Selective Serotonin Reuptake Inhibitors (SSRI, for short) are the famous class of anti-depressant medication that includes well-known brand names such as Prozac and Paxil.  It is a rare patient that one sees with many medical issues that hasn’t been tagged as “depressed” by someone and slapped with one of these drugs.  Do they work?  Sure they do.  Do they have side effects?  You bet your ass.

In the spring of 2003, I was sitting in an ICU writing in a patient’s chart when I started to have what I can only surmise was a panic attack.  It was Friday and I was going to be on-call that following weekend.  Call never bothered me to the degree where I would actually have panic  over it.  At the time, life was hell.  My wife didn’t resemble the woman I’d married.  She was verbally and emotionally abusive.  She was in a very unhappy job situation.  I couldn’t stand to be at work and I couldn’t stand to be at home.  That very same day, I called my doctor (a man I’d known professionally for years) and confessed that I had hit some sort of emotional bottom.  While I would absolutely never consider taking my life due to my religious beliefs and just plain ol’ stubborness…I had exhausted every psychologic coping skill that I had and was stuck.  He recommended that I start taking some medication and he prescribed Paxil CR (a long-acting Paxil that had just come on the market). I knew of one close professional colleague and confidante who swore by Prozac and how it “saved her marriage”.   At this point, I would have tried just about anything.  Little did I know that this would be the beginning of a four-year odyssey to find happiness in a pill form.

I suppose that anyone who consciously decides that they will take medication “A” for problem “B” does so with some trust that the desired effect will occur (as opposed to those elderly folks who are just handed out pill after pill and don’t have the mental faculties to decipher all of the pills much less the logic behind their use).  I can honestly say that while the full effect did not occur for the usual two to three weeks, the feelings of positiveness or “non-depression” came somewhat earlier.  The drug really did as advertised.   It did, however, do more.  They all do more.  The question is “how much more” and for “how long”?

Before I give you the meaty middle, I will give you the end and say that I have been off of all medication now for about a year.  In the beginning it was very difficult.  There is withdrawal associated with all of these medications that includes headaches and double-vision.   My wife and I were both worried that beyond depression that I would show less ability to remain calm when upset.  To a degree, I have managed to stay both positive in mood and fairly calm when upset.  I will admit that it is not quite as good as when I was medicated…but, then again…I was medicated.

In my journey through SSRI trying to find one that would work with side effects that I could tolerate, I tried nearly ALL of them.  I had never been one to experience allergies to medications or many side effects but this class gave me quite a load of side effects.  Some I tried to muddle through and others I simply could not tolerate.  For those keeping score at home, I did try Paxil, Prozac, Lexapro, Zoloft, Cymbalta and Effexor.  I tried none for fewer than two months so as to avoid any transient side effects that might abate with continued use. 

In the end, I experienced the following side effects.   Some are minor.  Some are not.   What I found is that they’re mostly not discussed.

1) Sexual dysfunction.  I know that most people want to get to the juiciest side effect that most people have heard of.  That’s why I am starting with this one first.   Aside from some very weird sensation with the first sexual experience on Paxil, I can say that I experienced very little in the way of this type of side effect from any of these medications.  At times, I thought there was orgasmic delay (which isn’t necessarily bad) but it wasn’t a consistent occurrence to make me think that the medications had a role.  I know that this occurs with many men on SSRI which is why they consider it for treament of premature ejaculation.

2) Headaches.  I had regular headaches with beginning and stopping each of these medications.

3) Double/blurry vision.  This was one of the worst side effects that I experienced with each of these meds.  The worst was probably Effexor and I can say that I thought I was going to lose my mind (if not my sight).

4) Sweating.  The initial use of Paxil CR would have been great had it not been for this side effect.  I would routinely soak through bed sheets and clothing.  When you work closely with people, looking like Albert Brooks in “Broadcast News” is not very endearing.

5) Hallucinations.  On Lexapro in particular, I experienced two consecutive nights of auditory hallucinations hearing voices while trying to sleep.

6) Nausea.  Most of these medications gave me nausea at one point or another.  Some were just in the beginning but others lasted intermittently for months.

7) Nose bleeds.  This was particular to Effexor.  I was in the middle of a department store when I began to have a nosebleed.  I was told somewhat insistently by the manufacturer and my doctor that Effexor does not cause nose bleeds.  They can believe that.   I had not previously had a spontaneous nose bleed in 31 years (since age six).

8. Constipation.  As though I didn’t have enough troubles with regularity…when I started on some of these medications, the bowels became hell on earth.

9) Weight gain.  I quickly gained ten to twenty pounds on these medications and could only start losing it once I stopped.  Like I needed more reason to be depressed.  I once even found myself chewing on an apple and not even knowing how it got into my hand.

10) Suicidal ideation.  I have never admitted this to anyone, not even my wife.  As I said before, I am very resistant to the idea of suicide but while I was on the Effexor, I could honestly see what these reports of increased risk of suicide were all about.  I started to have feelings of hopelessness and anxiety.  I even had the idea that perhaps I had “nothing to live for”.  While I have been very depressed on some occasions in my life, I never once espoused a desire to kill myself or the feeling that my life was worthless.

11) Memory loss- Effexor was the last medication that I took.  In addition to the nosebleeds and thoughts stated above, the thing that really pushed me to get off of all SSRIs was the loss of memory.  Throughout my life, I have been blessed with a fantastic memory.  Names, dates, places, faces.  I was good at all of them.  Now, all of a sudden I was starting to forget a lot.  Short-term memory was a real problem at times.  I will tell you now that I still feel as though my memory is not back to normal.   I should qualify this by saying that I did have a severe concussion once many years ago and people do lose memory as they age but it seems that this coincided with the medication.

12) Dizziness.  Beyond blurry vision there were many times on each of these medications that I experienced dizziness and sought out the nearest sofa or bed to lie down on.

13) Nightmares-  I did experience vivid nightmares.  Moreso with Lexapro and Effexor than any of the others.  I don’t normally experience much in the way of nightmares or vivid dreams of any kind.

Those are the low-lights dear friends.  I use them to illustrate the fact that no medication is without side effect and even the most innocent or seemingly helpful medication class can spell significant trouble for a patient.  

Where I go from here is unclear.  Of all of the medications, I would say that Paxil worked best for me but the side effects were intolerable.  Lexapro was the best tolerated but had the least effect on my mood (even at maximum dose).  I did try St. John’s Wort which did nothing for me.  I can imagine my life without anti-depressants but they did just enough for me on the whole to wonder what life could be like if they’d just be tolerable.  I should admit though that there were times when I felt “medicated” and slow in addition to times when I simply felt that I didn’t want to be on these drugs for the rest of my life.  Would they permanently change my neurotransmitters?  Would my brain be forever altered?  Would I be trading one illness for a new one that I’d created with the treatment?

Therein, lay the dark side.

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