Antidepressant Side Effect Experience of a Licensed Mental Health Counselor

I recently wrote a blog post on my decision to take antidepressants. What I didn’t put in that post was some of the negative outcomes of taking medication. Let me preface this with, I don’t regret taking medication or some of the positive benefits I received from it. That being said, I did realize some unexpected costs that I could no longer tolerate. I’ve been on Wellbutrin for approximately three years. Some of these effects I didn’t even notice until some long periods of introspection and until it seemed like the damage was already done. I’ll start with the ones that are more straightforward and progress to the more insidious ones.

The first side effect and the one I viewed as most detrimental were headaches and migraines. To be fair, if you read the side effects on any website or label for Wellbutrin, it says that there’s a pretty high incidence of headaches and migraines. There were a couple of things that made this unbearable for me, personally. The fear of side effects was something that made me not want to get on medication in the first place. Luckily for me, this side effect didn’t really start until about a year after I had been on them. It was long enough for me to be willing to stay on them and “deal” with the side effect. I can’t sugar coat it, it was really fucking inconvenient, though.

I’m also a pretty big baby when it comes to my brain hurting. I’m one of those blessed people that really never had headaches in life before Wellbutrin. I maybe only had one to two a year, and they were normally induced by caffeine. They were always manageable, and I never took any sort of medication for them. Up until the Wellbutrin, that is. I didn’t really understand why people took Tylenol or Ibuprofen for headaches. All that changed once I started experiencing frequent headaches that graduated into migraines. Prior to 25, I was lucky enough to never have experienced a migraine. I knew from stories they were excruciating. There’s a difference between knowing and experiencing, though. Once I started experiencing migraines from the Wellbutrin, I truly started to understand how detrimental they could be to someone’s life.

It got to the point where I had 2-3 debilitating migraines a week. Migraines that made it impossible to focus on anything besides the fact that my brain felt like it was trying to implode. I couldn’t even follow along in sessions with my clients. Being vertical was agonizing, but being horizontal was also agonizing. I just wanted to cry and let it out, but I also held the knowledge that crying would just make it hurt worse. It would build over the course of the day, getting worse the longer the day went on until I would be resigned to just laying in bed, in too much pain to be able to sleep. No relief in sight.

One thing I admire are people who have lived with chronic headaches and migraines and still manage to function. When I experienced those migraines, all I wanted to do was just destroy my brain for its betrayal.

I started out willing to change my medication to try to deal with the migraines. I went off of the extended-release and onto the immediate release. The migraines improved for the most part. However, I’m terrible at adherence to medications if I have to take something in the middle of the day, as the immediate release required. So, I eventually switched back to the extended-release. After the switchback, I had about 6 good months where I didn’t really experience any migraines. It was bliss. Things started to go back to “normal” and I felt like I could function again. Except, they would slowly build back to the point of 2-3 debilitating migraines a week. It became clear there was a pattern. So what did I do? I did what any wanna-be scientist would do, and experimented with myself. I would go off of them for about a week or two until the migraines stopped (or until I started to experience withdrawal symptoms) and then start them back up again.

Sidenote: don’t do what I did. Your parents were onto something when they said “Do as I say, not as I do.” They’re telling you they stepped on the land mine and it blew up in their faces. Take it from me, this isn’t the best route. I knew what I was doing was dangerous and that there could be serious withdrawal symptoms from antidepressants. At those points, I rationalized that it was better to take a “med-holiday” and take the risks than to continually endure the migraines. Not the smartest thing I’ve ever done, but at the time I ran out of fucks. I survived, no worse for wear. It's just not something I would recommend to others, nor something I would wish others to do for themselves because I want people to utilize the supports they have, such as doctors. You will see that I learned from these mistakes.

I went through the cycle about 3-4 times, maybe even more. Every time, it seemed like the relief period was shorter and shorter each time. I the time of writing this, I haven’t really had a relief period from migraines for the past several months. I can’t really remember the last time I went more than a couple of weeks without a migraine. When I made the decision to get off of the Wellbutrin, I was having up to 3-4 migraines on bad weeks. They seemed to be more excruciating than they had ever been, becoming less bearable and more debilitating. I finally reached a breaking point where I decided I would much rather deal with my depression than the migraines. It was about time I faced my demons.

I was terrified, though. It wasn’t an easy decision. Getting on Wellbutrin was the first time I had begun to feel like my depression was manageable and like I actually had a drive to do anything that wasn’t just escaping into the latest TV show or video game. It was the first time I wasn’t chronically suicidal for long periods of time. I can handle the sadness, the emptiness, the numbness, hell, even the sometimes inevitable thinking about suicide, without actually wanting to do it. The aspect of my depression that is the most difficult to handle, is how I become worthless. Not just that I feel worthless but legitimately, I become a blob that cannot be asked to do much of anything, because everything is too much. At my worst, I couldn’t shower regularly, and I couldn’t do any housework. I was completely dependent on another person for my survival. It was scary to think about risking the productive person I had become and the pride that had started to develop to ease the pain of migraines.

