Content Warnings: Depression, Suicidal Thoughts
By 10 a.m., a sense of dread slowly crept through me. My shoulders clenched. Instead of butterflies in my stomach, I felt worms.
When the nausea and dizziness hit, I realized what was happening: I had forgotten to take my antidepressant. I was at my desk at work. If I didn’t go home soon, I’d be a mess. My brain would dissolve into a hot fuzz. The floodgates would open, residue leaking down my face.
Every morning around 7 a.m., I am supposed to take a round, brownish red pill with 100 mg of desvenlafaxine, a generic form of Pristiq. I keep it in my kitchen, by my vitamins. I’ve been taking the antidepressant since it came on the market in 2008. I rarely miss a dose. But when I do, it’s only a matter of hours before I devolve from productive professional to zombie. I hate the fact that a little pill is the only thing that separates the two states.
Robert F. Kennedy Jr., the U.S. Secretary of Health and Human Services, called SSRIs, a type of antidepressant, a “threat.” SSRIs, which stands for selective serotonin reuptake inhibitor, prevent neurons from reabsorbing serotonin, so the neurotransmitter will stay active in the brain longer. Pristiq is a variation that also works on another neurotransmitter, norepinephrine. It’s tempting to dismiss Kennedy’s comments, considering his support for a range of disproven conspiracy theories (and the fact that he’s part of an administration that is not helping my depression). Psychiatric medications are not a threat; they save lives. They probably have saved mine.
But Kennedy’s comment at his confirmation hearing got my attention: “I know people, including members of my family, who’ve had a much worse time getting off SSRIs than they have getting off of heroin.”
I’ve never used heroin. But based on personal experience, there’s some truth to the fact that quitting an antidepressant can be hell. It raises the question: do I have a monkey on my back?
***
I tried so many antidepressants: Prozac, Zoloft, Paxil, Serzone, Wellbutrin, Cymbalta, Effexor, and Lexapro, and others with names I’ve forgotten before finding “the one.” I eventually stopped the other meds because they either did not work, made me feel numb, dazed or caused side effects such, as yawning, sleepiness, and nausea.
Years ago, I thought the Serzone might be working. Until I started having anxiety attacks at work, especially at large meetings and events, in which I would suddenly get clammy and panic that I was going to throw up. I quit taking it. Things didn’t get much better. Another medication caused a buzzing sensation in my head at a 4 on a scale of 1-10. At the time, I was a newspaper reporter, writing a story for the next day’s paper on deadline. I could barely type with my brain zapping away. I got up from my desk, walked out of the building, and called the doctor from the privacy of my old Camry in the parking lot. The doctor’s office put me through to a nurse.
“I’ve been taking the medication for a week now. Is it normal to have a buzzing feeling in my head?”
The nurse told me to stop taking the drug. I pushed my sparking and sputtering brain to finish my story. The doctor prescribed a different medication. Stopping the medication you’ve only been taking for a week is easy. The problem comes after the antidepressant rewires your brain.
When my OB/GYN prescribed Pristiq in 2008, I was a desperate sleep-deprived mom with a one-year-old baby. I preferred to think I was experiencing post-partum depression rather than major depression. Back then, I still worried about what people would think if they knew I had depression. The 50 mg pills were unlike anything I had tried before: they worked.
Pristiq’s medication’s initial magic didn’t last. A few years later, when I was going through a divorce, I couldn’t sleep; I cried all the time. I went to a psychiatrist who doubled my dose to 100 mg a day and prescribed Ambien. That was enough to lift my depression enough to think more clearly and get through each day.
Some people complain that antidepressants dull or flatten emotions. Others call antidepressants “happy pills.” Mine never brought me to the near delirium you see in the formerly depressed people frolicking outside in the TV ads.
Antidepressants didn’t keep me from being me. They have kept me from wanting to die.
***
I never wanted to need antidepressants to live. Feeling better a few years after my divorce, I tried to reduce my dose back to 50 mg. But you can’t change your dose abruptly; you have to taper. My doctor prescribed 50 mg pills plus 25 mg pills to lower my dose. I had plenty of reasons to want to lower my dose. The medication causes side effects, such as constipation, and although my doctors deny it, I’m convinced it causes weight gain. I also think mine causes fatigue. At first, I was hopeful. I tolerated mild nausea, dizziness, and anxiety, hoping it would pass. But within a few weeks at the lower dose, my depression raged back, strong as ever. One afternoon, I came home for lunch, so I could call my psychiatrist. Sitting on the floor by the kitchen in my apartment, shaking, tears streaming down my face, I told him what was happening. He said typically when people respond well to a higher dose of a medication, it’s because they need it.
“I will write a prescription for 100 mg,” he said.
The monkey won.
