“I have two kids at home, a new job, my husband is about to throw himself out a window, and you want me to pick up shells on the beach? All I did was brush my teeth today.”
This is what ran through Julia’s* head when a friend suggested they go sea kayaking last spring, just as COVID-19 had begun raging in and around her northeastern suburb and she, like so many office workers, was working from home.
Days would pass when the 46-year-old lawyer at a big-city law firm couldn’t remember the last time she showered. She missed her hour-long commute home–her time to decompress. With a working spouse, a nightmare boss, and a (very slowly) potty-training toddler, Julia found her workdays filled with distractions she couldn’t block out.
Known for her calm and focus, Julia now faced 9-to-5s marked by periodic sobbing, snapping at her kids, and “moving like a sloth to sign off on a single email.” At one point, it got so bad that Julia actually wondered if a case of COVID and time away in a hospital bed would be the lesser of two evils. All the while, a possible solution was sitting, like a socially distanced friend, six feet away: Lexapro, an antidepressant she had been prescribed but couldn’t bring herself to use. “It’s been staring at me from my desk, saying ‘Take me,’ ” she says of her ongoing ambivalence to medication.
A common SSRI (selective serotonin reuptake inhibitor), Lexapro helps increase serotonin—the “happy” chemical—in the brain. It’s among a class of medications whose popularity rose from mid-February to mid-March 2020 when antidepressant prescriptions increased nearly 19 percent. By June, approximately 40 percent of adult women in the U.S. reported symptoms of depression or anxiety, a huge jump from the same time period in 2019, according to a recently completed survey conducted by the Census Bureau and the National Center for Health Statistics.
In normal times, these stats would shock. But the coronavirus ushered in a colossal cluster of depression triggers: uncertainty, isolation, loss, and financial troubles. And women, lucky us, are faring worse than men: We’ve lost more jobs and taken on more homeschooling, and we’re showing more signs of depression.
People who never felt depressed are experiencing it for the first time. Others with existing depression are reaching new breaking points. And some who considered themselves anti-antidepressants are suddenly wondering if a pill might be the answer.
Julia is one of them. Though a therapy patient for years, she had always resisted antidepressants, even at the urging of her therapist and general practitioner. “It’s partially the stigma, partially that I feel I shouldn’t need a drug,” she explains. Plus, she adds, “I don’t want to be on this stuff forever.”
Tragically, a dangerous misconception persists: that people should be strong enough to push through mental illness. “I hear the whole weakness thing all the time—‘It’s a crutch, I’m giving in, if I were just stronger’—from really sophisticated people,” says Jane Erb, MD, the psychiatric director of Behavioral Health Integration in Primary Care at Brigham and Women’s Hospital in Boston and an assistant professor at Harvard Medical School. “But our bodies weren’t built for long-term uncertainty. When you stress people out for long periods of time, there are discernible brain changes.” For one, a jump in the stress hormone cortisol, which can damage your brain (think: Godzilla stomping through Tokyo), leaving inflammation that can lead to all kinds of health issues.
And a New Agey social media world doesn’t help, either, encouraging detoxing and magic dusts to help “cure” serious medical conditions. In other words, we blame ourselves when celery juice doesn’t wash down the sads.
When COVID hit, Suzanne,* a 25-year-old advocacy coordinator, found herself shuffling around the house, getting lost in small art projects, and sliding into bed at bizarre hours. “I wasn’t able to keep my life together without the external structures of a work routine or social life,” she says. Suzanne was sure she could “willpower my way out of it” with a no-napping policy, talk therapy, and self-compassion practices. When this yielded little improvement, she and her doctor eventually landed on a Lexapro/stimulant combination. Her plan is to take antidepressants short-term, which, for some, can be an option for what is called “situational depression.” While antidepressants are not addictive, so it is safe to use them for limited periods of need, experts warn against starting and stopping medication haphazardly. You usually have to taper up—meaning you won’t hit a therapeutic dose (the point where you notice a difference) right away—and it can take up to eight weeks before you feel significantly better. Not to mention that the first or second drug you try won’t necessarily do the trick. Even for an isolated period of depression, treatment guidelines recommend continuing a regimen for six to nine months, Erb says. At that point, you’ll need to taper off the medication slowly, under the care of your doctor, to avoid “antidepressant discontinuation syndrome,” which can cause headaches, nausea, dizziness, or tingling and may affect about 20 percent of patients.
