Antidepressants can be a controversial subject. I’m not a doctor, so I can’t give medical advice. But I am a person who has struggled with depression for 20-30 years, and for more than half that time I’ve been on antidepressants. I want to share my experiences and what I’ve learned along the way.
If you don’t want to read this whole article, here’s the short takeaway: If you have severe, long-term depression, you should seriously consider the tradeoffs that come with being on an antidepressant. If your depression isn’t severe and you think you can manage it with diet, exercise, sunlight, and therapy, that’s probably a better route than medication.
My Biases and Background
Before diving into my experience with antidepressants, I want to put my cards on the table so you understand my perspective.
Growing up, I put huge faith in doctors and the medical profession. I basically thought doctors were saints and you should do anything they told you. Now that I’m older (and a licensed professional myself), I’m more cynical.
I’ve realized that:
- Doctors are fallible humans who make mistakes.
- There are good doctors and bad doctors.
- Most doctors want to help people but suffer from the same problems other professionals do (arrogance, overconfidence, taking shortcuts).
- The American healthcare system creates bad incentives for treatment.
I’m not anti-modern medicine, but I am skeptical. I believe in being an educated consumer of healthcare. I’ve used physical therapy successfully, and when I had a hernia, I got surgery and took the prescribed medication. I just think we tend to over-treat in America, giving people pills and surgeries when lifestyle changes might help more.
Most importantly: Your body, mind, and life are unique. When I say unique, I mean it in the true sense – there’s nobody else with your exact combination of genetics, experiences, and circumstances. People react differently to medications, so you can’t just take my experience and apply it directly to yourself.
My Health Background
I’m a 45-year-old man, 6’1″, 180 pounds. I’m relatively healthy, physically active, and eat fairly well. My wife and I don’t eat much processed food, and I follow a low-carb diet that helps me maintain my weight. I exercise 3-4 days a week for about two hours each session, and my job as a land surveyor keeps me active outdoors.
I don’t take much medication beyond my antidepressant. During allergy season (mid-March to mid-May), I take an over-the-counter allergy pill because we have terrible air quality in California’s Central Valley.
I don’t like taking painkillers, even though I have chronic knee pain and wrist pain from keyboard use. I try to manage these with stretches, massage therapy, and acupressure instead. When I had my wisdom teeth out in my 20s, Vicodin made me sick, so I switched to ibuprofen quickly.
The only exception was after my hernia surgery a few years ago when I took oxycodone. That was a weird experience – I really loved that drug. It took away all my pain and gave me a warm glow. I liked it so much that it scared me. After a few days, I gave the bottle to my wife and told her to only let me take them at night to sleep. A week later, I had her flush the remaining pills.
My History with Antidepressants
I’ve been on antidepressants for about 10-15 years. I’ve tried at least three different kinds:
- I started on Prozac.
- Then switched to Zoloft (10mg).
- Now I’m on Paxil (25mg).
There might have been another one in there, but I don’t remember the name. All three are SSRIs (Selective Serotonin Reuptake Inhibitors), which change how your body reacts to the neurotransmitter serotonin. This affects how signals are transmitted in your brain.
I recently learned that serotonin also influences other processes in your body, like your immune system and digestive system. That makes sense to me because I’ve noticed it’s harder to keep weight off when I’m on antidepressants.
I’m on a pretty low dose of Paxil. I think this is because I try to manage my depression in other ways too:
- Diet and exercise.
- Getting lots of sunlight.
- Meeting my spiritual and emotional needs.
- Managing negative thoughts.
Side Effects I’ve Experienced
Weight Gain
Over the first 10 years I was on antidepressants, I put on about 60 pounds. I’ve managed to lose that weight in the last two years, but it took major lifestyle changes:
- Rigorous exercise.
- Being very careful about my diet (low-carb, lean meat, vegetables, little fruit).
When I had my hernia surgery and couldn’t exercise for two months, I quickly put on 10-15 pounds. So I suspect the medication affects my metabolism in some way.
One complication here: gaining weight can lower testosterone production in men, and low testosterone can contribute to depression. So it creates a complex cycle.
Increased Sweating
I sweat more than normal when on antidepressants. It’s not a huge deal, but it’s noticeable. Paxil seems better for this side effect than the other drugs I tried.
Digestive Issues
I have diarrhea more frequently than most people. I’ve read that antidepressants can affect your digestive system, so this might be related.
Heat Sensitivity And Altitude Sickness (Most Serious Side Effect)
By far the most debilitating side effect for me is increased vulnerability to heat exhaustion and heat stroke. The medication affects my body’s ability to shed heat through sweating.
This is particularly problematic because I’m a land surveyor working in central California. For about five months of the year, I’m trying to work in temperatures over 100 degrees. When I’m in the valley, it doesn’t impact me much. But if I get above 4,000 feet in the foothills or Sierra Nevada (where we do a lot of our work), it becomes a major problem.
What happens is frightening. I can go from feeling normal to completely incapacitated in about three minutes. Suddenly I’m:
- Lying on the ground.
- Extremely dizzy.
- Nauseated.
- Experiencing cold sweats.
- Having an accelerated heart rate.
- Feeling like I might die.
This can last anywhere from 10-45 minutes of pure misery. I’ve learned to crawl into shade when it starts. If I couldn’t get to shade and cool down, it could potentially become life-threatening.
