Experimenting with SSRIs to Treat SMA-related Depression

I’ve thought about starting an antidepressant medication several times over the years. As a sophomore in college, fresh off the realization that my anxiety and depression weren’t just character flaws but in fact genuine disorders, it seemed like the obvious choice. I could take a medication with the possibility of my mental illnesses just going away? That was amazing! The best thing I’d ever heard! I went to my therapist and said in no uncertain terms that I wanted to try an antidepressant — stat.

I don’t remember how she responded. But I do know that eventually, I decided against psychopharmacology. I’d just started therapy, and I wanted to give it a chance before looking to medication. I filed the possibility away, where it would simmer and grow for the next few years.

I’ve spent most of my secondary education studying psychopharmacology, so I know more now than I did back then. Antidepressants don’t work for everyone. To really get the full effect, you need to work with your prescribing care provider (PCP) to find the right dosage. Some people are able to wean themselves off after a while, while others stay on antidepressants their entire lives. Most importantly, antidepressants don’t fix things — they generally work best in conjunction with psychotherapy.

Over the years, my view of antidepressants has shifted, morphed. I always thought that as a counselor, I would encourage people to treat psychopharmacology as a last resort. For the most part, I still believe that. I am, of course, biased — you don’t spend five years of your life studying counseling without developing a bias — but I generally believe that without therapy, antidepressants are a Band-Aid. Can they help? Of course. Have they saved lives? Absolutely. But they’re still a hammer in a toolbox: You can use them to build a house, but at the end of the day, they’re not the structure you live in.

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I didn’t consider psychopharmacology until one of my best friends started taking an antidepressant for her anxiety. All things considered, I’ve gotten better; I’ve never returned to that nebulous state of living that was my sophomore year of college. But the antidepressant helped my friend, which forced me to step back and notice the threads of mental illness that ran through the tapestry of my life. I was better, but anxiety still influenced everything I did or didn’t do. It capitalized on my inaction, feeding my depression. I was in a cycle — anxiety led to depression, which only led to more anxiety and more depression — and the thought of fighting my way out, while tantalizing, was exhausting.

Not that long ago, I thought I was going to die — more anxiety! Yay! But the surety of it, my conviction, sharpened my awareness of mortality. I am dying. We all are, but my SMA makes the knowledge crueler, keener. Barring some miracle, my life will be shorter than most. I have a limited amount of time on this earth. More than anything, I want to live whatever life I have left free of depression and anxiety. I am tired of letting mental illness run my life.

Antidepressants are a means to an end, which is why I spoke to my PCP a few weeks ago about starting one. I sat in the waiting room and felt the stigma of mental illness pressing down on me, nervous and annoyed at my own distress. I have a bachelor’s degree in psychology! I’m a year away from having a master’s in counseling! I’ve taken more exams on selective serotonin reuptake inhibitors (SSRIs) than I can count! Yet I still felt as though I’d failed, disappointing everyone — including myself — by wanting a better life and taking steps toward it. Why is that, I wonder? Why is it so difficult to practice self-compassion?

But my PCP was kind. Understanding. She gave me patient education and sent me home with a prescription for Prozac (fluoxetine). I took the first dose this morning and apart from a few traces of nausea — which could just as easily be symptomatic of anxiety — I feel fine. It could be an omen or it could mean nothing at all, but I’m proud of myself for taking that first step toward mental health.

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