SSR-Why is it so hard to find a medication that works?

By Kelly Weldon, NAMI-UW WiChat Coordinator

The pharmaceutical companies would have you believe that anti-depressants and anti-anxiolytics are magic pills that will instantly cure your mental ailments (my frustration with Big Pharma is shining through). As great as that would be, it’s generally a much more complicated story. My current medication offers me emotional stability and allows me to productively challenge my irrational thoughts, but before any big improvement in my mental health I walked a long and winding road littered with various prescription receipts. I share my experiences with SSRIs and SNRIs to be real about how difficult it can be to find a medication that works, but also that it can be worth the perseverance.

Escitalopram (Lexapro): I started seeing a counselor at the beginning of my junior year of high school and was quickly diagnosed with generalized anxiety disorder. I went to therapy for a few months without any mention of medication, but it soon became a topic of conversation. I was hesitant of a prescription because that would have somehow confirmed I was sick or broken (not an accurate thought, but another blog post for another time). After deliberation about the pros and cons with my parents and my partner, I was prescribed my first medication for GAD. At first, it was everything Big Pharma would have you believe about SSRIs: I noticed stability in my mood and success when working on my CBT assignments. I was on this medication for about a year before the side effects became too much to ignore (right before college, yay!). The weirdest side effect I experienced was throwing up after meals, which was frustrating for someone who gets hungry easily.

Venlafaxine (Effexor): My doctor decided to switch me to venlafaxine right before I left for Madison. To be honest, I don’t really remember how it affected my anxiety, but I don’t think it was effective. I probably didn’t think much of it at the time because moving away was such a huge and stressful transition in my life. I was on it for about a month before the hives set in, where one morning I woke up at 6 am to a body covered in giant red blotches. I called my mom, who told me to call a nurse, who told me if my throat wasn’t swelling shut I should just pop some Benadryl. Which is what I did. For two months. I don’t know why it didn’t dawn on me earlier that I was having an allergic reaction to my medication, but it probably didn’t help that all the doctors I went to said it was probably mold or laundry detergent. Finally, I went to an allergist who immediately told me to get off my medication. In those previous two months, however, I lived with blotchy, itchy skin, painful joints, and constant aches.

Fluoxetine (Prozac): I tried this prescription at the end of winter break and I didn’t notice any change for a couple of weeks. Eventually, I seemed to be stabilizing and was adjusting to school. I had even gotten a babysitting job 30 minutes away via bus! This is also when I started to notice how nauseous I was getting on the rides to and from my dorm, and then sick I would feel after elevator rides. Just little movements could make me sick for an hour afterwards and I do not deal with nausea well, so it was back to the drawing board again.

Buspirone (Buspar): By the time I got around to buspirone, I was frustrated and nervous. My doctor emailed me that I was running out of options, so something had to work soon. I did not want to hear that I might have to deal without medication, because this meant full-blown GAD again. Instead, I dutifully tried this medication as well. It did not work. I had never experienced depression before, but boy did I get a full taste of it this go around. With all my medications, I never noticed the side effects right away, as it always took time for me to come to the realization that I was inducing these side effects. I realized it this time around when having a conversation with my partner in his dorm room about how I was feeling so depressed that I wanted to die. Vocalizing this freaked us both out, and we concluded that I needed to stop this medication, which also meant I was going to have to send another email to my doctor.

Citalopram (Celexa): Low and behold, I finally found a medication that worked! My doctor was hesitant to prescribe citalopram to me because it has the same active chemical as escitalopram (my first medication). I love organic chemistry (I know, unpopular opinion), so I’ll just give a short overview. Citalopram is a mixture of two stereoisomers (R-citalopram and S-citalopram), while escitalopram only contains one stereoisomer (S-citalopram), which is the active molecule in both drugs. As enantiomers, S-citalopram and R-citalopram have the same chemical structure, but the spatial arrangement of the atoms is different. This can affect how the chemical interacts with different receptors in the brain, like a key fits into a lock. I have no idea why one had a ton of side effects and the other was my solution. It’s crazy and it’s weird, but the body is cool and complicated, so there are probably many interactions in the brain.

​I have been on citalopram since the very end of my freshman year of college and it has allowed me to gain control over my anxiety. I know I painted a grim picture of doctor’s visits, new prescriptions, and side effects, but it was to get to this point! I finally can put in the work to combat my GAD and feel stable. I know that finding something that works can be incredibly frustrating, especially when advertisements tell us that medication offers a quick fix, but there is probably something out there for you. Furthermore, I know medication isn’t for everyone and I wouldn’t be where I am today without other coping strategies as well. One of my biggest regrets was trying to figure out medication without actively going to therapy. I probably could have dealt with my side effects and my anxiety more effectively if I had attempted multiple strategies at once. Regardless, wherever you are in your journey to recovery and whatever you are doing, you are not alone in your struggles and perseverance can pay off. There is hope.