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Pros and Cons of Antidepressants

Last month, Rachel Griffin started the #imnotashamed hashtag on Twitter for people to talk about and try to destigmatize mental illness. Naturally, there were a handful of people who took this as an invitation to try to undermine that message.

This is the example I ended up arguing with, which led to me designating a brand new subspecies of internet troll: a genital sensitivity concern troll. She asked if I was still in that relationship, what meds I was on, talked to me about how my medication usually causes emotional numbness and sexual dysfunction, and so on. Gosh, it’s nice to know that whatever else happens, some random stranger is Very Worried about whether or not my genitals are fully functional.

Well, I’ve been on Zoloft for more than three years now, and I’m happy to say that not only has it helped my life immensely, everything (with the exception of my pancreas — and that’s a totally separate issue) remains fully functional.

Data - Fully Functional

Too much information? Maybe. But @jailina was just so worried about all of us people on antidepressants, and whether or not our various bits still worked. She also seemed convinced that antidepressants were just a conspiracy by Big Pharma to sell drugs, and we all get depressed sometimes, and so on.

Now, she wasn’t entirely off-base. Mostly, but not entirely.

Most medications have potential side effects. For Zoloft, those side effects can include sexual problems, as well as sleepiness, nervousness, insomnia, dizziness, nausea, skin rash, headache, diarrhea, constipation, upset stomach, stomach pain, changes in appetite, dry mouth, and weight loss.

Sounds intimidating, eh? But so far, the only side effect I’ve run into was some dry mouth in the beginning.

Shall we compare that to the “side effects” of my untreated depression? Because those effects included oversleeping, impaired relationships with my children, impaired relationships with my wife, reduced productivity as a writer, and oh yes, a major reduction in my sex life. When I was younger, there were also effects like suicidal tendencies.

Side note: suicide also has a negative effect on your sex life.

The More You Know

I get the fears. What if medication turns me into an emotionally numb zombie? What if it takes away my creativity and spirit as a writer/artist?

Let’s start by busting that last myth: Depression does not make you a better writer!

The myth of the tortured artist is bullshit. Not only do you not have to be tormented and miserable to be creative, you’ll almost always be far more productive if you’re mentally and emotionally stable. I almost doubled my writing output the year after I started getting my depression under control. Every writer I’ve talked to who has a mental illness has told me they do better when that illness is managed.

As for the side effects? Tell your doctor what you’re worried about. Talk about the potential side effects and what to watch for. The first medication you try might not be the right one for you, or the dosage might need to be adjusted. It can take time to find the right treatment. If you encounter side effects, you and your doctor can adjust your medication. You’re not damned to an eternity of dizziness, dry mouth, and numb genitals.

Depression is not just a bad mood. Mental illness is not something you can overcome through stubbornness. I liken it to my diabetes. I can’t tough my way through having a nonfunctional pancreas. Trying to do so would quickly put me into a coma, and then into a grave. Likewise, stubbornness isn’t going to straighten out neurochemical imbalances in your brain.

Don’t let the genital sensitivity concern trolls scare you out of asking for help if you need it. Educate yourself, yes. Ask about side effects and treatment options. In my case, the combination of medication and talking to a therapist is what worked best.

“Antidepressants destroy love?” That’s some Jenny McCarthy-level ignorance there. 100% pure, uneducated ass-talking.

Without exception, my relationships are stronger, healthier, and more loving today than they were before I started antidepressants. (They’re not perfect, mind you. No pill can do that. But they’re so much better than before.)

Mental illness isn’t something to be ashamed of. And getting help isn’t something to be afraid of.

Mirrored from Jim C. Hines.

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( 27 comments — Leave a comment )
siege
Feb. 12th, 2016 01:02 am (UTC)
Thank you for this. Ironically, I'm hoping that hormone therapy will deal with my depression issues (it often can when appropriate), but I may have to add an antidepressant anyway.
eglantine_br
Feb. 12th, 2016 01:08 am (UTC)
I* am on Effexor. Have been on others in the past, including Zoloft. They work for a few years, and then they kind of crap out. But I would not be able to write, to take care of my family, or do anything much without them. I totally agree with what you have said above. Depression interferes with my life to the point that without meds I cannot love anybody.

Side effects have been minimal for me.

Edited at 2016-02-12 01:08 am (UTC)
starcat_jewel
Feb. 12th, 2016 01:28 am (UTC)
People directly telling you that the thing that's helping you can't possibly be helping you is gaslighting, and prima facie abusive. If you really want to wind them up, chide them gently about being in denial.
dragonsally
Feb. 12th, 2016 01:34 am (UTC)
Antidepressants destroy love? What a wanker (heh - unintended pun). I really hate these trolls.
deborahblakehps
Feb. 12th, 2016 01:45 am (UTC)
Different meds have different effects on different people. Some work well in most cases, but either way, folks have to make their own choices.

