429 - My first antidepressant experience

The image above uses a copyright-free, marked for reuse with modification, of the paroxétine molecule, the medication I'm discussing in this entry.


Trigger warning for emetophobia content as well as depression related material, at the side effects section

For years and years, I suffered my various mental illnesses, trying my best to get by and cope, starting with maladaptive and then developing some adaptive coping skills, accepting therapies and support from mental health activists who became friends, but had refused any kind of medication, due to several reasons, such as fear of developing an addiction, but also on ethical grounds as medicines are tested on animals in France and don't always have veg-friendly ingredients.


However, my struggles with depression had become quite difficult to deal with, and I had to accept that living in an imperfect world that isn't always easy for us vegans, that sometimes we have no other choice but use products that are contradictory to our wishes, because suffering from my various mental illnesses wasn't going away by therapies and support alone. 

I had accepted using an anti-anxiety medication that is per-needed and not a daily treatment, and during my last psychotherapy back in February, my therapist suggested putting me on my very first anti-depressant, an SSRI called Paroxétine, which is also sold under the names Paxil, Seroxat, and others. 

My therapist explained that this one isn't addictive, tends to be mild and affect under-current, not to make me either hyper or stoned, and to try a dosage of half a pill of 20mg every moring, until the following session at the end of this month of April. 

He did warn that the main effect wouldn't start immediately, but didn't go into details as to how long it generally takes, nor what side effects I may experience, leaving me to discover on paper, and on the field, by myself - and friends who told me about their own SSRI's. 

Indeed,  I wanted to find out what to expect, so I chatted with friends and did online research about SSRI's in general and a bit on Paroxétine itself. Information concurred that it'd take a minimum of 2 and most probably up to 8 weeks for its main effect in reducing my depression to start - it was indeed closer to 8, at the end of my second box. 

To better understand why it would take that long, I had researched the question, finding this answer - in short, it's because it targets the genes that code for the serotonin transport, which isn't a straight road from the mouth to the brain, to cause an immediate effect, but rather takes a long DNA detour. I did well to wait and I suggest anyone new to antidepressants in general, or changing treatment, to wait and see if the required effect starts after a period, as they don't tend to become active too fast, so don't lose patience with the process. 

When I got the box, I found out that contrary to what I was told, this medication is to be taken cautiously as it may cause drowsiness and thus driving and other such activities are somewhat risky, as can be seen from this 'level 2' alertness signal and somewhat at odds with the therapist's assertions. I wonder if all French doctors mitigate the information they give their patients, thinking we'd all become hysterical if we heard all that is at stake!

Side effects didn't wait, they started right away, even at my low dosage : 

Indigestion and nausea,
Fatigue,sleepiness, 
Sleep disturbance, odd/vivid dreams, 
Sluggish brain, cognitive difficulties with attention, concentration, memory and forgetfulness. 

How these affect me, and what solutions I found:

The first two are evident, especially that they trigger my emetophobia.  After trying to eat some cookies an hour after my medication, I followed my wife's suggestion to try soy yogurt instead, for its probiotics, and it has indeed been very helpful, reducing these 2 effects by about 80%, as long as I eat the yogurt about 15-30 minutes after the medication.

Fatigue and sleepiness are worse in the morning, but as the hours pass, I become more functional. Thus far, I have no solution, as even a full night's sleep didn't stop it, though I seldom sleep a full night, which could be exaggerated by the medication. 

I've had odd an vivid dreams, but since most of the time they aren't nightmares, I'm ok with this side effect, as I'm quite used to cptsd and anxiety nightmares that keep waking me up several times a night, as mentioned on this blog before. 


I struggle reading, memorizing what I read, finding myself slow paced,often getting stuck on the same passage, even for a pleasant reading and a topic or story I'm passionate and involved in ; my solution for this is reading in mid morning or early afternoon, but not straight after lunch, due to 'food coma' that makes me sleepy. 

I often forget things that I did, said, or didn't. I may repeat myself, or make people repeat what they said, because I don't retain things immediately, and thus far, this is both a problem and its solution, making people repeat, apologizing and explaining if I am told that I already discussed that repeated part before, and move on. I asked to be told, specifying these side effects and that I wouldn't be upset to be told not to repeat.

As for daily tasks or shopping, I tend to make lists as a solution to my forgetfulness. 

It was an opportune moment to start my medication, as quite soon after, we experienced personal losses, and then covid19's lockdown. I do feel far less morose and though I still struggle with my mental illnesses and from the lockdown, it somewhat less than I did 2 months ago, and couldn't have coped as well with the griefs of our losses without this medication, so I can tell it has been 'working' well within my body.

Current fears about the treatment and possible solutions :  

That other side effects (such as the ones listed on this official website) may start at some point, especially those pertaining to emotions - either their lack, or difficulties managing their instability as I used to struggle with this a lot, on and off, all my life, and have had some limited reprieve in this kind of issue. As a friend of mine already experiences flat/lack of emotions due to her own SSRI, I went ahead and researched for solutions for her current situation, and my eventual one over a period of time, and found several tools and coping mechanisms, which I'll discuss fuller another time, but link to medicalnewstoday's article about feeling numb, for this present entry. 


I also fear that any of the other side effects may start, or the ones I already have worsen, and shall have to be extremely attentive to my mood and thought patterns, to discern if my depression, suicidal ideation, anxiety or any other of my mental illnesses or physical shape start to suddenly worsen, to discuss with my therapist and find out, in such cases, if they are linked to the medication and take proper precautions and measures to correct these eventual complications. 

For now, I'm trying to take it one step at a time, to mindfully take notice of my state, whenever I think of it, and not to overthink risks that may or may not occur during my treatment - be it temporary until I get better, or for the rest of my life, as I guess is foreseeable. 

On the ethical side: 

I couldn't find if this particular medication is still required to be tested on animals in France ; it might be as the general rule, or may have been when it was first came to the market and no longer because it's been out for some time, I don't know and cannot find this very specific information anywhere. However, my depression had become really severe over the years, and am now middle-aged and at higher risks of it worsening, so, as I said earlier, we live in an imperfect world and this may mean that my vegan ethics aren't met for this particular, necessary treatment, and if it changed towards a generic form or such, that would be more ethical, I'd automatically ask to swap. I'd sure love if our world was kinder, but I alone cannot change it, and have no choice but to accept several of my treatments cannot currently match my philosophy.

On the other hand,  the composition doesn't include lactose/dairy, gelatin or other really nasty animal ingredients ; they include several vegan sourced E additives (341, 464, 171, 400, 460, 420, 422, 216, 218, 331, 330, 110) whilst the other E's may or may not (470b, 433, 954), so the overall pill has a majority of vegan ingredients, if not all (3 are doubts). 

In conclusion:

I experienced the side/secondary effects immediately, finding some management for two of them and the main, warranted effect of reducing my depression struggles have in fact started just about the 8-week mark, which have been helpful in respect of the crisis and losses of the last couple months - having thus began the antidepressant treatment in the nick of time. 

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