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Depression
25 Years on Prozac
What I've learned personally and professionally.
Posted June 25, 2019 Reviewed by Ekua Hagan
I have been taking Prozac since 1993 after a second depressive episode occurred postpartum. As both a doctor and a patient, the experience has been life-changing and has given me unique insights into the world of mental illness.
In the beginning, I was told I'd likely be on Prozac for about a year. Back in the early days of SSRIs, antidepressants were originally considered a short-term treatment for depressive episodes, to be taken six to nine months. But as I weaned off my medication, my depressive symptoms returned. So, I continued taking Prozac for a few years. Again, when I tried to discontinue the medication, after the third try, I accepted that long-term use of Prozac was a must for me.
Now, 25 years later, this is what I've learned.
As a Patient
1. The Real Life of Emotions: Taking Prozac for decades has taught me that while my severe depressive symptoms, like negative thinking, hopelessness, and despair were reduced, I was able to still feel a range of emotions. The notion that antidepressants dulled one's emotional life was more myth than fact.
Taking Prozac didn't compromise my creativity or workflow. It actually enriched my world by lifting the haze of depression enough for me to actively write better, teach better and explore creative outlets. Prozac allowed me to use the skills I learned in my own psychotherapy to further manage my well-being. My depression isn't cured; it's managed. Maintained. Prozac didn't change me. It offered a better version of me.
2. Don't Ask, Don't Tell: I've learned to selectively disclose that I take antidepressant medication. As a rule, I don't inform new doctors that I take Prozac because I've experienced diagnostic overshadowing — where health professionals wrongly presume that present physical symptoms are a consequence of a patient’s mental illness. I take this approach because medical issues were overlooked or minimized when my depression history was revealed.
Once I get the evaluation or tests needed, I update the doctor about my medication status. Most doctors raise an eyebrow and say that diagnostic overshadowing wouldn't have happened with them, but since I've used this approach, I haven't had a single stigmatizing experience.
3. Timing Is Everything: Long ago, I learned the importance of medication adherence — the consistent, timely, regimented doses of medication. Missing doses, taking ones later than the day before, or other such things negatively affected my well-being. As I'm always up around noon, this became my dosage time and I've been consistent with it for decades. Also, keeping extra doses at work, in my purse, and managing the monthly refills are go-to tools for good mental health.
4. Acceptance Is Key: Living with the chronic mental illness of depression has required me to redefine who I am—and what I can and can't do. I don't drink alcohol and have to be mindful of the dosages of certain over-the-counter medications and other prescription drugs. I've learned what events, situations, or experiences are triggers, and how to cope more effectively with them.
For a long time, I felt like there was something broken within me because I needed daily doses of medicine to function. That I couldn't do it on my own with the skills and tools I learned. Over the years, though, I've come to accept how Prozac offers me a more meaningful life—free from the corrosive despair and suicidal thoughts. My depression is part of who I am, but it does not completely define me.
5. Stigma Is Common: No matter how educated the general public is by new studies—or how the celebrity du jour disclosing depression enlightens the masses—stigma exists. Many people with depression struggle with symptoms and limitations from the illness. They are also challenged by the stereotypes and discrimination from loved ones, friends, and health care professionals resulting from misconceptions about mental illness.
Surrounding myself with supportive organizations, like the National Alliance on Mental Illness and Bring Change to Mind, offers tremendous comfort. Being connected to others who know helps me feel validated, supported, and empowered.
As a Doctor
1. Genetic Testing: The single most important approach I use when working with a patient who is depressed is genetic testing. Personalized medicine, sometimes called precision medicine, uses genetics to uniquely target medicines that work. This affordable test can reduce the months, even years, it takes to find antidepressant medications that are successful. And it can reduce adverse side effects as well. Additionally, genetic testing can identify treatment-resistant depression, helping to fast-track non-traditional treatments.
2. Advocacy: I think it's very important that patients become an authority about their own mental illness. This means not only learning about antidepressant medications, but also the intricacies of their depressive disorder. By becoming well-versed through education, advocacy becomes second nature.
3. Complementary and Alternative Medicine (CAM): Using holistic, alternative or complementary therapies (aromatherapy, acupuncture, rTMS, 5-HTP, music therapy, meditation, exercise, weighted blankets, etc.) are extremely helpful when living with depression. However, these alone cannot reduce moderate or severe depressive disorders. Evidence-based studies show when it comes to effectively treating moderate or severe mood disorders, CAM therapies must dovetail with traditional treatments.CAM therapies are, however, singularly useful for mild depression.
I wholeheartedly endorse using CAM therapies in my practice and use many in my personal life. Depression is a physical and emotional experience of depletion, and many CAM therapies nurture the mind, body, and soul.
4. Psychotherapy Is Underutilized: As a clinician, I believe many individuals don't utilize psychotherapy like they used to. Nowadays, I find that teens and adults who seek treatment for depression do not continue to a full state of remission. Instead, they work their treatment plan until a reduction of depressive symptoms occurs—the clinical stage called response. Despite trying to address this resistance in sessions, I'm not always successful at keeping patients in treatment. With suicide rates being higher than ever, this trend of shorter attendance in psychotherapy may have some bearing on that.
5. Sharing the Research: When patients ask about the long-term use of antidepressant medication, the truth is there really isn't any. Prozac has been around since the 1980s but published long-term studies of antidepressant medications range from 3 to 15 years. The best advice I have for children and adults who need to explore medication is to read evidence-based summaries, talk to others who take medication, and realize that Prozac and other antidepressants are a tool. Depression is not a one-size-fits-all illness, nor is the treatment that addresses it.
If you or someone you know is struggling with severe depressive or suicidal thoughts, please reach out for help. The National Suicide Prevention Lifeline is open 24 hours a day at 800-273-8255. Or Text CONNECT to 741741 at Crisis Text Line.
To find a therapist, please visit the Psychology Today Therapy Directory.
