The Meds Stopped Working

One of the first posts to gain traction on this blog was about anti-depressants. After Timothy Morton outed himself as a particularly callous moron on the subject, I went through a few of Mark Fisher’s most famous comments on the pharmacological treatment of depression and how it is often used to cover over any analysis of the more structural / material problems at work in society today.

At the time, the NHS was running a kind of awareness campaign to normalise the usage of SSRIs and hear from people who had had their lives changed by them for the better. But this wholly ignored far more damning issues with the NHS’s treatment of mental issues, including 1) how social circumstances lead to an endemic depressions today and 2) the ways that the NHS’s treatment for those with mental health issues is impossible to access for so many because of those same circumstances.

I made a few points related to all of the above, but what was key for me was that, despite finding Morton’s flippant comments utterly disgusting, I had plenty of faith in anti-depressants themselves. As much as I appreciated Fisher’s scepticism towards them, I’d actually always found that they worked just fine for me. It’s everything else that doesn’t work and that needs to be addressed. Because the fact remains: medication works for some, not all; the system itself, however, works for far fewer people than that.

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I’ve been thinking back to this post often the past week or so. Things have changed a lot recently. After over a decade on citalopram (on and off), I found that, despite being on the highest available dose, the medication had stopped working for me. I had a full-on suicidal breakdown whilst taking my medication and I found that the “capitalist palliative” just wasn’t cutting it anymore.

There were many reasons for this, no doubt. Not only had I presumably built up a tolerance to citalopram, my personal life completely fell apart and there came a point where I found myself incapable of responding rationally to anything else that life might throw at me, with my emotions becoming completely dysregulated in the process. Medication only did so much to actually soften the blows at that time and even therapy, which I’d been paying for for six months, was starting to make things worse rather than better. It felt clear that none of the support I had at my immediate disposal was actually suitable to my needs, but it was also a real struggle to make any meaningful change to my treatment plan.

Following months of struggling to access any effective treatment whatsoever, I was eventually given a new regime of medications, which were eventually whittled back to a single daily dose of sertraline. (I’ve written about this a few times, so I won’t retread over the details.)

Sertraline is the most commonly proscribed antidepressant these days, as it is seen as a bit more bespoke than an older drug like citalopram, or so I was told. Whereas the maximum dosage for citalopram is 40mg, sertraline can go up to a maximum of 200mg, meaning there is more of a range to work with so that the drug can be prescribed at varying intensities to best treat an individual’s particular needs.

It worked for me, for a time. I felt myself stabilise. But I never actually began to feel better. It felt like the medication had simply hit pause, rather than do anything to fix my situation. I found this was a very different reaction than I ever had to citalopram. Whereas citalopram, when it worked, helped to raise up the low end of my emotional range, so that I could not fall into too deep of a depression and could function better day to day, sertraline put a limit on my top end too. It squeezed the middle, and didn’t make me feel good at all, but instead like even more of a powder keg with no way to alleviate the pressure, meaning I’d become quickly overwhelmed by daily life, falling into a habit of sleeping all day.

For the last three months, that has been my reality. I’ve struggled to write or do anything creative. This blog, previously an integral outlet for me, shrivelled up. I’ve pushed through this feeling necessarily at times, in order to hit deadlines and have a social life, but I have generally found a lot of things that used to come easily a lot more difficult. I’d find myself exhausted by the slightest bit of mental exertion, with just a few days of concentrated engagement with people and events always leading to a complete burn out, or just a few hours working on a book draft resulting in at least a four-hour nap every day. Over time, these limitations meant I started to socially withdraw more and more.

As the months flew by, life itself didn’t change much. I still found a lot of things hard, particularly a constant awareness that I lacked any real foundation, pitying myself as I felt turned and spurned like a stray dog. But ultimately, I didn’t do anything about it. I put no effort into changing my circumstances. Because all I felt was numb.

After three months on sertraline, I became deeply fed up of this numbness, and I gradually identified that it wasn’t because I was irreparably broken or whatever. It was the meds themselves.

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Maybe my dosage was too high. Maybe there were other medicines I could have explored. But as long as I wasn’t actively suicidal, my GP seemed to have no interest in any of my concerns. I wasn’t allowed to have any meaningful say in my own treatment, primarily because, at my most unwell, I’d abused what I’d been prescribed and taken an overdose. But the solution from the medical professionals around me was presumably to numb my feelings altogether and leave me to it. Every complaint (about emotional flatness, too much or too little sleep) was dismissed. I was told to just wait and see, hang on until my next medication review. But when was that going to be? In another three months time? Six months, more likely… Sertraline left me without hope. Though it stopped me from feeling suicidal, it only intensified my despair as I thought daily about how I could not go on like this.

