much all of the most commonly prescribed SSRIs in more than 100,000 people found that, overall, in the long-term, they are more likely to benefit patients’ mental health, than harm it.

Different meds have different side effects. A friend of mine affectionately referred to citalopram as ‘ci-prang-atam’ for a while because everyone she knew went ‘fully mental’ in the first few weeks of taking it. Most of the common SSRIs (fluoxetine aka Prozac, citalopram, escitalopram, sertraline) are associated with the same initial side effects: stomach upsets, nausea, sexual dysfunction, rashes and agitation (which I assume was my affliction). I’ve also heard a lot of patients say they struggle with sleeping in the first few weeks on fluoxetine and struggle to reach orgasm (see: sexual problems). FWIW neither have ever been an issue for me. I stumbled across this useful NHS guide to the various side effects associated with the most regularly prescribed antidepressants, if helpful.

So what happens if you get a month or two down the line, and you’re still struggling? TRY ANOTHER PILL. There are SO many different types of antidepressants: different drug families, different doses e.t.c. Some of them work in totally opposite ways. Don’t tar them all with the same brush.

Withdrawal is a thing - recognised by health watchdogs NICE since 2019. But these problems are far more likely to happen - and badly - if you go cold turkey. Whatever you do, don’t stop your pill suddenly, without advice from your doctor. Most GPs will recommend tapering off gradually; so one pill every two days for a couple of weeks before stopping completely.

Another thing. Try and take your meds at the same time every morning. Some studies show that irregularity with taking medication prolongs the time it takes for the body to get used to it. The NHS advises eating something when you swallow the SSRI, so probably do that too.

I’ve been a Prozac girl for six months now, which is around the time doctors suggest coming off them if you feel better. I do feel less insane than I used to. But with a challenging year ahead, I’d rather not risking letting my brain marinate in its natural, deranged juices. I am fully aware that there’s a chance I could be on them for the next two, three or even five years. And, as long as I’m getting out of bed in the morning, I really couldn’t give less of a shit about it.