I’ve gotten better at managing this by:
- Limiting caffeine on days I’ll be in the mountains.
- Drinking lots of electrolyte water.
- Carrying frozen neck bands.
- Stopping immediately when I feel the first symptoms coming on.
Even with these precautions, I still had 3-4 incidents of bad heat exhaustion/altitude sickness last summer. This has had a major impact on my work – I can’t work alone in the mountains anymore. It’s too dangerous.
Long-Term Effects
The honest answer about long-term effects of antidepressants is: we don’t know. It hasn’t been well studied, especially for the newer drugs.
There is some evidence of potential negative effects from long-term use. For example, one study showed a correlation (not causation) between long-term Paxil use and higher risk of dementia or Alzheimer’s.
In my case, my family doesn’t have a history of dementia, and I’m otherwise healthy, so this risk doesn’t worry me as much as it might others. But it’s something to research and discuss with your doctor if you’re considering long-term use.
The Benefits I Experience
Despite the side effects, the benefits are enormous. I can’t put into words how helpful this medication is for me.
The way I describe it is that it turns down the intensity dial on my emotions. All my emotions are less amplified – both good and bad. Since depression means I have more negative emotions than positive ones, this is a huge net positive.
I’m not exactly a robot, but I am less emotional overall. My wife notices this, and it has probably had some impact on our marriage – though less impact than me being suicidally depressed. I have to work to remember to be affectionate and happy, because my wife is a naturally happy person.
The biggest benefit: I don’t deal with suicidal depression anymore. I went from being suicidally depressed 2-4 days at a time, twice a month, to maybe once a year having a really bad few days. That’s a life-changing difference.
My Internal Struggle
Here’s something I haven’t admitted often: If I could push a button right now to get off my antidepressant, I would.
Why? It’s not even really because of the side effects. It’s because taking antidepressants makes me feel weak. It makes me feel like I’m not a real man. It makes me feel defective, flawed, or broken.
I wish I could be strong enough to not need medication. I know that’s not logical, but it’s how I feel.
If it weren’t for my wife, I probably wouldn’t take my antidepressant. I would just suffer. I take it for her.
Why does my wife want me to take the medication? She worries about what might happen if I don’t, and she doesn’t like to see me suffer. The prideful part of me would rather suffer with suicidal depression a couple times a month than take “this stinking antidepressant.” But my wife is being more reasonable. As she puts it, she’s not going to let me “have a gun barrel in my mouth once a month just because you don’t want to take an antidepressant, knucklehead.”
This is why young men with depression need an advocate. They need someone who loves them to say, “Hey, you should really think about taking this antidepressant or staying on it.” I talk to my wife about getting off my medication probably once a year. She doesn’t even have to think about it – her answer is always a firm no.
She sees me in ways I cannot see myself. She sees me when I get depressed, when I have flashbacks of child abuse. I have to trust her judgment because I cannot fully trust my own in this one area of my life.
It may be the only area where I feel I’m not competent to make decisions for myself. Because I love and trust my wife, I let her influence this decision heavily. I hope you have someone in your life you can do that with if you’re in a similar situation.
The Logical Argument
Now that I’ve told you how I feel emotionally about being on antidepressants, here’s what the logical part of my brain says:
Why on earth would I get off my antidepressant when the side effects are minor and the benefits are enormous? Why would I go back to that suffering?
For me, there’s a huge downside risk to getting off antidepressants: I might commit suicide. My depression is suicidal. Why risk the one time I might actually pull the trigger or cut my wrist?
I understand that ending my life would have a devastating impact on my circle of family and friends. I would hurt so many people.
Because the risk of suicide is so real for me, I can’t gamble with getting off antidepressants. I think I could probably manage with exercise, diet, sunlight, and therapy – but there’s maybe a 2.5% chance that without medication, I would have a really bad episode and seriously consider suicide.
If I get severely depressed four times a year, and there’s a 1-in-40 chance I might take steps to end my life during one of those episodes, that means once every 10 years I might get dangerously close.
For me, 2.5% is too high a risk. I have people who count on me – employees, a business partner, a foster son with autism, a wife with a major neurological disorder. I can’t risk it, so I have to deal with the side effects and swallow my pride.
Final Thoughts
I believe we over-prescribe antidepressants in America. But if you have severe depression and you’re not on antidepressants, you probably need to be. If you’re thinking about taking your own life several times a year, you almost certainly need medication.
Don’t fool yourself. To some extent, you might need to do what I’ve done and outsource that decision to someone who loves you. It’s hard to let go of control, but your mental health might be the one area where you can’t fully trust your own judgment.
That doesn’t mean you shouldn’t educate yourself, talk to doctors, get second opinions, or consult therapists. Do all that, but involve the person you trust in the process and make the decision together.
One final important note: If you do decide to get off antidepressants, do not stop cold turkey. You need to taper off slowly. The research is clear that stopping suddenly can cause an immediate deep depressive episode, which is dangerous. The tapering process isn’t quick – it can take several months, and you should do it under the supervision of a doctor and possibly a therapist.
This is another reason to be cautious about starting antidepressants unless you really need them. Once you’re on them for a long time, getting off isn’t simple.
But for me, and perhaps for you if you have severe depression, the benefits far outweigh the costs. Sometimes medication is the right answer, even if it’s hard to accept that.
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