Also, depression will f-ing kill you. A lack-luster sex life probably won't.

As always, you said all of the above much better than I could, Jim.
funwithrage
Feb. 12th, 2016 02:30 am (UTC)
First of all, FUCKING YES on the subject of mental illness not making you a better "creative" type. I can vaguely see the possibility for either someone using art as an escape/coping mechanism to get more done if they need it, or for unhappiness to provide source material in a way (I wrote a lot more amusing blog posts when I could crack wise about how Retail Job X blew chunks), but as a general rule? No. And even in those cases, you'll find new motivation and new inspiration.

On the sexual side effects: on the one hand, I do wish that, as with so many other drugs (oh, hormonal birth control) there was more discussion about/research into potential sexual issues. (Society tends to dismiss those as "things that shouldn't be that important," especially in women, and they often are.) BUT: the issues in question don't come up (pun not intended) for everyone, often you can address them by switching medications*, and there are workarounds like temporary drug holidays, taking the pill at night post-sex, etc.

Plus, everything you said.

* I myself have anxiety disorder, for which there's an annoying lack of non-sexual-side-effect-inducing medications, since Wellbutrin increases anxiety a lot of the time. But there are still options.
malaisia
Feb. 12th, 2016 03:16 am (UTC)
My takeaway from this quote writing
"Mental illness isn’t something to be ashamed of. And getting help isn’t something to be afraid of."

Very well said my friend...

The only thing to be ashamed of is not getting the help you should and sitting in the shadows not doing what you can to get the help you need and deserve.
georgmi
Feb. 13th, 2016 10:14 pm (UTC)
Re: My takeaway from this quote writing
I had a long rant here, but it boils down to:

Telling people they should be ashamed because their mental illness manifests in an inability to seek help is not helpful. Please stop doing that.

attilathepbnun
Feb. 12th, 2016 03:17 am (UTC)
To all the above commenters --- -Ayyy-men!!!!
idancewithlife
Feb. 12th, 2016 04:44 am (UTC)
Hm. I wonder of your troll from from a certain RH inspired self-help group that doesn't believe in these kind of drugs.
brendanpodger
Feb. 12th, 2016 04:52 am (UTC)
The person you wee talking to didn't try try to convert you to Scientology, did they?
jimhines
Feb. 12th, 2016 01:35 pm (UTC)
They did not.
martianmooncrab
Feb. 12th, 2016 10:24 am (UTC)
I just had a go around with a BP med, Lisinopril, and its side effects were subtle until the coughing marathon.

not taking that anymore.
cypherindigo
Feb. 12th, 2016 02:13 pm (UTC)
I had that side effect too. :-) I thought the guys in my office would kill me before I got it changed. I am much happier on the one I am now on.
martianmooncrab
Feb. 12th, 2016 07:48 pm (UTC)
it was also disconnecting me from my life, and the days were becoming a bit of a struggle. When I told the nurse I was going to stop the med (just days before the coughing marathon) I handed her the three page printout of the side effects with the ones I had highlighted... which made things simpler. There was a lot of highlight.
cypherindigo
Feb. 12th, 2016 02:10 pm (UTC)
Everyone has different body chemistry, so no tow people will have identical reactions to any depression medication. I have been on them for 30 years off and on, mostly on.

I started with tricyclic antidepressants (as this was before SSRIs like Prozac), and had some issues. I fell asleep while driving on one of them, and was taken off that one ASAP.

SSRIs worked for me, and I had some side effect issues (weight gain and the "bits" side effects) but at the time it was worth it to be a functioning human being. I completed 2 college degrees, was employed in my field, learned new hobbies ...

I was having issues with my other chronic conditions (Lupus/RA/Fibro) and my doctor thought that an SNRI would help with some of those issues. This was not the medication for me, it was an all around bad experience. However I know that people do very well on them and do not have my issues.

Currently I am using Welbutrin, which is considered an Atypical Antidepressant, and I am very happy with it.

That was the long form, with examples, of Everyone is Different.

Jim, I am sorry for blathering on. Please delete this if you don't want it cluttering up your feed.
jimhines
Feb. 12th, 2016 02:17 pm (UTC)
Nothing to apologize for. I appreciate people sharing their different experiences. Like you said, people have different reactions and responses, so being able to read about those different responses gives a fuller, more informed understanding of things.
mt_yvr
Feb. 12th, 2016 03:46 pm (UTC)
Actually I've been through four anti-depressants before I got to Wellbutrin. I had an absolute destruction of my sex life on the first, along with massive weight gain. All as I tried to start my first ever real relationship. Luckily he was incredibly understanding as I sorted it out.

