‘Every morning, I take a 5ml spoonful of a minty liquid Prozac. And each day when I swallow that liquid I wonder whether I really need to continue.’
I wrote that paragraph 19 years ago, for a Vogue article I decided not to publish. At the time I had been on the drug for six years. I am still on it, which means I have now taken Prozac for 25 years.
Not much has changed, except for the fact that, in 2005, I was in much more of a minority. Nowadays, approximately nine million people in Britain, more than one in ten, are prescribed anti-depressants.
And being in a minority meant there was still a stigma around the idea of needing to take anti-depressants. I was editor-in-chief of Vogue and one of my staff members who read the piece advised me not to run it. With hindsight I should have.
I didn’t start Prozac because I considered myself depressed – unhappy yes, anxious certainly. I was suffering physical symptoms that were utterly disabling, but I didn’t think I was depressed.
I began taking Prozac because one day, in 1999, after several months of feeling worse and worse, I was having lunch with Manolo Blahnik at Wiltons in London’s St James’s, when my vision began to blur.
The fact prescriptions for anti-depressants are so common means that, in many cases, there is no monitoring at all, says Alexandra Shulman
The shoe designer regularly took me there for lunch and I had ordered the fish pie. Why I remember it was fish pie I have no idea, but I was unable to see either it or Manolo clearly because the periphery of my sight line was shaking and the weight on my head, like a 12kg dumbbell, threatened to knock me into that fish pie.
When I returned to my office at Vogue, I couldn’t walk down the corridor without reaching out to the wall for support, such was the vertigo I was experiencing. I phoned a private cognitive psychologist I knew and booked in to see her, pleading for a quick appointment. She recommended prescribed medication. It wasn’t hard for me to understand why this was happening. Two months previously my husband and I had called time on our marriage after a difficult period of trying, and failing, to hold it together.
The strain of misery and guilt was awful for both of us, particularly knowing our very young son was to be deprived of the family life we had hoped he would have.
I was editing one of the country’s most important magazines and had to try to keep a normal home life going for a three-year-old and a 15-year-old stepdaughter, without their father in situ.
I had very much wanted my stepdaughter to stay living with us, as she had for the past three years. I loved having her there and she was a key element in making my son feel that nothing much had changed. In those early days of the break-up, even the weekend handovers were a torment.
I had been prone to panic attacks ever since I had my first aged 20, but previous episodes had gone hand in hand with situations in which I felt trapped, the opposite of what I felt about my husband and my separation.
If anything, I felt freed from living in the unhappy house together. So this was different – it was a panic prompted by a fear of the disabling dizziness and vertigo that had taken me over.
I became anxious about waking up in the morning. I would open my eyes to find my bedroom no longer a haven, but a dangerous place spinning around as if I was in the throes of the most nightmarish episode of alcohol abuse. I felt as if my brain was in a tumble dryer.
Then there were the 3am wake ups, when a shaft of pure white terror (what I now recognise to be a surge of adrenaline) would infuse my body and mind and I’d be fearful of passing out or sometimes of dying – especially as I was the only adult in a house with two children.
Free floating anxiety is what it’s called, though that sounds a great deal more enjoyable than it actually is.
On one occasion, I had flown to New York for the fashion shows and as I woke at dawn for the early-morning flight back to London, my brain switched into the now familiar horror mode.
Alexandra and her Son Sam at the Vogue Magazine 90th Anniversary Party in 2006
The room spun and spun. I crawled out of the room and just about managed to get myself out of the hotel and into a car to JFK Airport. However, such was my inability to stand straight that British Airways wouldn’t let me onto the flight, even though I had a son in London who needed me to look after him that weekend.
A common reaction to mental instability is to deny it’s happening and to put off doing anything about it. I knew the vertigo attacks were some kind of psychological manifestation of the anxiety I was feeling day in day out, but even so it was difficult for me to take the step of getting professional help. It was that lunch with Manolo Blahnik that pushed me over the edge. I was put on Prozac, an SSRI (Selective serotonin reuptake inhibitor) that regulates mood by controlling the flow of serotonin, a chemical messenger in the brain.
It is one of the family of antidepressants that Thomas Kingston – husband of Prince and Princess Michael of Kent’s daughter Lady Gabriella – was taking before he tragically killed himself earlier this year.
At the inquest into his death last week, it emerged that Kingston, 45, who complained of having trouble sleeping due to stress at work, was initially given sertraline, a drug used to treat depression, and a sleeping tablet, zopiclone, by a GP at the Royal Mews surgery, a practice based at Buckingham Palace and used by royal household staff.
