Being anti-depressed: My experience taking setraline (Guest Post)

By Evgenij Thorstensen from his blog Journey is return.

Quite a lot has been written about what being depressed feels like. However, I have seen comparatively little about what taking an antidepressant feels like. Note the "feels like": There's plenty of information about the risks, effects, and side-effects in clinical terms, on wikipedia and beyond. When I went to see a doctor about my depression and started taking an antidepressant, I had done my research, but I can't say that I knew what it would feel like.

Backstory

In retrospect, I remember having depressive episodes since the age of 14. I am now 25; I finally sought medical treatment about a year ago. My doctor prescribed me setraline, initially 50mg/day, a low therapeutic dose. I took this for about two months with initial positive effect that gradually died down. My doctor then proposed to up the dose to 100mg/day, which I accepted and have been taking for about seven months (with persistent positive effect) before gradually tapering off over a month. At the time of writing, I am no longer taking setraline as of three weeks ago. The reason I decided to stop taking the drug was basically to see what would happen, since I had been free from depression for eight months or so, and since the (mostly sexual) side effects, while bearable, were nevertheless unpleasant. These, as they say, are the facts; the goal of this article is to describe what effect taking setraline had on me, and more specifically, what it felt like.

The phrase "anti-depressed" in the title of this article is from an article by Johann Hari, which I found a few months after starting treatment. In it, he talks about his experience taking an SSRI (paroxetine) for many years. The whole article is worth reading, but in particular, he reports, from his own experience, that

You enter a new state that I think of as ‘anti-depression’. We are not depressed, but nor are we like the undepressed. We are different. Whatever we do, wherever we go, we will never be truly, madly, deeply unhappy. It’s like we have been inoculated from the miseries of life.

I relate strongly to this. For me, a large part of being depressed was that nearly everything had strong emotional significance. The smallest experiences had intense emotional affect attached, whether good or bad. During the first month of taking setraline, I noticed my emotions gradually lose some of their intensity. The small things and experiences in my life no longer had much emotional impact on me.

As an illustration of what I mean by that, consider the song "Breaking the habit". It's a favourite of mine (Linkin Park seems to be high on the "depressed people's choice" list of bands), and has plenty of emotional significance. Before taking setraline, I remember listening to it on repeat (ten times? fifteen?), raw emotion going through me, without abating even after the song had repeated a few times. Sometimes this (or other) songs would play in my head as background music, with vivid emotions attached. On setraline, listening to it no longer immediately brings a strong emotional reaction. The memories I associate with this song feel more detached, less vivid. Most days, it's now just a song I like. Putting it on repeat becomes boring after one repetition, maybe two.

Before taking setraline, strong emotions were my constant companion. In retrospect, it was like the stereotypical description of being fourteen --- an intense level of emotional affect attached to everyday things. I felt in tune with the universe, but with a constant and consuming undercurrent of being not of this world, of not belonging. This undercurrent would rise to the surface from time to time (sometimes triggered by something, sometimes not), and presto! Depressive episode. On setraline, this "in-tunedness" went away, only making appearances in settings that should have a strong emotional effect on a person, say upon reading a particularly emotive scene in a novel, or having a deeply heartfelt conversation with a close friend.

Apropos friends, the second effect I noticed was that I felt less affected by other people. In particular, I felt less connected to people around me, perhaps less empathic. It doesn't sound very nice, but bear with me. Empathy, in one sense, is feeling what someone you're interacting with feels. Before taking setraline, I felt a strong sense of connection when interacting with my friends, and it seemed to me that I felt what they felt when it came to emotional situations. On setraline and looking back, however, it seems that in such situations, rather than feeling what somebody else was, the feelings on my side were a lot stronger --- a kind of magnified empathy, out of proportion to the other person's actual emotions. When a friend told me about something bad that happened to them, I felt strongly for them, even when the incident hadn't affected them very much. If someone was upset, it felt to me like it was a big deal for them, even when it was actually small and insignificant.

Before taking setraline, wronging someone felt like the end of the world, and being apart from people felt like crushing loneliness. After, the strength of emotion that other people's experiences and stories inspire in me seem more proportional to the strength of their emotions. It has become easier to apologise, since doing someone a minor wrong does not feel like the end of the world any more. I feel much less lonely, even if I have seen less of my friends recently, rather than more. In short, everything is less intense, which echoes the quote from Hari's article above. However, his article continues:

People who cannot feel physical pain end up getting into terrible accidents. They burn their hands without realising it, crush their legs in doors, contract illnesses that eat away at them unawares.
There is a similar process when you cannot feel searing mental pain. Like all the anti-depressed people I know, I have racked up big debts, been crazily casual about my health, and allowed myself to continue in emotionally damaging relationships for years, all because none of it really hurts.

Here his experience and mine part ways. I would instead liken my experience to having my pain threshold go from an extremely low level (everything is emotionally significant) to a moderate one. Likewise, the part about it "none of it really hurting" has not been true for me. Everything does hurt less, and it has become much easier to push away something that's on my mind. So far, however, a lot of the worrying in my life has been what I call worrying "on idle", like a parked car with the engine running. You're worrying about something, but not actually getting anywhere or doing anything about it, mainly because there isn't anything that can be done, at least for the moment. Instead of leaving it be and doing something else, however, we worry and ruminate. I knew how to deal with it even before I started setraline, but...

On setraline, this "idling" is pretty much gone. Pushing something that I don't want to think about away from my mind and doing something else (productive or otherwise) is much easier. As for the things that do need attention, I find that they are still amenable to rational thought, without as much anxiety and worry attached. Such thought then either leads to a plan and then to action, or to pushing the issue away, without the idling. It does sometimes require effort to not ignore something I'd rather not think about, but I haven't found it to be a problem. So far, my life hasn't slid out of control as per Hari's description, anyway. And as for everything painful hurting less, I'd say it's less rather than not at all. Breaking up with my ex-boyfriend hurt, for example, but instead of sending me into a depressive episode I spent a week in a funk, then gradually went back to normal the week after that. From what I hear, that is the healthy emotional reaction to an amicable breakup.

Actually, re-reading this paragraph I am reminded of the serenity prayer, which goes

God, grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And wisdom to know the difference.

Ignoring God and the wisdom part, there's a more general point to be made here. Of the things I tend to worry about, there are more of the kind that I can't do anything about, at least in the short term. Consequently, given an issue that is on my mind, letting it slide is the right decision more frequently than worrying about it would be, and so erring on the side of letting things slide seems to have the higher expected utility. Other people's ratio of things worth worrying about to things worth leaving alone may of course be different, and that may be one possible explanation of why my experience differs from Johann Hari's.

Now that I am no longer taking setraline, some of the emotional intensity of everyday things has come back, but (so far) nowhere near the original level. Likewise, putting something out of my mind requires more effort. Picture a line from "nothing is emotionally significant" to "everything is". Taking setraline took me from the latter end to somewhere closer to the middle, rather than to the other end. Now that I am no longer taking it, I can feel myself slowly move in the "everything" direction. This, again, is similar to what Johann Hari reports experiencing, and his article concludes:

It feels real. It feels human. It feels like me, after all these years.

For me it feels more like "old me", which would be the depressed me. However, as of yet there isn't a non-depressed (rather than anti-depressed) me to compare to. I hope that there soon will be.

P.S: I very much recommend Johann Hari's other articles about depression.

This post was offered to Depressed Academics by Evgenij Thorstensen.  It originally appeared on his blog Journey is return. It is published here under Creative Commons and Evgenij retains copyright. We thank Evgenij very much for this very interesting and personal post.