When I was first prescribed fluoxetine (the generic name for Prozac), I didn’t think to ask my psychiatrist about side effects. I was only eighteen. I didn’t even really know what I was taking—just that this professional, whom I trusted, told me it would help. In the time leading up to my going to the doctor, I had grown more and more withdrawn. Nothing seemed worth doing. Though I didn’t know the term until much later, I had been edging toward a major depressive episode.
I didn’t feel very different right away, but over the next few months it got harder and harder to fall asleep, and I started to wake up in the middle of the night a lot more. I got headaches constantly and couldn’t focus as well. What really made me take a step back and question my medication, though, was losing my sex drive (which I won’t elaborate on here). I thought about stopping altogether, but I swallowed my embarrassment and talked to my psychiatrist about the side effects I was having. I just wish I had known what to expect before I started the prescription.
The Facts About SSRIs
Though they’re one of the most widely prescribed types of antidepressants, we still don’t know exactly why SSRIs like Prozac work. SSRI stands for selective serotonin reuptake inhibitor — other examples of SSRIs include citalopram, fluvoxamine, and sertraline. We know they temporarily increase the amount of serotonin (an important neurotransmitter that affects your mood, among other things) in the synapses between neurons of your brain. But that doesn’t explain why it takes weeks for them to take effect, why withdrawal from SSRIs is so dangerous, or why some people — but not others — respond to them. They’re prescribed for more than just depression, too: obsessive-compulsive disorder, eating disorders, and anxiety disorders all can be treated with SSRIs.
SSRI medications seem to work really well for select people; for some people with major depression, nothing else has worked. But we don’t have a way to reliably predict who SSRIs will help, or who will get side effects like the ones I experienced. I was lucky—mine resolved after I stopped my medication, but unfortunately, that isn’t the case for everyone.
Common antidepressant side effects range from irritating to serious. Suicidal ideation, increased risk of bone fracture, and restless leg syndrome can occur from most SSRIs. Sexual side effects are some of the most concerning, though, and the most common. Troublingly, they sometimes persist even after you stop the medication. They can manifest as low or lost libido, inability to orgasm, erectile dysfunction, and loss of pleasure with orgasm. Historically, these effects have been underreported, and only in recent years are they getting the serious concern and research they deserve.
The side effects of SSRIs are as varied as their use, though. Sleep issues can come up, but surprisingly in either direction: insomnia and excessive sleep are both standard. Frequent awakenings, poor quality of sleep, and nightmares are reported. A rarer effect known as sleep paralysis can also occur — a phenomenon where you wake up but are unable to move, often accompanied by the sensation of a strange presence in the room with you.
Discontinuing an SSRI medication too suddenly also comes with significant risks. Many of the above side effects can occur, in addition to frightening “brain zaps”— electric shock-like sensations felt in your head. Anxiety, confusion, and flu-like symptoms can follow.
Considering the unpredictable side effects and mental and physical risks entailed by SSRIs, it’s surprising that they’re so readily prescribed. It may be due to a lack of research into alternative therapies (though this is changing in recent years), or it may be due to something as insidious as pharmaceutical companies pushing to make a profit at the expense of those who are suffering. Either way, it’s important to consider alternatives to these risky medications.
Antidepressants and Psychedelics
For people who experience the ill side effects of SSRIs, there are other options. We are increasingly aware of how effective psychedelics can be in treating depression in its various forms. Psilocybin has been shown to specifically interact with brain regions involved in depression and improve your outlook on life. A more in-depth, integrated psychedelic experience may help you address the root causes contributing to depression. With an experienced treatment center that helps patients to integrate their experience into their day-to-day life, many individuals have found lasting improvement in their mood, outlook, and quality of life.
Before you seek out these alternative therapies, though, note that individuals taking SSRIs or other antidepressant medications—myself included—can have unpredictable reactions to psychedelics. Often it’s simply that we are more resistant to their effects, but sometimes a dangerous and potentially life-threatening reaction called “serotonin syndrome” can occur, in which a person may experience increased heart rate, shivering, twitching, lethargy, and confusion. This is especially true for combining SSRIs with MAOIs (mono-amine oxidase inhibitors, one of the key ingredients of ayahuasca), MDMA, or LSD.
If you’re currently taking antidepressants (or any psychiatric medication) or have recently stopped a prescription, consult a professional before exploring psychedelics. Serotonin syndrome is especially a concern if you’re taking a psychedelic that you don’t know the source of. To be safe, it’s always best to seek a professional who will guide you safely through the whole experience.