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Over the past 10 years antidepressant prescriptions have doubled in the UK, hitting 71 million in 2018. With the isolation of lockdown forcing us to confront our feelings about it, four people describe how they have navigated life on Sertraline. 

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I first went to therapy at 14 as I had started suffering from panic attacks and then later at 17 was offered antidepressants. I declined, not wanting to deal with the effects of starting a new medication when I was studying for my exams. By the time I was 19 and back at the GP, reporting my terror at the prospect of starting university, I was given a depression diagnosis and recommended to try a six month course of 50mg of Sertraline daily. Although I had never heard of it before, I figured that if it could make life feel a little easier then it would be worth it. 

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That was three years ago. Living with Sertraline as a mental health treatment feels like a turbulent journey. When I reflect, I often wonder how I might have struggled if I had not taken it. It gave me the ability to stop questioning every thought I had, have enough confidence to pursue friendships and I will even finish my degree this year.  However, the biggest downside of Sertraline is suddenly stopping it not only causes a relapse of my depression symptoms, but also accompanies it with a fierce anxiety. As society became more open to discussing mental health in the last couple of years, I came to realise how many of my friends and acquaintances were not only prescribed antidepressants, but the exact same type as I was. Having had Sertraline as a part of my life for a long time, I’m interested in how other people find living with the treatment. 

It is no surprise more young people are turning to medication as rates of mental health problems rise. Before the pandemic The Office for National Statistics recorded one in nine 16-39 year olds reported moderate to severe depression and now as the age group most likely to be hit by depression during the pandemic, one in three are affected. With 7.3 people prescribed a form of antidepressant between 2017-2018, I am certainly not alone in using Sertraline to treat my mental health problems. 

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The majority of the time, a doctor will recommend starting a patient at 25mg, or 50mg, and then slowly building up the dosage if it is ineffective, to a maximum of 200mg. This is to help stop those initial effects being significantly worse and allow the body to gradually adjust. However in Ruby's case she was immediately put onto 100mg. I meet Ruby at a park in New Cross on a dull day, although her bright orange hair brings some brightness to the gloom. 

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“I originally started in August 2019 at 100mg.” 
I question her again, “Straight away? To 100? Not 25, 50, 100?”. 
Ruby gives a soft laugh, “Yeah, they gave me 100 straight away.” 
I asked her how it felt at first, telling her that the way I felt going onto 50 was crazy, so I can only imagine how she might have felt. 

“I remember that day they gave it to me, I took it in the afternoon then for the next couple of months I took it in the morning and that-” Ruby pauses to laugh again, raising her eyebrows- “Would make me so fucking tired. For the entire day I would be yawning constantly, just big fucking yawns.” Ruby smiles, recalling the absurdity of a medication that makes you yawn a lot. 

Unfortunately, Ruby’s symptoms didn't stop there; “Other than being constantly tired, I wasn’t eating, I was purposely starving myself. I would sneak to the kitchen at 3am and make myself something, then stay up till 5am and sleep in the day.” Ruby shakes her head slightly remembering this, as she goes on to elaborate her initial emotional states on medication; “the way I felt coming onto it was kind of like a wall.” she pauses contemplatively. “Like a wall of blankness. And it felt obvious after the first month, so I felt kind of at ease with things. I was concentrating on things other than thinking”.

 

Ruby conveys a conflicted relationship with her view of antidepressant medication; “Sertraline is a thing that’s come into my life that’s solved a lot of problems but also made its own. I’m always having to deal with the pros and cons of being on it.” I agree, telling her how hard it is to weigh up the negatives and positives of using sertraline, opposed to coping with your mental illness without that assistance.Ruby nods, her eyebrows creasing a little, “exactly. It’s kind of scary though sometimes. Because I’m always questioning my autonomy and how I live. It’s an inner conflict for me for some reason-” Ruby pauses waving her hand in the air searching for the words to describe it. I tell her it is an understandable inner conflict, and explain that some of the time I get the feeling that I need to stop using sertraline as a treatment. But then I end up questioning those feelings and wondering if perhaps it is because  of a general stigma around treating mental health as an ailment and the confusing concept of having an element of choice in whether to be resigned to taking medication for life or not. Ruby smiles.

“You don’t wanna feel like you have a mental illness, but you have a mental illness””
We dissolve into slightly restrained laughter at the dichotomy of the situation. 

While it’s likely that Ruby’s symptoms at the start of using the medication were exacerbated by a higher dosage, I spoke to Aisha after Ruby and she reported a similar experience despite starting at a lower dose of 50mg. Fortunately, as we live together, I was able to interview Aisha from the comfort of her own room where she sits cross-legged on her bed, cheerfully sipping tea, while reflecting on the past when she initially began sertraline. 