I had to take a risk that my skills were good enough. I had to hope that I had enough experience in the positives of behavioral activation to continue on this path I had grown to enjoy. An experience in the positives of “Just Do It” is now I can see that if I continue to make myself do the things I’m going to be miserable either way. Things like chores and paperwork are not any less shitty when you’re leading a productive life. I guess I’d much rather say I at least tried to do the things than just lay down and accept defeat again. Wellbutrin helped me see that I am capable, and now I want to be independently capable. I can’t say I’ve been successful in all the areas, though. I’m still not following a consistent workout routine, still not working toward some of my more long-term goals. I’m only conquering what is right in front of me, right now. Maybe that’s enough when I’m making changes to my neurochemistry by stopping a medication. I still wish it was more though. To be fair, even if I was working towards those things, I would still be wishing it was more. I want to save the world, and I can’t do it fast enough.

An even scarier thought that I haven’t let myself sit in, is the fear that the migraines might not go away once this transition off is complete. I mostly don’t let myself think about it because I try to focus only on crossing the bridges when I arrive. I don’t want to spend all of this mental energy building bridges that I might never cross. I try to remind myself that it is extremely rare for side effects to continue after the discontinuation of a medication. Knowing my luck, I’d be that fucking rarity that continues to have these migraines for the rest of my life as a result of being on Wellbutrin and staying on it for as long as I did. I would probably hate myself for the fact that I went on it in the first place, but I’m not there yet. Hopefully, I don’t ever have to cross that bridge.

The one side effect that I didn’t really realize I was experiencing, and probably the one that cost me way more in the long run was my sense of connection with others. I had one of my best friends tell me about how Wellbutrin had impacted them socially when I was first on it. I didn’t realize that I was starting to exhibit some of the signs that had caused them to stop using it. It wasn’t as severe and blatant as it was for them, so it was harder for me to see in myself. It didn’t help that I had some life events (like a pandemic) that had also lessened my sense of connection with others.

When I started Wellbutrin, I was in a relationship that really challenged me to set boundaries with them and with others. So I thought a significant amount of the social riff I felt might be a result of that boundary setting rather than a side-effect of my meds. Most people don’t like it when boundaries are set. They like getting away with what they’ve gotten so far, giving that up doesn’t sound fun. When this happens to me, they are used to me being a bleeding heart and push over so they naturally are thrown off and disconcerted when I set a boundary. The thing about this is, prior to Wellbutrin, I would have found ways to make amends even if it was at a large cost to myself. Is that healthy? Not necessarily. Is it a trait that I used to like about myself? Truthfully, yeah. Some of the time that trait saved friendships that would have been lost if had I been on Wellbutrin.

I had no motivation to attempt to rebuild any of the social bridges I had burnt down. I had no motivation to connect with others. I went from being a person who would talk to my friends at least weekly, to being a person they rarely heard from. Not because I was isolating, either. I was always hella busy and surrounded by people. For the first time in my life, I would get overwhelmed by my phone. Any time I felt like someone was wanting to connect, I just wanted to pull away. There would only be a person or two at a time that I wouldn’t want to pull away from when they would text, and it was a fine line people could cross at any moment.

I was so driven to accomplish everything I felt like had gone by the wayside while I was severely depressed, that I didn’t have time for people. Me, the extroverted soul I am, didn’t want anything to do with people. Those close to me know this is extremely weird for me. I want to be around people all the time and being a Therapist, I can’t help but know all about what is going on with them. It had gotten to the point where I questioned if I was still even an extrovert. If you ask anyone who knows me, they’ll tell you I used to be an extremely extroverted person. So it's jarring to think about something causing me to feel so disconnected from people that I question if I’m an extrovert.

I apparently even wrote about it in one of my random stints of journaling and poetry. This poem is something I wrote in April of 2019. Just to give you some context of that time in my life, it was a time when I was extremely busy with Roller Derby and starting to feel the most successful I ever had in my derby career. I had just returned from the best professional conference of my life where I made some excellent friends. I was a month away from going on a trip of a lifetime with my best friends (to Germany, Amsterdam, and Iceland). My life was the shit when I wrote this!

An ache of missing humanity

Echoes in my chest

The only spark a result of mirrors

Existing in the presence of others

It feels like robbery

To carbon copy their spark

Only the people in my inner circle could take a stab in the dark and know I was feeling this way. To actually realize I had that difficulty connecting. Looking back at that time, I regret not getting off of Wellbutrin prior to my trip. I think of how that trip could have been more enjoyable for me as well as my best friends if I hadn’t been on the Wellbutrin. They definitely tried their hardest to find that human still in me.