It seems clear that the meds aren’t working for me anymore. And without that basic silver lining, I felt there was little hope to hold out for. I was numbed to the point I couldn’t articulate my thoughts, I couldn’t be bothered to act in my own best interests, and I couldn’t feel much of anything — sadness or happiness. By any measure, despite being on anti-depressants, I was still struggling with all the anhedonic symptoms of depression. I was simply not a risk to myself anymore. But this new regime of treatment began to feel like a fate worse than death. I took pain from nothing and joy from little. It was horrible in that surreal sense of medicalised ennui. I was drugged so I wouldn’t suffer, but found that feeling nothing was its own kind of torture. I struggled to connect with other people and sustain relationships and felt all the more alienated as I wandered around in a constant brain fog.

No one around me seemed to get it. (Hard to blame them, since I have barely understood it myself.) My assumption has been, perhaps I’m just a shitty, annoying and inconsiderate person. I’m being treated, after all. I’m no longer acting insane. This is meant to be me “well”. But taking the doctors at their word, I was questioning everything about myself and nothing about what was being done to me. The more important questions, then, were never asked, by myself or by anyone else: is this medication really doing what it is supposed to…?

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Enough is enough. With the meds no longer working, and the system itself still so broken that I have no faith in it fixing things, last week I decided to go cold turkey on the sertraline. Whether this is a wise decision or not, I don’t know. I’m sure my doctor will think it is reckless when they realise I haven’t picked up my prescription in a while. Then again, I don’t expect anyone to notice. They seem to care very little and are so administratively incompetent that staying medicated has been a challenge. So if they’re not going to try and make things work, neither am I.

It has been a strange experience so far. I am over the worst of the withdrawal symptoms, with the worst “brain zaps” of my life having finally begun to subside. But I am also already feeling the positives. My emotional range has expanded in ways I’d forgotten it could. I made a new show for Slack’s at home and found such euphoria in the process. I was grinning from ear to ear like I had not done in months. At the same time, I’ve been crying at just about every melancholic moment on the TV going, from silly melodramatic sitcoms to overtly sentimental Christmas adverts. I have even found myself frequently laughing at the things that have made me sad. But it is a novelty to feel things so fully for the first time in months. I am sure the mood swings will quiet down soon, but right now I’m almost glad for them. Crying is cathartic, after all. It has been oddly uncomfortable to find it an impossible thing to do.

All in all, I actually feel so much better for giving up on the meds. I feel like I have taken charge of my own treatment. I will do something else now, and what I do is fully up to me. I feel reenergised. I will try and put other things in place that make my life work better. It’s about time I went out fully on my own, got my own place, set up a life and routine that works for me and is not tied up unnecessarily with other people’s, including the assertions of my useless GP. I need to build a foundation for my own life before I can hope to share it purposefully with anyone else and that is what I intend to do. In fact, I am excited that this is what 2023 will have in store for me. 2022 has been a lot of trial and a lot of error. But I feel like I have done little for myself. I have white-knuckled it, being petrified in place, stuck in medicated purgatory, admitting I have no idea what I’m doing and relying on medical professionals to tell me what is best. The truth is: none of them know or care. Their priorities are limited, their conduct neglectful and their advice unfit for purpose.

But what will continue to sadden me is that I now know what it is like to experience the medicated life from the other side. I know what it is like to find the first port of call for most physicians no longer works for me. I will still advocate for SSRIs regardless — they are worth taking a chance on, in case they do work for you. But it also seems clear to me now that they are not and never have been a long-term and meaningful fix under the current system. If you can build up a tolerance, or if certain medications don’t affect you like they do others, what are you supposed to do? Changing the circumstances of your life is one thing, but how doable is that? Eat better, exercise more, drink less. Yes, these are all things that help. But please kindly shut the fuck up if it’s your only piece of advice. None of those things will exorcise your demons. None of those things will free you from drudgery. All are palliatives. Because all they do is allow you to “function” in a very restricted sense. (To get you back to work, which, in my experience, is just as effective at making you ill.)

This is the struggle I feel left with, moving forwards into 2023. I need to change my circumstances, but I am hardly in a position to ever live comfortably, with myself or others. Accepting a bumpy past and inevitable future of neurodivergence and the ways that I — never mind anyone else — can learn to accommodate it is a tough pill to swallow. And so the next year is undoubtedly going to be a real struggle, financially and otherwise. I imagine it will be lonely too. But it will force me to carve out a space for myself in a world that feels far from accommodating than anywhere available to me in the present. That is ultimately what it takes. The meds aren’t a solution anymore — perhaps they never were. All I can do is affirm what agency I have and never again let myself be put in a position, by our ineffective system, where that agency is medically diminished or taken away.

That cunt Morton would never understand that.