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“I felt very nauseous, I was yawning a lot, but not feeling sleepy. Tired all the time, and lethargic without wanting to move about”. Despite the difficulty in coping with the initial physical changes, there are indisputably positive effects that come from the use of sertraline. Aisha is an exception of the four people I interviewed. She is the only one to use private healthcare, and it seems that this has allowed her to have a better relationship with medication, as she has not often had to suffer the side effects of not having her prescription, or being rushed out of a doctor’s office. Aisha tells me that her doctor warned her she would be tired for the first week or two, and that she might yawn a lot. However, even with her private healthcare, she still needed more information as she is on two different SSRI medications; “He didn't give me as much information as I wanted. You know, I would go onto reddit to see other people’s experiences.” I tell Aisha I resonate with looking up symptoms online and trying to understand if they are normal or not, however we both agree we would rather have a professional to ask our questions to. 

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Having now been on medication for two and a half years, Aisha has generally had a good experience with sertraline. Reaching up to tuck her hair behind her ear, Aisha considers the benefits medication has had on her life;  “It does affect people very differently, but I felt my confidence come back. Before I was feeling that I wasn't myself, I’m not the cheerful person I was. I don’t feel like I'm engaging in any conversation.” But after being on sertraline for a while, Aisha noticed some changes, she paused to take another sip of tea, before continuing; “My emotions were so much clearer. It felt like I could introspectively understand my feelings better.” In addition to that, Aisha found a greater ease with completing day to day tasks, “Even years before that it would take the longest time to do the smallest thing. So, in terms of that, I felt way more motivated to even take a shower.” 

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Unfortunately, overcoming the initial side-effects and feeling the positive mood changes is not the end of using sertraline. Patients can have trouble getting their medication, and during lockdown the process for collecting a requested prescription from the pharmacy went from taking 24 hours to 72. In addition to this, each prescription costs £9.66, so if a patient has to collect their repeat prescription every two months, they will be paying £57.96 a year just for their medication alone. This can increase if a patient initially is given their medication on a monthly basis rather than on a repeat prescription. 

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John, is the third individual I interviewed, and having been on sertraline for two and a half years explained how he had been collecting his prescriptions normally for a year until it became difficult.
“Suddenly it said I needed a review for my prescription, and I wasn’t about to get it. I need this thing if I don’t have it I’m going to get irritable. Then all the review was highlighting that I should keep taking it. Then I wonder why they take it away from me in the first place?” 
We are sitting on a bench in Harrow, it is drizzling and John has his black hood pulled up to protect his head from the rain. He explains how initially, like myself, he was told he could try sertraline for six months, “to get on your feet. But then if you don’t go and get therapy or any kind of help then you just end up taking it. Then you can’t get off it without a doctor’s approval either.” John speaks in a monotone, his eyes almost closed against the cold day. 

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But John cannot discredit the benefits he sees sertraline having had on his life; “it boosts you initially but you have to keep it going, I wouldn't be where I am now if I hadn’t started taking it. God knows where I would be if I hadn't started taking it because I wouldn't have been able to get out of bed.” However, it's impossible to ignore the suffering that can be caused by being unable to access medication, particularly when, it is common knowledge that there are effects from suddenly stopping it; “the thing is they so strongly advise against that, but then sometimes you can’t help it, like when they withhold the prescription because they’re waiting to do a review with you”.

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It’s easy for those who have not experienced sertraline withdrawals to wonder why individuals feel as though they “need” sertraline. However, increasingly the evidence is showing that the numerous unpleasant side effects that can occur if an individual suddenly stops taking it have been understated by health care professionals. In 2019 The Royal College of Psychiatrists released a position statement arguing that  “there can be substantial variation in people’s experience, with symptoms lasting much longer and being more severe for some patients''. Additionally, with patients reporting that side effects of stopping medication which were thought to last a week, can in fact stretch out to lasting up to six months. 

Eva is the last person I met to interview. Today, the park in Welling is bright, and her Rottweiler, Stitch, is excitedly jumping everywhere, turning his head back every so often to check we are still following him.

 

Eva falls into the 36% of British antidepressant users who have taken them for at least five years, and eloquently explains how she “first started 7 or 8 years ago at the hospital and they put me on 200mg straight away. And for the past 7 years I have been on that. A couple of months ago I decided to start lowering my dose because I want to come off them eventually, so I’m now on 150mg.”

 

Eva pauses to recall Stitch who is attempting to entangle himself in another dog. I tell Eva how Ruby was also put on a higher dose to start with and suffered side effects. As it was several years ago, Eva has a hard time recalling her exact feelings. Though she does remember the circumstances; “I had a lot of therapy from 12-17. I was institutionalised at 17 and I feel like they just thought I’ve got to drug her now, obviously the therapy isn't helping much. And the whole time I was on therapy they were offering me drugs and I said no I want to do this by myself.  But when I went to hospital I didn't have a choice in whether I would take pills or not. They gave me the medication and they will make sure you take them.”

