By Eve Simmons, Deputy Health Editor For The Mail On Sunday
Updated: 09:27 19 Mar 2023
In the six years I’ve worked for The Mail on Sunday, I’ve recovered from an eating disorder, suffered several bouts of severe anxiety, moved house twice and got married. Now I’m in the process of getting divorced.
Yet I’d not taken a single day off for mental health reasons until late last year – and it was nothing to do with any of this.
In fact, my meltdown was caused by the pills I was taking to help me cope with the stress of the above.
It happened in September, two weeks after I’d started on the antidepressant Prozac, also known by its generic name, fluoxetine.
I’d decided to go on the medication when my anxiety symptoms – racing heart, tight chest, knotted stomach – started making daily life difficult.
Like eight million others in the UK, I’ve suffered with bouts of anxiety, on and off, for most of my 31 years, usually sparked by stress. I’ve been prescribed Prozac – one of the most commonly prescribed antidepressants – twice before, during my teens and early 20s, to treat anxiety. But this most recent time something felt different. Within a fortnight of starting treatment, I started to feel… a little off.
I was at a friend’s birthday barbecue. It was a delightful day – warm weather, pots of dip and three kinds of sausages – but I started to feel as if someone had ignited a fire in my chest, or how I imagine it might feel to be held at gunpoint. My body was rigid, anxious thoughts racing.
I came home afterwards and collapsed on the sofa, cried and then spent two hours Googling things like ‘How can you turn off your thoughts?’ and ‘How do you know if you have schizophrenia?’
More alarmingly, I developed the sensation of disassociation – a feeling of the body being separate from the mind. Basically, I thought I was going insane.
After minimal sleep, the following morning I called in to my MoS Health colleagues and, for the first time, admitted I wasn’t OK.
IT’S A FACT
An estimated 21million antidepressants were prescribed between January and March 2022, according to NHS data.
I’m not ashamed to discuss my mental health, but my work has always been a kind of sanctuary from my troubled mind.
This time I couldn’t do anything – write, read or comprehend. Information simply wasn’t going in.
My editor insisted I take off as much time as I needed.
What followed was a frantic call to the doctor, who prescribed a low dose of the sedative diazepam and told me to phone back in a couple of days. ‘It’s very common for fluoxetine to make you feel worse at first,’ he told me, ‘but the side effects will usually wear off in a month or two.’
I could feel like this for two months? I wasn’t sure if I would make it through the next day.
In light of all this, it may surprise you that, today, I remain a loyal advocate for Prozac and all antidepressants. I’m still taking the pills.
The GP was right. The side effects eased after about a month and the treatment has kept me afloat during a turbulent time in my life. But, as a health journalist who has written prolifically about the benefits of antidepressants, I was thrown by my blip.
In November, I received a string of criticisms after writing in these pages that my childhood GP had first prescribed Prozac when I was just 15, to treat severe anxiety. On Twitter, some accused me of pushing potent drugs on to teenagers that were known for side effects such as suicidal thoughts.
According to official guidance, antidepressants should only be prescribed to under-18s by a psychiatrist, and only in severe cases. I immediately responded, arguing the evidence showed that, on the whole, antidepressants do more good than harm – and even for teenagers, they can be life saving. But had my own recent experience proven that I was wrong?
The most commonly prescribed antidepressants in the UK are selective serotonin reuptake inhibitors, or SSRIs.
Several reviews, looking at hundreds of studies, found that, on average, about 40 to 50 per cent of people with depression and anxiety who take SSRIs see an overall improvement in mental health. Around half of patients will experience at least one side effect. For one in ten, these problems are so severe they stop taking them.
Side effects differ between drugs, but they are mostly fatigue, nausea, dizziness, stomach upsets, sexual problems and severe agitation/ anxiety. About four per cent of patients experience suicidal thoughts, according to the American Medical Association.
But there is little clear information about how long these problems last. Guidance from the UK’s drug watchdog, the National Institute for Health and Care Excellence (NICE), makes vague mention, stating that the pills should take effect within four weeks while some side effects ‘may persist throughout treatment’. But GPs I’ve spoken to say they’ve noticed a clear trend.