My libido has been significantly impacted, which added to aging and slow lowering of testosterone means increasingly I have issues with ... everything.

Each year I check in and have checked in to make sure that the devil's deal made to retain my sanity is still worth it.

One of the things that frustrates me is the dismissal of the impact a lowered healthy sex life, and sexual function, can have. It has at times become an issue that is as serious to me as the manic depression I'm balancing. And the insistence that "well, it's better than what the depression untreated does" is, in fact, insulting.

It's not, actually.

There IS in fact a really tough line to balance between being able to mentally function and the emotional impact of the loss of intimacy in your relationship. Or even the ability to consider intimacy.

Too often I've had to face that tradeoff dilemma as people tell me that the tradeoff between whatever I am going through and what I COULD be going through is worth it. To them. Not being effected by whatever.

I lost the ability to drink due to medications for my HIV. At all. Ever. And the response "oh, just stop drinking, ha ha" from one doctor was infuriating. That I lost my ability to have sex, "oh at least you're not depressed" when, in fact, I was. That I throw up daily due to my HIV meds is "better than being dead without them".

Chronic, long term issues are not singular events. It's an adaptation, change / alteration of your LIFE permanently. With no end in sight. The dismissal for the concerns and questions around how to be normal while on medication is offensive, frankly.

There is a difference between not feeling like having sex one week and never feeling like you can ever perform or even be interested again. Imagine facing that as I did at 24.

The complicated aspect of this is that yes, the idea that "what MIGHT happen should stop any discussion" is insane. We need to encourage people to view any medication as a first but not necessarily last option in a list of medications one can generally try out. But as is often the case these conversations turns to polarization of ideologies. Either all medications are evil or all medications are divine.

They're neither. They've got serious issues that might come up and recognizing that they are possibilities is key. Because when you know these things can happen you can address them. And by that you can try other options and eventually find a way to balance as best as possible.

But what bothers me most is that often in these discussions the aspect of "settle and be thankful" starts to show up in even the best of individuals. No. Don't settle. Ask. Because the belief that "well at least you're not X" is NOT in fact reasonable.

As an HIV positive, manic depressive person I have the right to a life that enjoys all the aspects of this body and NOT to be inundated with "well, at least you're alive". People seem to have forgotten the 80s. We chanted in the streets, we argued in the courts and in the hospitals: Quality over quantity. And that message still stands. We have the right to a life that is worth living in all ways, not simply being alive.



Edited at 2016-02-12 03:48 pm (UTC)
fuyuhimi
Feb. 12th, 2016 05:30 pm (UTC)
Thank you for writing this, and also concisely articulating why some myths are just not founded in reality and facts.
socchan
Feb. 12th, 2016 09:33 pm (UTC)
Four of the five side-effects the Tweet lists are related more to sex than to love, IMO. There are more than a few aromantic, asexual, and/or varioriented people who could tell you that those are far from being the same thing.
violetcheetah
Feb. 14th, 2016 04:45 am (UTC)
Yes: this. I am asexual, and largely a-romantic. So my main working definition of "love" involves close friendships: being connected to people who in turn want to be -- and enjoy being -- connected to me. Ideally, for my own mental stability, this should occasionally include being in the same room with those people, perhaps even hugging or being held. When I am depressed, the self-loathing -- no, self-hate, self-disgust -- is so strong that it's hard to even have an honest email discussion with my closest friends, let alone visit with them, let alone hug them or let them hug me. I went through a phase like that recently when my longstanding, trusty SSRI grew less and less effective; over the course of 12 months, I hugged/was-hugged-by a total of 3 people, on 4 occasions. Each time I was nearly screaming with sobs because I couldn't imagine they weren't disgusted just touching me, and I despised myself for inflicting my disgusting self on them. Now the new med has been working well enough long enough that I've stopped thinking each good day is a fluke, and I have actually made plans to go over to my best friends' house, and hang out and make jam and probably hug a lot. For me, that's my "love life." It's a sight better when my depression is controlled.
northernwalker
Feb. 13th, 2016 03:03 am (UTC)
Jazz musician Tom Harrell is one of the greatest trumpet players around. Mr. Harrell also suffers from paranoid schizophrenia, which has driven him to suicide attempts.

In his own words: “If I take the medicine, then the voices … I don't hear anything,” he says.

And if he doesn't take the medicine?

I don't know. It's just better if I do,” he says.