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Eva does not sound bitter or critical of what happened to her though, rather she is calmly reflective of what happened and sympathetic to the doctors who were attempting to offer treatment. 
“They are doing what they think is best in a way, but everyone there was just on heavy medication.” 
“It did help. Because I got out of hospital, and I thought I can’t be like this forever I need to sort it out and it helped my balance. But now I’m trying to get off them because it’s not a long term thing. Seven years is a long time to be on antidepressants, really the main course is meant to be 6 months.” 

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Having been on the highest dose possible of sertraline at 200mg for a number of years, Eva has gone through strong side effects from suddenly stopping sertraline; “I didn’t realise how addicting it would be. And not to the point where it’s like ahh!- I need to take my pills right now.” Eva says gesturing her hands in the air. “But when I stop taking them, say I can’t get my prescription on time or I run out and don't realise how much I had left then I start having nightmares and cold sweats and bad dreams. It makes you feel like a drug addict.” 

This is something I resonated with heavily, having been unable to get my prescription for a week during lockdown, I suffered from flu-like symptoms, with vomiting, nausea, dizziness and trouble sleeping. I felt that I had not been prepared to suffer from such strong withdrawals by the doctor. Each person I interviewed had at least one similar experience to mine, where for a reason they were unable to get their prescription, and so had to go through the uncomfortable side effects. 

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When this happens, it is not only a relapse of the symptoms the patient experienced before, but often a worsening in addition to new effects from the withdrawals. Aisha begins by saying, “Disclaimer, do not do this”, while putting a hand sincerely to her chest. “I stopped taking sertraline for a month and the whole time I felt so fucked. I did not want to put it down to just my sertraline withdrawals, I put it down to the weather, missing home, lockdown.” Though later Aisha confirms that all of those things had still been occurring for the past year, and the sertraline withdrawal exacerbated them. 

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Despite the 2019 RC Psych recommendation that healthcare professionals should give “greater recognition of the potential in some people for severe and long-lasting withdrawal symptoms in patient information”, each person I interviewed felt that their doctor had not properly conveyed to them how severe and long lasting sertraline withdrawal can be. Furthermore, patients can have their own confusing feelings about treating medication with mental health. Because you cannot see mental illness in the same way you can see a physical ailment, it can feel conflicting to be continuously taking something, especially when the medication is working and an individual may feel more stable in their mood. 

John related to me how “you don’t realise what you’re taking, when you open the box, and you open the leaflet and read all the potential things that could happen to you. Those bizarre cases where it says 1 in 100, it could be you. There’s good and bad to it, it helps you but you need other methods like therapy”. 

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Similarly, Eva related to me how despite the fact that she was coming off the highest dose of her medication for the first time in several years, she had not been offered any therapy. In fact, Sim had to decide herself and inform her doctor of her decision, “I had to initiate that conversation though and then they said “okay try this dosage for a month and then call us”. But they don’t offer therapy while you're coming down off of it.” Ultimately, Eva accredits her ability to lower her sertraline dose to the support of Stitch; “The past seven years it never occurred to me to lower my dose. But now I’ve got this big beast. Who is a bit crazy but takes up a lot of my time, my energy, keeps me entertained. He’s my therapy dog in a way. I know that I’ve got him, I can do this.” 

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It seems alarming the lack of support offered, particularly when clinicians are being made aware of how awful individuals can feel coming off of sertraline, even if they are gradually lowering their dose in the recommended way. However, each of the interviewees did recognise that doctors were not at fault for their medication predicaments. 

Each person I interviewed believed that medication would be a precursor to talking therapy, however an increasingly stretched NHS underfunds mental health services in unable to offer the support that people need. Despite money being pledged to the NHS in the 2018 Autumn budget, the NHS Support Federation argued that 50% of staff say underfunding stops them from doing their jobs properly and that significant cuts to social care and mental health add additional pressure to the NHS, because services are insufficient outside of hospitals. In addition to this, the NHS struggles to recruit new staff, meaning that only 4 in 10 people who need it receive mental health care and support. It seems people have an awareness of the situation the NHS is in and have grown accustomed to the idea that they would need to wait up to 3 months for therapy. 

While RC Psych released their position statement in 2019, little effect has been seen on the NHS, and with young adults reporting that their mental health has been worse during lockdown, the NHS is in desperate need of more funding to facilitate better mental health care for young people. Otherwise there could be even more individuals resorting to medication alone to treat their mental health problems, when increasingly evidence shows that Sertraline works best when used in conjunction with talking therapies. However without additional funding from the government, waiting times will increase and people will continue to struggle to get the support they need. 

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