I spent a significant period of the three years I was on it just being grateful for my ability to be logical. Logic used to be a lost art on me. My brain used to be predominately emotional with little bouts of logic (if you know about MBTI, you will understand all about this just by telling you I’m an ENFP). I was grateful for that increased ability to be logical. It made me cold emotionally though. I get it now. I didn’t feel like a “zombie” on it like most people do. I didn’t walk around looking like I had skipped my coffee that day. It took me a long time to realize even though I didn’t feel it, the meds made me come across as one. Or maybe a robot. I have definitely been less feeling driven and more callous over the past couple of years.

In hindsight after being off the meds, I’ve been able to see the bigger picture more. In some respects, meds were super beneficial. They were one of the things I needed in order to work on healing some old wounds with my parents. Not saying they are fully healed, but the relationship is way more manageable now. In others, it was harmful. I felt empty frequently. I equated this emptiness to depression because I frequently would feel bouts of emptiness with my depression. However, now, I’m wondering how much of this was due to carving out a huge component of myself. Without my emotions, I’m not me. When you look big picture, emotions are naturally removed from the equation at times. So adding a big picture to my lack of emotionality, it just felt like the world was a series of predictable currents that had no spontaneity to it. It's like when you read a certain genre of books enough that you can predict the entire plotline just from the first couple of chapters of a new book. It becomes so boring and feels pointless.

That’s how life felt: boring, predictable, and semi-pointless. I could only feel in snapshots. I could occasionally induce feelings by listening to certain music and spending time with certain people. It just didn’t come effortlessly. It was exhausting at times to fill my side of the script of interactions, to play the part I know people were used to getting from me. I tried to communicate about it so people didn’t take it personally. Honestly, I wasn’t really sure how the fuck to communicate

“I’m not me. I don’t know why not. I’m just not and I don’t know how to be me.”

I really can’t tell you if people preferred the person I was on the meds or if they felt like something was missing, though after talking to my partner, it was the latter. All I can say is something was missing for me, and I miss people. I miss my close friendships and emotion-driven self. I can’t say I miss feeling depressed. I understand operating like that and there’s some comfort in it. However, I don’t miss feeling like my bed has a gravitational pull that’s ten times stronger than anything and feeling bouts of emptiness, numbness, and anhedonia (loss of love for activities and things). There are aspects of being driven by the desperate hedonism that I miss, such as being “in the moment.” I just don’t want to feel like a robot anymore.

I really hope I can strike a happy balance somewhere. Maybe I can start to re-engage in meaningful ways and I can maintain a healthy level of logic. It’ll take time to see how feasible this all is, I guess this blog is all about that. Trying to find that feasible middle ground. It's also to help those who are feeling that zombie or robot feeling due to medication. One of the things that are most helpful for many is knowing we aren’t alone in what we experience. It helps remove the stigma and the “Am I crazy” in our minds. Here are some things you can do to help yourself if you are experiencing side effects:

1. Use your supports. I had a couple of friends that understood what I was going through without me verbalizing it. They always made sure to have a non-judgmental, reassuring, “I’m here for you dude” kind of vibe. Feeling that was crucial to my not feeling like an utter shitbag. They also were vocal when they noticed some changes they knew I would want someone to tell me about (like the fact that my anger was sometimes my most visible emotion).

2. Be willing to try other medications. For some people, medication is our hail mary. It is our “I feel like I’ve done everything and failed.” So if you feel that way, try working on your willingness to try other medications. I know that finding the right med can be a guinea pig process and it isn’t something I was willing to do for myself. Could it have turned out better for me if I had been more willing? Quite possibly. If you have experience with this, I’d love to hear more.

3. Try therapy. Meds are supposed to be the belt you use when you’re weightlifting. They help support you and make sure you don’t break your back from lifting so much, but they aren’t meant to lift the weight for you. Going to therapy is a great way to learn skills as you go. If you have gone and didn’t like it, try treating it like the meds, try a new one. Maybe that one you went to was shit, I’ve seen some shit counselors, but I know good ones are out there so I kept trying.

4. Do the hard shit. This one is the most important. I would not have been able to even attempt to go off the medication if I didn’t tell my comfort zone to fuck off. I try to tell people that therapy is all about doing the hard shit that we don’t want to do. I had to push myself through years of resistance in order to accomplish enough therapeutic change to feel safe going off of my meds. I’m still terrified of an awful regression, but I think the likelihood of it is less due to implementing a lot of changes in my life.

5. Run your risks. Ultimately, making this decision required cost-benefit analysis. I decided that the costs of being on the medication were no longer worth the benefits. I decided to test my luck by gambling that the costs of going off would be less than the costs of staying on the medication.