Mental illness is pretty rampant in fiction, undiagnosed or not (we see you, Colleen Hoover characters). But the talking of and treatment of mental illness in fiction is still something we don’t see often, and it’s because it can be pretty complicated to get the hang of, and even regular doctors have difficulty understanding mental health sometimes.
Depression, Anxiety, and SSRIs
Depression and anxiety are a lot more common than people think, but ostracized due to what little understanding the common world has of it and the unwillingness to speak on it. A study in 2020 showed that an estimated 21 million adults in the United States had experienced at least one major depressive episode, while 66% of US adults received mental health treatment.
When people think of mental health, therapy, and psychiatry, they think it means a lifetime of it, and for a majority of people, it doesn’t. Most people stop antidepressants after their first year, if they even started it, and return to normal life after the conclusion of whatever it was they had to work through to be healthy again. Some people use therapy just as a healthy way to vent and release their frustrations on a regular basis.
Long-term depression introduces the science behind depression: your brain is not making enough serotonin, and it probably won’t. This is where Selective Sereotonin Reuptake Inhibitors (SSRIs, or commonly known as antidepressants) come in. They work by increasing the level of serotonin in your brain gradually until your brain eventually kicks in to do it itself. For most people, they’re only on SSRIs for 6 months to a year. Some people, their brain never kicks back in.
The first plan of attack is Sertraline (Zoloft). You do want to make 100% sure your patient is not bipolar before prescribing it, as it can lead to a manic episode (but also, it’s fiction, and you’re not a doctor, but tread lightly). Zoloft is safe to take during pregnancy and breastfeeding, and commonly prescribed for postpartum depression and postpartum anxiety.
Other medications include Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), and Paroxetine (Paxil). The tricky thing about SSRIs is the first one might not work for your patient, and they shouldn’t be discouraged. They might need to take a few medications before finding the right one. No other SSRI is safe for pregnancy or breastfeeding.
Let’s talk side effects. Dry mouth, insomnia, and sexual problems such as inability to provide lubrication or achieve an erection. If your patient experiences these, they can be moved to another one. Another big side effect is weight gain, but this is largely due to the impact on appetite.
And finally: timing! I’m so sorry to say that one magical Zoloft pill will not cure all your problems. Patients typically start seeing improvement in 6-8 weeks, but every patient is different. My SSRIs took about 3 months to kick in.
And what does it feel like when it kicks in? Again, three months of magical Zoloft pills does not cure your problems, but it makes it… bearable.
You still might have destructive behaviors, you still might be dealing with the thing that made you depressed in the first place, you might still be healing, but the medication makes it fine. It makes it bearable. It gives you a newfound power and energy to put towards something else.
My favorite SSRI story is my own, and that’s that I knew the exact day my Lexapro kicked in because I stopped smoking cigarettes and I stopped biting my nails. Just didn’t have the need or even the want. It makes you feel kind of numb, but that numbness is how you get your brain ready to tackle the harder part: healing from what made you sad in the first place.
Bipolar and Borderline Personality
Even though I grouped these into the same category, these are not the same things (and yes, both have the acronym of BPD). Both disorders are characterized by manic episodes, but bipolar leans towards being genetic while borderline personality is caused by trauma or other life circumstances.
Bipolar disorder affects 2.8% of the American population, with Borderline Personality affecting 1.4%. The exact causes of both disorders are not entirely known, and both disorders can be caused genetics or environmental factors such as childhood abuse and neglect.
The three main categories of medications are mood stabilizers, antipsychotics, and antidepressants. As I said earlier, antidepressants like Zoloft can trigger a manic episode, so these are usually prescribed with mood stabilizers as well.
The most common mood stabilizers are Lithium, Valproate, Carbamazepine, and Lamotrigine. Lithium is the most commonly prescribed in controlling mania and preventing future manic episodes.
Patients on mood stabilizers have reduced highs (known as mania) and lows (known as depression), and prevent future manic or depressive episodes from occurring. However some patients have discussed a feeling of dullness or feeling numb.
Antipsychotic medications are atypical, and aren't prescribed unless the patient is in genuine need. These medications include Olanzapine, Quetiapine, Risperidone, and Aripiparzole.
Antipsychotic medications treat hallucinations, delusions, and extreme anxiety. They stop these episodes from occurring, but leave the patient feeling numb as described above. Antipsychotics can have side effects such as muscle spasms, restlessness, rigidity, tremors, and jerky movements.
When writing characters with mental health disorders, it is extremely important to do your research and try to keep their story as accurate as possible. This is why sensitivity readers and Own Voices representation is key to creating an accurate story that brings mental health and its treatment to the forefront.
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