‘It can take around three weeks to a month before you feel normal again,’ said The Mail on Sunday’s GP columnist Dr Ellie Cannon, who added that she also experienced short-lived side effects when taking SSRIs. ‘They’ve made me feel very out of sorts in the first few weeks, and if I adjust the dose it can feel like I’m going crazy.’
Dr Clare Gerada, a psychiatrist and president of the Royal College of GPs, said: ‘Patients absolutely feel worse in the first three weeks. They tend to get very severe anxiety symptoms. I sometimes prescribe a sleeping tablet in the first week to help patients cope with increased panic at night.
‘But if they stick with the antidepressants, things usually improve.’
Dr Penny Ward, visiting professor in pharmaceutical medicine at King’s College London, says there are several possible explanations. ‘The chemical combination in some SSRIs has a knock-on effect on other compounds in the brain and rest of the body,’ she says.
‘SSRIs switch off the body’s ability to dampen down the serotonin [a neurotransmitter that carries messages between nerve cells in the brain and the rest of the body].
‘This could have an impact on the central nervous system, which controls our natural fear response and could, in theory, exacerbate anxiety. But once serotonin has reached a level that improves mood, the anxiety becomes less bothersome.’
Few studies monitor the duration of specific side effects, but many do report that a lot of patients stop taking the pills because of side effects, and when.
In a study of more than 600 patients, only 15 per cent said severe side effects drove them to quit the pills within the first three months, even though 60 per cent had severe side effects in the first week. Another US trial of 400 patients found 40 per cent suffered drowsiness, 30 per cent had sexual problems (such as erectile dysfunction), 22 per cent had insomnia and 19 per cent suffered anxiety.
For about two-thirds of cases, the symptoms were a problem for only the first two weeks.
But some SSRIs are associated with more early side effects than others – and fluoxetine seems like one of the worst offenders.
‘I’d always prefer not to prescribe fluoxetine,’ says Dr Gerada. ‘You see much more anxiety with it, compared with other SSRIs.
‘You get a sense of irritability and restlessness to begin with, because it has a slight stimulant effect.’
A number of doctors I’ve spoken to over the years have told me patients often find antidepressants don’t work because they quit too soon. Studies show that about 60 per cent of people see benefits after three months, compared with 40 per cent after a month.
IT’S A FACT
Some of the rarer side effects of SSRI drugs include flu-like symptoms, problems going to the toilet and an irregular heart rhythm.
The message is, if you can, try to stick with it. ‘Ask a loved one to keep a close eye on you for the first few weeks,’ says Dr Cannon.
And if not, try something else. In 2008, experts from Pittsburgh University found 40 per cent of a group of 334 depressed patients saw a mental health improvement after changing SSRIs.
But doctors say these drugs aren’t the be all and end all. There are drug classes which work on different brain chemicals to improve mood and ease anxiety.
For instance, SNRIs, which affect another mood-related brain chemical called noradrenaline, can be effective in those who don’t get on with SSRIs – particularly venlafaxine. There are also older classes of antidepressants such as tricyclics, including amitriptyline and nortriptyline – although these are associated with side effects such as drowsiness and falls.
A 2018 review by University of Oxford researchers compared clinical trial drop-out rates – the percentage of patients who quit taking a treatment before the study has ended – and efficacy across 21 different antidepressants.
Those that came out on top were, oddly, atypical antidepressants including agomelatine, which increases production of the hormone melatonin, mirtazapine and a tricyclic antidepressant called clomipramine. But all the drugs studied, including SSRIs, were found to be effective.
I’ve now been on Prozac for six months, which is around the time doctors suggest coming off them if you feel better. And while I do feel far less deranged, with a challenging year ahead I’d rather not risk letting my brain marinate in its natural juices.
I am aware there’s a chance I could be on them for the next two, three or even five years, but as long as I’m getting out of bed in the morning, I honestly don’t mind.