I developed a phobia of not having access to my medication. Once, on a trip to a conference in Atlanta, I couldn’t find my pills. I had to miss a session at my conference as I went back to my hotel room to ask my CVS in Texas to allow me to get some pills at the CVS near my hotel. Wobbly and light-headed by mid-morning, I rushed down the street to get my medication, gulping it down in the Uber back to the conference. When I got home from the conference, I found that I had the pills had been in my suitcase all along.
I can’t even imagine what would happen if a political or natural disaster made it impossible to get medication. Would I be like the suicidal Eleanor Lawrence in The Handmaid’s Tale, wife of the architect of Gilead, where women can’t get mental health care?
My other worst fear: the meds simply stop working.
***
One website links the monkey-on-my-back idiom to an Aesop’s fable about a dolphin who rescues a monkey it thinks is a man. The monkey claims to be of noble heritage. The dolphin discovers the story is a lie and dives underwater, shaking the monkey loose to drown. There’s another story that the phrase comes from Sinbad’s tale from Arabian Nights, in which a monkey climbs on Sinbad’s back and refuses to leave. Sinbad eventually tricks the monkey into drinking wine, which causes him to loosen his grip. Then, Sinbad kills him.
Monkeys also have been seen as protectors, like the pets in Frida Kahlo’s Self-Portrait with Monkeys. One sits on her arm, a monkey’s hand rests on her neck, while another’s tail curls around the artist’s arm.
I had a hard time seeing the monkey as a friend. However, it untangled my mind, so I could live without worrying quite as much about things that may or may not happen. The monkey kept my thoughts and emotions from running wild. I still wanted to get rid of it.
The National Institute on Drug Abuse defines a substance use disorder as “a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences.” Based on the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard text on mental health, my relationship with Pristiq does not meet the criteria for a substance use disorder. I don’t crave the drug or use more than the intended dose. I don’t have urges to take Pristiq, neglect my responsibilities, or put myself in risky situations, like robbing banks, to get my meds.
***
So, if it’s not an addiction, what’s the name for my body’s violent reaction after a missed dose? I don’t feel sick if I miss my allergy pill. On the other hand, maybe it’s more accurate to compare antidepressants to a different type of mediation, such as insulin for people with diabetes. The thing is, there’s no test to find out if your serotonin levels are normal. No one even really knows why antidepressants work. Scientists still debate what causes depression. A 2022 study published in Molecular Psychiatry found no convincing evidence that low serotonin levels caused depression.
In the late 1700s and early 1800s, the theory was that depression resulted from an imbalance of fluids in the body. The solution: bloodletting. Only 100 years ago, Henry Cotton, MD, a doctor at New Jersey’s Trenton State Hospital, pulled patients’ rotting teeth, which he believed caused “madness.” When that didn’t work, Cotton removed parts of stomachs, small intestines and other tissue.
***
I wish I could blame my depression on a bad tooth. On that day at work a few years ago, I took an early lunch to rush home to take my precious desvenlafaxine, like Gollum searching for the ring. Within a couple of hours of being reunited with my precious meds, I started to feel relief. Perched at my kitchen table, I opened my bottle of desvenlafaxine to count how many I had left before my next refill. I placed one of the pills in a baggie and slipped my emergency stash into a pocket in my purse, just in case.
Sources consulted:
https://www.newsweek.com/rfk-jr-antidepressants-ssris-drugs-maha-2032297
https://www.gatewayfoundation.org/blog/dsm-5-substance-use-disorder/
https://www.forbes.com/sites/saradorn/2024/11/15/rfk-jrs-conspiracy-theories-heres-what-trumps-pick-for-health-secretary-has-promoted/
https://www.psychologytoday.com/us/blog/insight-therapy/202207/depression-is-not-caused-chemical-imbalance-in-the-brain
https://www.quantamagazine.org/the-cause-of-depression-is-probably-not-what-you-think-20230126/
https://grammarist.com/idiom/monkey-on-ones-back/
https://www.newagejournal.com/understanding-the-monkey-on-your-back/
https://www.anothermag.com/design-living/1467/frida-kahlos-monkeys-dogs-birds
https://www.gminsights.com/industry-analysis/antidepressant-drugs-market
https://www.wsj.com/articles/SB10001424052702303289904579195872550052950
https://www.cdc.gov/nchs/products/databriefs/db377.htm
https://www.theatlantic.com/health/archive/2014/10/the-tragic-sadistic-mental-illness-treatment-from-the-knick-is-real/381751/
Kim Horner (she/her) is author of Probably Someday Cancer (University of North Texas Press, 2019). Her work has appeared in So It Goes, Parhelion, and The Texas Observer.
Twitter: @kimhorner
Instagram: @hornerkim
Website: kimdhorner.com