Three weeks ago, Lucy Arnold, 28, started taking an antidepressant to treat her stress-induced anxiety. Since taking it, she’s been sick nearly every day. “Sometimes it comes in waves and I can hold it, but other times I can’t,” she explains. “Today I had to leave work earlier than planned as I vomited all over my brand new office floor.”
Ideally, Lucy would have been signed off work – like her GP advised – but because she’s self-employed, it has proved impossible to take time out. Worse, the drugs’ horrendous side effects could last for another six weeks. “I’ve been so tired but still trying to pull 12-hour days,” she says.
In 2016, there were 64.7m prescriptions for antidepressants in England - an increase of 108.5% in a decade. Around one in 100 people taking antidepressants will experience common side effects such as nausea, headaches and tiredness – and yet recent research for the mental health charity Mind shows that many people choose not to tell their employers about mental health issues.
Which makes you realise that many people at work – perhaps even some in your office – might be silently struggling with the side effects of antidepressants while trying to find a treatment that’s right for them.
Antidepressants help millions of people with depression and anxiety in the UK. The drugs work by boosting or prolonging the activity of particular brain chemicals which are thought to be involved with regulating mood. But the process of taking them is far from an easy ride.
Selective serotonin reuptake inhibitors (SSRIs) are the most widely used type of antidepressants. While the NHS says they have fewer side effects than other types of antidepressant, tiredness, nausea and headaches are still common.
Margaret Jones*, 34, had to try multiple antidepressants before finding the right one - most take four to six weeks to work, so trials can be lengthy. Margaret, who was already juggling work with looking after a young child, also found herself experiencing side effects including suicidal thoughts, anxiety and numbness. “The path to finding the right medication was the hardest battle I’ve fought in my life,” she says. “You will likely need to try several different medications and different doses before finally finding the right one, or even combination, that will work for you.”
The first SSRI she took left her feeling “full-on suicidal and extremely anxious”. After several attempts to correct the dosage she was given a different type of antidepressant – a noradrenaline and specific serotonergic antidepressant (NASSA). The side effects of NASSAs can be similar to those of SSRIs, but they’re thought to cause fewer sexual problems and more drowsiness. “Again, there was an issue with the dosage,” says Margaret. “When it was raised, I just felt extremely numb, but once it was lowered, the depression started to creep in again.”
It’s normal for people to start mental health medication with an initial dose for three weeks and then have a review, explains Dr John Hillery, president of the College of Psychiatrists of Ireland (CPI) and chairman of online GP videoDoc’s medical committee. At that point, the dose might be increased – best practice is for that to be done gradually. If you’re experiencing side effects or an increase in dose has no impact, it might be time to try another type of medication, advises Hillery.
For Margaret, the most challenging aspect of her struggle to find the right medication was her fear of telling anyone about what she was going through, which left her feeling isolated. Eventually, she visited a psychiatrist who prescribed a combination of antidepressants which suited her better, but still wasn’t perfect. While she still feels numb, she believes “it’s the price you pay for being able to function, but one I’d pay a million times over.”
When the mental health charity Mind surveyed 44,000 people earlier this year, almost half (48%) said they had experienced poor mental health while working at their current organisation, but only half of them chose to tell their employer.
Mind’s head of workplace wellbeing, Emma Mamo, explains that many people experiencing poor mental health such as stress, anxiety and depression feel they need to stay silent at work, because they don’t feel comfortable disclosing their mental health problem, worry their employer will think they can’t do their job, or don’t want to be treated differently.
It is essential that business owners and employers make it clear that it’s fine for employees to open up without negative consequences, Mind argues. They can play a “crucial role” in ensuring staff don’t feel ashamed or embarrassed about seeking help or receiving treatment for their mental health.
“It’s the price you pay for being able to function, but one I’d pay a million times over.””
But it isn’t just employees who are worried about how others may judge them. Emma Burdett, who runs her own theatre company, says she didn’t tell people about the side effects from her SSRI – which included extreme tiredness – in case people thought she “wasn’t up to running the company”.
Emma had to nap every day on her lunch break and would sometimes sleep through her alarm, waking up four hours later. “I also looked tired to the point I felt makeup could not cover it up, which knocked my confidence when going for meetings with potential future clients,” she says. “Many times I just felt that although I was there physically, I was not there mentally.”
The NHS says side effects are usually mild and go away after a couple of weeks, which is true in some cases but not all. Emma says while the tiredness wore off after a couple of weeks, she still struggles to think creatively. In fact, when she accidentally misses taking an antidepressant she finds her creativity returns.
“My hope is that in the next few months I can start to gradually come off the antidepressants, as I do feel the ‘numbness’ is really zapping away a huge part of who I am,” she adds.
*Some names have been changed.
If you’re concerned about antidepressants speak to your GP or visit Mind for more information.