***

Harrell firmly rejects any romantic notion that mental illness is in any way of benefit to an artist, something that provides unusual insight. “It’s biochemical,” he says brusquely. “First of all, take the medicine.”


Do medicines come with side effects? Of course they do. Some need to be adjusted, some don't work for the individual or the side effects are too severe. Mr. Harrell had a toxic reaction to a medicine that nearly killed him. But he still chooses to take a different product, which has helped him. The tweeter above sounds like a concern troll.

http://jazzprofiles.blogspot.com/2009/05/tom-harrell-part-1-interviews.html

Edited at 2016-02-13 03:07 am (UTC)
elialshadowpine
Feb. 13th, 2016 04:02 am (UTC)
I have less experience with SSRIS. I have bipolar disorder, not depression, and while I was on an SNRI for fibromyalgia (did nothing, made me suicidal if I missed a dose), most of my experience has been with the mood stabilizers side.

I have gotten exceedingly lucky, and the initial one worked great, then the added a second in part for sleep, which also worked great. Bipolar medication has the "it'll kill your creativity and make you a zombie" thing attached, so a lot of creative types are unwilling to even try something for fear of this. I keep saying, repeatedly, this is not true of a medication that works for you. If it works properly then you won't have that side effect. If you do, it's the wrong med -- and if your doctor doesn't care and thinks you should stay on it anyway (surprisingly common for bipolar patients, because we're so dangerous unmedicated, you know), then you need a new doctor STAT. Unfortunately, the new doc is not always possible and I have known some people to flat go unmedicated because it's not worth the tradeoff, and I can't say I blame them.

But to use such a large brush, that it'll ALWAYS happen, is not cool. Not cool at all.
songblaze
Feb. 18th, 2016 03:07 am (UTC)
So much this.

I'm bipolar, but spent the first 5 years of my diagnosis avoiding bipolar meds because the periodic use of an ssri was good enough, and I didn't want to risk messing with it. The manic side of things slowly got worse until that was no longer a good option over the course of about a year. I spent 10 months on the medication merry go round, including 6 months on something that sank me slowly into the deepest depression I'd ever been in. Much like a frog in slowly heated water doesn't realize it's danger until it is acute, I didn't see it until I was drinking almost daily to get by (even when depressed, I'm a happy drunk).

I stayed off everything for most of a year, until the stress of law school, health crises, and a really awful abusive roommate across the country from everyone I knew and loved made me suicidal. I convinced my new therapist that I didn't want to mess with bipolar meds again, and we went back to the ssri that used to work. It didn't. Then we went to a snri, which we had to stack with anxiety meds, which held for a while until I had my first taste of psychosis. One night of being convinced that I could hear my neighbor drilling/tunneling through the wall between our apartments to kill me was quite enough, thank you. I finally let him put me on another mood stabilizer, and thank all the gods, it was finally the right one. Things were a little bumpy until we titrated up to the right dose. I won't pretend it's perfect. It contributes to the dry mouth that has caused some minor dental damage and the withdrawal starts very quickly and is vicious - I cannot sleep without it. But during the 7 years I've been on it, I've been so much better! No depression, at worst a handful of panic attacks a year (even under the stress of law school and multiple undiagnosed, untreated health issues that have since been identified), none of the manic impulses to spend or do dangerous things or fight or just scream at people. This medication has saved my life, and made so many things possible for me that I otherwise could not do. I even write better on it. I don't paint as much, but I also don't feel driven to work on things to the point of injuring myself and beyond.
ironed_orchid
Feb. 13th, 2016 05:18 am (UTC)
Oh ffs.

My meds DO lower my libido, and have a few other effects that some people might consider deal breakers, like weight gain.

To me, these are a completely acceptable cost for the overall benefit, which is that I am not suicidal, I have had less than 5 panic attacks in 10 years, and I can function and have a job and interact with other humans. To other people, they might not be an acceptable cost, but no one gets to make that call except the individual who is living with the consequences of their decision.

As for blunted emotional responses, these days I have a full range of emotional responses, rather than just sadness or apathy. I also have appropriate emotional responses instead of meltdowns when dealing with external pressures.
lokifan
Feb. 14th, 2016 02:19 pm (UTC)
YES to the myth of the tortured artist. this is a great post!!

And made me giggle a lot about your Fully Functional genitals, which is not a sentence I ever expected to type, Mr Hines.
bookblather
Feb. 14th, 2016 11:20 pm (UTC)
Fucking word to all of this. My antidepressents HELP me write, because when I'm depressed I can't do shit. My relationship is 100% better when I'm on antidepressents because I don't want to hurt myself by ending it (and other means). Life is 100% better on antidepressents. Fuck the concern trolls.
( 27 comments — Leave a comment )

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