Are You On Drugs or Something?

In response to my prior post, some people have requested specifics about the medications.

My first was sertraline (Z*l*ft), an SSRI. Started at 25mg daily, then 50, and eventually 100. Worked great. Felt like myself again, except that I didn’t get depressed and I was no longer afraid of spiders. (I still had some trouble talking on the phone—another phobia of mine—but it was a lot better.) Side effects were entirely manageable, not unlike having had an extra cup of coffee … with the exception of that one pesky thing. Libido wasn’t so much the issue. I could open negotiations, I just had a hard time sealing the deal. I enjoyed casting, but I didn’t reel one in very often. I could crank the starter, but the engine didn’t always turn over. The water got hot, but the pot wouldn’t boil. I could paddle the surfboard, but it was hard to catch a wave. I had a nice time mountain climbing, but had to turn back before the summit. If I were Cracklin’ Rosie, even Neil Diamond might have run out of time.

What’s that? Get to the point? I couldn’t, that’s the point.

It didn’t matter too much at first, because I was busy and single. But then I met my future husband, and I began to long for what I was missing. I’d never been a zero-to-60 in four seconds kind of girl to begin with, and we didn’t have that much free time. So, as I described previously, I stopped. But being happy in the sack doesn’t make up for being clinically depressed, as it turns out.

The next medication I went on was buproprion (W*llb*trin), 150mg twice a day. It’s in a completely different class than sertraline. Worked great for the depression, and practically no side effects. Its one drawback is that it doesn’t have any effect on anxiety; SSRIs are really the only ones available that work for that. So spiders started to freak me out again, and it got harder to start conversations with people I didn’t know. But overall a good choice.

Enter infertility treatment. Much stress, much anxiety, not much sleep. Then a new job on top of that. I started to feel as if I was overloading the buproprion. I got a new psychiatrist finally (I had been seeing my PCP, who was great, but not, obviously, a specialist in tweaking these meds). And he said, you know, the sexual side effects of SSRIs are dose-related, and you were taking a relatively high dose. How about we leave you on the buproprion, but add a whiff of sertraline back?

Simple but brilliant. I added 25mg of sertraline, with no appreciable effect on my sex life but a definite dampening of the anxiety.

I was, naturally, worried about what to do if I ever did manage to get pregnant. When I broached the subject with my husband, I was relieved to find he had a strong opinion that it was much riskier to go off meds during such a stressful time than to expose a baby to medication that has not been shown to do any real harm. We decided that since the real issue was depression, once/if I actually got pregnant, I’d taper off the sertraline, just to decrease any possible risk. In fact, I upped the sertraline to 50mg during the worst of the IVF treatment and left it there until we’d seen a heartbeat, then tapered off. I continued buproprion during pregnancy and restarted 25mg of sertraline once the baby was born. (Buproprion does get into breastmilk, but again we decided that the benefits clearly outweighed the risks.)

I find it interesting that a lot of people are afraid to try antidepressants, not because they might not work, but because they might. If you start and find out that you feel like a completely different person, what then? Are you stuck forever? It’s hard to explain why this doesn’t really make sense, because you won’t truly understand unless you try it. What I tell my patients is that if the antidepressants work, you will feel—normal. Not a different person, just yourself, the person that you can remember being, though perhaps long ago. As testament to this, most people who are on antidepressants for a long time eventually get to a point where they feel like the meds aren’t working, because they feel utterly normal. And a lot of people can eventually go off while continuing to hold on to their normal self. The reason I can’t is that it is very likely that if I were not to continue antidepressants for the rest of my life, I could expect the episodes of depression to come more frequently and become more intense. Some people have episodes every once in a blue moon and can use antidepressants as needed, but my last depression came with so little warning and so little provocation that I don’t want to risk it.

And as long as I can make the sale, catch some fish, start the car, boil some water, catch a wave, and get to the top of the mountain, I’m good.