Low libido—one of the most talked-about side effects—causes some to flat-out avoid medication. Around 40 percent of women on antidepressants experienced sexual dysfunction, according to a 2016 meta-analysis published in Mayo Clinic Proceedings. Personal chemistry comes into play, but a study published in the Postgraduate Medical Journal found that some serotonin-related meds may be more likely to dampen desire or stall orgasms. Bupropion (a norepinephrine-dopamine re-uptake inhibitor and the generic name for Wellbutrin, among a few others) is, in Erb’s experience, “devoid of sexual side effects.” Bupropion also tends to interact well with other antidepressants, multiple experts agreed, if you want help with sexual issues and your doctor advises that you add another prescription.
Weight gain is another common concern with antidepressants. Some studies, including one published in 2006 in the Journal of Clinical Psychology, show that mirtazapine—often an alternative to medications with more pronounced sexual side effects—is associated with greater weight gain, according to Erb, as it may interrupt some satiety signals. Other drugs linked to weight gain when used long term include fluoxetine (one of its brand names is the OG SSRI Prozac), as well as classics like paroxetine (Paxil is one brand name) and sertraline (marketed as Zoloft), according to a number of studies, including a 2018 study in the British Medical Journal and a 2016 study in the Journal of Clinical Medicine.
Other meds typically do not mess with your metabolism, and bupropion has even been associated with weight loss in some patients when combined with an exercise and diet program. But it’s also not for everyone, “because it’s super stimulating, like being on five espressos at once,” Erb says. That’s a deal-breaker for certain patients with generalized anxiety disorder, PTSD, panic attacks, or seizures. It also can throw off your electrolyte balance if you have an active eating disorder, Erb says. And it’s possible it could destabilize mood in those with some types of bipolar disorder.
Navigating the waters of prescription types and their side effects isn’t meant to be done alone. With guidance and careful monitoring by an experienced physician, however, these drugs can be a lifeline. Not to mention, of course, that recognizing the difference between normal, everyday crappiness and actual depression requires a medical degree. Erb cites the example of how one may feel after a loved one’s death. “You wouldn’t typically jump to an antidepressant right away,” she says. “But if the sadness or inability to focus starts impacting how you function and messing with your sleep—or if you start thinking about not going on—it may be time to consider medication.”
Some professionals suggest trying psychotherapy before pills. “The data is very clear based on hundreds of studies that for mild depression, psychotherapy is either the preferred intervention or equivalent to medication,” says Kathleen Pike, Ph.D., a professor of psychology at Columbia University Irving Medical Center and the scientific adviser to the Maybelline Brave Together program, an initiative designed to break the stigma around young women seeking mental health support and help fund services. That said, she acknowledges therapy isn’t practical or accessible for everyone.
To wit, while Sue Varma, MD, a board-certified psychiatrist and clinical assistant professor of psychiatry at NYU Langone Health, believes the benefits of therapy can last longer and lead to structural brain changes, “medication works faster for many people,” she says.
For Suzanne, the advocacy coordinator, therapy wasn’t enough. “I wanted to be able to sleep on a regular schedule, stay functional during a longer period of isolation, and feel like a productive coworker. I wasn’t able to do that on my own.” Medication is keeping her afloat. Meanwhile, as of press time, Julia has not started Lexapro. “If one good thing comes out of COVID,” Suzanne says, “I hope it’s that we’re gentler with each other, our brains, and our vastly varying [mental health] needs.”
Editor’s note: This article is not intended to provide medical advice. Always consult a physician or other licensed medical professional before taking any prescription medications.
*Names have been changed.
This story first appears in the March 2021 issue of ELLE.
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