When he said the drugs weren’t making him feel better, he was moved onto citalopram, another anti-depressant. He had apparently suffered from side-effects and stopped taking the medication shortly before his death. Lady Gabriella described his suicide as ‘impulsive’ and said that ‘anyone taking pills such as these needs to be made more aware of the side-effects to prevent any future deaths’.
But the fact such prescriptions are so common means that, in many cases, there is no monitoring at all, as indeed there hasn’t been for me. I don’t remember the last time my prescription was reviewed or there was a discussion of whether I should still be on this drug or move to another.
Unlike me, Kingston had only been taking SSRIs for a short time. He found the side-effects unbearable and decided to stop them. It’s not the first time I’ve heard of someone committing suicide after withdrawing from this family of drugs – there are thousands of stories of the gruesome side-effects from both being on the drugs and coming off them.
Some people immediately have adverse side-effects when prescribed SSRIs – loss of libido, sleeping problems, excessive sweating and nausea – but I was lucky enough to have a good GP who emphasised the importance of introducing my body to the drug gradually.
He prescribed me liquid Prozac rather than the more common tablets which enabled me to easily, incrementally, increase to a daily 5ml dose (a teaspoonful) over several weeks.
At first, it made me feel as if I was living behind a frosted glass screen that was insulating me from the world, but as far as I was concerned that was fine.
The real world, with my sadness over my marriage and the stress of trying to do my job while my family life had collapsed, was not something I was keen to experience any more vividly than necessary.
A bit of disassociation was fine by me. That glass screen struck me as protective and safe. Others find it alienating.
Over the years I have continued to find Prozac helpful, calculating that the positives of the drug well outweigh the potential negatives of stopping.
At one point, after I had been on it for about four years, I asked my GP whether I should continue taking the drug. He told me people are perfectly happy to remain on drugs that remedy problems with most parts of their body, but when it comes to above the neck they are worried. Meddling with the workings of the brain troubles them.
He gave me what seemed like a rational explanation of what Prozac was doing … My body has too little serotonin, often called the body’s natural ‘feel good’ chemical, which helps you feel more emotionally stable, and calmer, and Prozac tops this up.
Even so, there have been times when I thought I should come off it. After all, who wants to feel reliant on any more medication than needs be? So, very occasionally, I have tried to stop taking the small amount of Prozac I now take two or three times a week. And each time I have returned to that bottle.
One January a few years ago, after some weeks of diminishing my dose (if you are trying to withdraw from antidepressants I now know you should do it in the light-infused summer, not the dark days of winter), I was in Paris at the Haute Couture shows and suddenly couldn’t stand straight.
I was outside the Pompidou Centre and terrified I would collapse in the big courtyard.
Once back in my hotel, I didn’t know how to get myself to the fashion show that evening where I feared I would pass out. But I did get there. Because you do. Don’t you?
Another time, I had decided to stop taking it, then changed my mind. My life was going well, my son was happy, I was considering buying a larger house, it was spring and seemed like the right moment – and then my father became very ill and I was not willing to risk anything that would make me less able to cope. There’s always something to put one off stopping. You might call it life. Naturally this begs the question of whether, without the drug, I will always experience these symptoms or whether it might be withdrawal that causes them. I haven’t been determined enough to find out yet.
At one point, after I had been on it for about four years, I asked my GP whether I should continue taking the drug, writes Alexandra
Now, however, I am newly examining my relationship with Prozac because recently, that old dizziness has increased.
It could be the after-effects of the trauma of cancer surgery and a pulmonary embolism I suffered over summer; it could be the vestibular migraine I am told I might have; or it could be that the Prozac I have relied on for so long to keep the vertigo at bay is no longer working.
I realised I hadn’t spoken to a doctor in years about whether I should continue with the prescription, but I’m dithering over whether to make the appointment.
Since that first dose 25 years ago, anti-depressants have changed. There are new ones on the market and Prozac is the old lady in town.
Perhaps there might be something better for me, but, then again, maybe a changed dose or a change of medication will bring with it some of the deeply unpleasant side effects I have been lucky to escape.
Our relationship with our medication is just as complex as our relationship with other people. Sometimes it’s easiest just to stick with the devil you know.
If you’re struggling and need to talk, the Samaritans operate a free helpline open 24/7 on 116 123. Or, you can email jo@samaritans.org or visit their site to find your local branch.
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