OCD treatment: SSRIs

(I obviously have zero medical or pharmaceutical expertise and this post is just about my personal experiences with tablets I’ve been prescribed for OCD. Everyone reacts to drugs differently and what works for one may not work for another. Always talk to your GP or a mental health professional before taking medications.)

I’ve already written a post about OCD treatment in the form of Cognitive Behavioural Therapy, so today I’m gunna write about medicinal treatments that I’ve encountered. In the past, I’ve felt uncomfortable talking about mental health medication because there’s a (really dumb) stigma around it. In the past I’ve also tried my hardest not to have to take them, because I’m a stubborn little shit and I felt like I “shouldn’t have to take a tablet in order to feel normal”. Some people are entirely against medication for certain mental health issues, as they believe that they ‘mask the real issue’. Others believe that they may not even be effective and that they simply instigate a placebo effect. I have taken SSRIs multiple times throughout my life, both for depression and for OCD. Today I’ll be sharing a wee bit about my experiences with a couple of SSRIs I’ve taken for OCD specifically. For me personally, I see SSRIs as something that helps my brain behave the way it should. My lil brain struggles to produce certain neurotransmitters, and so I help it along because we’re mates, sort of like Kenan and Kel (I’m Kenan and my brain is obv Kel). I sort of compare it to someone who is hard of hearing wearing a hearing aid in order to help their ear do what it’s supposed to do. Where’s the shame or doubt in that?

WHAT IS AN SSRI?

Selective Serotonin Reuptake Inhibitors (SSRIs) are a group of medicines which are used to treat a number of mental illnesses. The brain has an equilibrium of chemicals which are passed through synaptic nerves, and help us to function ‘normally’ (whatever normal means). Serotonin is a monoamine neurotransmitter which is associated with feelings of happiness. Its role within our brains is very complicated however, and a lack of Serotonin can cause a number of illnesses stretching further than unhappiness, such as depression and OCD. SSRIs aim to slow the reabsorption of Serotonin from the synaptic clefts which connect all of the synaptic nerves, which basically means that our brains will have more serotonin floating around. SSRIs and the resulting maintenance of serotonin levels has been shown to help lessen the symptoms of OCD in many people.

THE SHORT-LIVED GOLDEN ERA: FLUOXETINE

I began SSRIs for OCD in the summer of 2017, and I saw them as a (very welcome) last resort. I had tried to cope on my own with the symptoms I was experiencing associated with OCD. I was then diagnosed and I did 6 months of CBT. As discussed in the aforementioned CBT post, the CBT helped dramatically in terms of learning and utilising coping mechanisms, and changing my thought patterns in the areas that I could. I soon found however, that the CBT wasn’t working as well as it had at first. Perhaps it was because the CBT alone wasn’t working on my brain chemistry. I reached a new low in the July of 2017, and my GP and I decided that SSRIs might be the best option for me. I had been on and off Fluoxetine (Prozac) for years for bouts of depression and they had been effective, so we decided to see if Fluoxetine would manage the OCD.

The combination of Fluoxetine and the CBT skills I had learned worked like magic. I finally had my brain and my life back. As well as regaining my thoughts, the ability to do menial things such as socialising and putting my handbag on restaurant floors felt like the most delicious relief. As far as I was concerned, I’d won the ruddy lottery. This relief was tainted, however, by the fear that the Fluoxetine would stop working and that OCD would develop an immunity to it, sort of like how the Flu virus mutates each year. In the back of my misbehaving little mind, I knew OCD was too cunning to be completely banished. I repeatedly told myself nervously “I can’t go back to where I was. I refuse.”

Fast-forward to December last year, when somebody who I love very much passed away suddenly. In hindsight, I think the grief that followed was very much a catalyst for a steep decline in my mental health. Depression struck, but it has a way of creeping up on you day by day so that you adjust to it. At the same time as the depression reared its ugly head for the first time in years, OCD also took the opportunity to sneak in. I spent a couple of months feeling pretty bloody terrible, but just kind of accepting it and waiting until I lifted again. The lift had broken down though fellas, and soon I was struggling to get out of bed and leave my house. I stopped being able to see my friends, I couldn’t write for the blog, and my charity work ceased entirely. My world became really really tiny.

