There was a lot of media coverage in the UK press earlier this year about how more people should take pills to beat depression. This is a topic I know something about having been prescribed and taken Cipralex (Citalopram), one of the key anti-depressants covered in the media, for over three years. While there is a stigma still very much attached to taking or requiring ‘happy pills’ or rather ‘sanity pills’ as I used to call them, it is important that sufferers of anxiety or depression know what they are likely to experience when taking anti-depressants and also, how difficult and testing withdrawal can be.
In late 2011, I was under a lot of pressure at work, and in what in hindsight I can sadly say was a rather toxic relationship. In the mornings, I would be incredibly anxious about what lay waiting for me at the office, and once evening came, what lay waiting for me once it was time to go home. I was living in Dubai, a veritable playground, and should have been having the time of my life — a confusing thought that often led to internal wrestling and self-dishonesty. Remaining stiff upper-lipped while being tough on myself were simply signs of complete denial. Eventually, I took myself off to see a psychiatric doctor to see what they had to say.
Acute anxiety and mild depression was the diagnosis. I was prescribed Cipralex (Citalopram) on a 10mg daily dose. The placebo effect of taking the pills started working from day one, though I was slightly reticent at first, fighting fears of a lifelong dependency — that’ll be the anxiety then! I was told to take Vitamin B12 supplement alongside the pills, to help their effectiveness and accelerate the chemical change in my brain for the drugs to work. Sure enough, they began to take effect. I can only describe the early sensations immediately after taking each pill as a feeling of calm and an ever so slight tingly feeling in my body about an hour or two after swallowing.
Over the following months, that immediate after-effect wore off as my body and mind became used to them. They played their role as a ‘crutch’ effectively. I knew that by taking 10mg (a relatively small dose) Citalopram in the morning, I had the ‘strength’ to make it through the day, regardless of whatever came at me. On the odd occasion when I knew a stressful day lay ahead, I would double up on the dose to steel me further.
During this time, I also attended weekly therapy sessions with a psychologist to help me understand and address my thought patterns through cognitive behavioural therapy (CBT). As things became less manic inside my head, these sessions became bi-weekly and then monthly as I gained the strength and awareness to understand my negative and self-inflicting thought patterns.
Eventually, my mentality became more robust and I no longer wanted to have to rely on taking a pill every morning. I had grown tired of experiencing only a limited range of emotions. At this point, I should explain how Citalopram (and indeed other Selective Serotonin Reuptake Inhibitors) actually make you feel.
Imagine an oscillating wave. The high points are when you are most happy, laughing out loud, or feeling invincible because you’ve just achieved something special — the ‘top of the world’ kind of feeling. The bottom of the wave is when you feel upset, or emotional — like when you cry at a sad movie or ‘get some dust in your eye’. The middle of the wave is one’s usual mood — not super happy, but not miserable — just getting on with the humdrum of life.
Under the affect of Citalopram, the upper and lower extremes of one’s emotional range are pinched so what was once a euphoric ‘high’ became more of a ‘well, that’s not bad’ sort of emotion and a miserable low became more of a ‘it’s not that bad’ kind of feeling. In short, I felt numbed. Unable to guffaw with my friends when out having a good time, and incapable of feeling anything more than ‘meh’ at times when sympathy, empathy and frankly caring a damn were the least I should be feeling.
There came a point when I no longer wanted to feel this emotional ‘numbness’ and general ‘care factor zero’ about my life. It was time to get off the pills.
Like any withdrawal, patience and dedication were key. I sought advice from the prescribing psychiatrist as to how to wean myself off them. “Slowly reduce the dose and then go from one pill every day, to one every other day, to one every two days and so on,” he said. That was the theory, anyway. The first day I ‘missed’ a pill started well, but by about 3pm I started experiencing sensations in my mind that I later learned are known in the trade as brain ‘zaps’. They felt like a micro short circuit in my head. This was a wholly new sensation to me and if this was what withdrawal felt like, I wasn’t able to handle it straight off the bat. An hour of brain zaps later I reached for the day’s dose. The first step towards withdrawal was complete as I now had an inkling of the challenge ahead. This was progress and while I could have given myself a hard time for failing the very first test, that kind of negative self-thought was ‘the old me’ and had I done so would have meant writing off the previous 18 months’ emotional understanding and evolution.
The overall weaning off process took more than six months. First step was to further reduce my dose that meant biting the daily 10mg pill in half every morning. As well as the very first stage of the withdrawal process, this also served as a financial boon too. I was paying over 150 US dollars every two and a half months or so (mental illness treatment and prescription medicine is not covered by medical insurance in the UAE), so biting pills in half served two positive purposes — catalysing withdrawal and saving money.
Over the next eight months, I was able to wean myself off Citalopram. Pushing through that first step, and ‘missing’ a day a week, was the hardest part. There were many times I found myself reaching for withdrawal symptom relief. I also thought that ‘it would be OK’ if I had to take these things daily for the rest of my life. As the withdrawal process tested my resolve physically, in hindsight I realise that it strengthened me mentally. Soon enough I was going 3–4 days without a pill while the ‘voltage’ of the brain zaps dialled down concurrently. I took my last sanity pill on 22nd April 2015 — a day that at one point I thought would never come, and a day that I’ll always remember. I’ll never take an anti-depressant again. They have served their purpose — as a crutch to get me through the toughest of times, and then as a tool to help rebuild my own mental strength and resolve as I battled and eventually conquered withdrawal.
If you’re reading this and are wondering if you’ll ‘ever get off medication’ the answer is yes, you can. It’s not easy but the strength and belief in yourself that you’ll gain along the journey will be well worth it. And the satisfaction in the knowledge you’ll never take pills to ‘live again’ can be called upon time and time again when things get difficult.