Weirdly, the moment that made me realise that my mental health was at a low was on a Friday afternoon in May, when my hamster Dave (lovely bloke) jumped out of my hands as I was putting him back in his cage. He’s a strong little bastard, and after looking a bit stunned for a second, he went back to eating snacks and generally being a chubby little legend. This was obviously menial and like anyone would, I soon forgot it had happened. SIKE! I went and lost my marbles didn’t I. Cried buckets. Panicked. Told myself repeatedly that I’m a terrible human, a terrible hamster-mum, and that I didn’t deserve to be around animals. “I’m a danger to them, I can’t be trusted”. OCD YOU PREDICTABLY NASTY ARSEFACE. The panic lasted for about 15 minutes, after which I dried my face, had a strong cuppa, and decided very suddenly and certainly that I wasn’t okay and that I needed to seek some help.

I emailed my GP the following day and explained how desperate I was feeling. She saw me an hour later and I broke down in her office. I opened up about how much I was struggling, and we agreed that the Fluoxetine had stopped working for me. This had been my biggest fear since 2017, and it was happening much more quickly than I had imagined it would.

THE NEW ERA: SERTRALINE 

The plan of action went like this; for one week I would double down on my dose of Fluoxetine in order to taper off of it completely. After a week, I would begin a low dose of Sertraline (aka Zoloft), which I had never tried before. My GP would then review how I was feeling in one month, and we’d increase the dose if necessary. This seemed fairly simple in my head. I was admittedly shitting my lacy knickers about changing anything in fear of goading the unpredictable beast that is OCD, but I thought that I surely couldn’t feel any worse than I had been, right? WRONG! SO DELUSIONAL AND WRONG MIM, WHEN WILL YOU LEARN??

The following two weeks were horrific. I fell further and further into a black hole, and after a very public and extremely embarrassing meltdown I ended up being seen by my GP sooner than planned. She doubled the Sertraline dose, and we arranged another check-up.

That was about three weeks ago, and the Sertraline has absolutely dominated the depression. I feel like myself again, and I’m unbelievably grateful. The Sertraline is taking a little while to kick the OCD into touch, so I’ve been exposed to symptoms such as intrusive thoughts and images, dirt-phobia, mild paranoia and checking behaviours. In many cases, depression responds to SSRIs more quickly than OCD, and my GP told me on Thursday that the Sertraline could take up to 10 weeks to kick in for OCD. She also said that we can increase the dose accordingly for the OCD during my next check-up. I’ve currently got my fingers, toes, legs and eyes crossed that Sertraline will be as effective as Fluoxetine.

SSRI SIDE-EFFECTS

I was first prescribed fluoxetine years and years ago for depression. So long ago in fact, that I can’t really remember the initial side side-effects. When I started taking it in 2017, the initial side-effects were minimal. My headaches perhaps worsened for a couple of weeks, and I would sweat more than usual. I have found coming off of Fluoxetine far harder than starting it, however the line blurs between stopping Fluoxetine and starting Sertraline. I’ve never switched from one drug to another straight away and so it’s been a very new and intimidating experience for me, and I’m not sure which symptoms are the result of which drug.

Whether it’s due to stopping the Fluoxetine, or beginning the Sertraline, here is a list of things I’ve been experiencing over the last few weeks:

  • Increased sweating (men; please form an orderly queue)
  • Severe insomnia
  • Lack of refreshing sleep
  • Minor hair loss (I think this one might be from stopping the Fluoxetine because I’m certain it happened a few years ago when I stopped it)
  • Daily nausea
  • Dry mouth and increased thirst
  • Lack of coordination and about 7 full mugs of coffee dropped on the floor MY BAD (I may as well just paint my walls coffee coloured at this point)
  • Drowsiness
  • Increased hunger
  • Decrease in energy 

My GP has reassured me that these side-effects should be temporary (the should makes me feel nervous lol) and are all quite common. As mentioned at the start, every individual reacts different to different medications, and so some people may experience some of these side effects, while others may experience none. I would never want to put anybody off of taking medication, because in my experience these current side-effects are more than worth it for my mental wellbeing.

I’m not sure what the aim of today’s blog post actually is. I suppose I just wanted to get back on the horse somehow, and so wrote about something relevant to the hiatus. I hope that the stigma around taking medicines for mental health dissipates, both for people who are on them, and for the people who are being deterred from taking them because of the shame that often accompanies them. All I know is that CBT and SSRIs gave me my life back, and I will never feel hesitant or ashamed to take medication for my brain ever again. I’m also getting used to the fact that recovery is a very bumpy road, and that sometimes I’ll have to tweak and change my course of treatment in order to feel like Mim.

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