Editorial Note: This post reflects a probably not uncommon reality. There is no doubt people can be left with permanent dysfunction after a short course of SSRIs, or permanent depersonalization, so a permanent change of identity is possible and even likely for some – but features nowhere in the books.
The author initially figured his problems were linked to memory but is now not so sure. He is open to any ideas anyone has. Effects like this don’t necessarily occur in the brain. A lot of memory for instance is caught up in muscles and there is a lot of serotonin in muscles – it may be just coincidence but Tiger Woods appears to have lost his golfing touch around a time when he took medication.
In 2014, at the age of 24, I was prescribed Sertraline 50 mg which I took once a day to deal with a longstanding problem with severe anxiety and social phobia, including Obsessive Compulsive Disorder (OCD) elements, experienced mainly in my work environment, stemming from years of trauma as a teenager.
I had been seeing a clinical psychologist for about 2 years before trying medication, with huge benefits for my insight into my condition, but without impacting sufficiently on my symptoms to deal with an increasingly stressful work situation.
I decided I needed to test medication, to see if my problems were neurological rather than psychological, though I was totally opposed to psychiatric medication in principle, having been subjected to other psychiatric medication forcibly as a teenager.
At the time of my experience with Sertraline I was employed as a trainee solicitor in London, with considerable demands of time and performance on me.
These were nothing however to the social anxiety I felt working around very domineering and confident people, as I was secretly a person with very low self esteem. I had worked my way through education over many years, after working in heavy industry with my hands, only acquiring high school level qualifications in my early 20’s, and I secretly felt inadequate in my new work environment.
On the recommendation of my psychologist, I first went to my general practitioner asking to be prescribed Escitalopram. On being offered only Citalopram instead (cheaper apparently), I decided I wanted a consultation with a psychiatrist specifically, who would have a comprehensive knowledge of psychiatric drugs.
At the subsequent consultation with a psychiatrist, I summarized everything I had learned about my condition from my psychologist, and specified particularly that in my present early stages of my new career, any medication prescribed must not affect my work.
I was prescribed one Sertraline pill daily, and warned that the first week would include side effects of nausea and dizziness, so it was recommended I begin the drugs during the Christmas holiday to avoid difficulty at work.
In the event, my Christmas holiday was spent with family and was delightful and stress-free, so I actually began the medication only the day before returning to work.
On taking the first pill I experienced an immediate (within 15 minutes) cessation of continuous residual background over-processing of events and problems in my mind. My mind just emptied, and a foolish grin appeared on my face.
In the first week, I took a pill each morning before work as prescribed. In the first 3 days I indeed experienced dizziness.
Another effect also quickly appeared. Apparently I could not remember anything. I found myself idiotically and totally unexpectedly stumped to recall famous actor’s names, or things I intended to do, and then I noticed I could not recall characters’ names in books on my bookshelf that I had read 5 or 6 times over. I could not recall any dates of historical events relevant to my particular sporting hobby, in which I was very well versed.
At work, when presented with documents to draft, I discovered my professional knowledge and technique that I’d built up, like a hole which opened beneath me, was missing when I needed it. I did not know where to start with my work.
More than that, I found it impossible to frame in my mind the actual issue or problems of the case I had to deal with. I started to use bits of note paper divided and arranged around my feet to separate out different parts of it late at night, but it took me that first week to produce a substandard version of document I would normally have spent a morning on.
But I was also constantly experiencing a kind of quiet euphoria. My mood was lifted, my attention, was rapidly diverted and I was more outgoing. I felt distractedly and buzzingly like it was my birthday and Christmas at once, and comfortably very lazy.
Problems of intense social awkwardness and eye contact with colleagues were swept away. I became overnight, comparatively loud and boorish instead. I rejoiced in this enormous triumph initially.
In evenings in the gym, I discovered, however, I had absolutely zero ability to push my way through any kind of pain barrier to continue repetitions of exercise. I simply didn’t have the patience or attention to.
The muddle in the middle
I was very concerned about both the benefits and the drawbacks I was experiencing, but not wanting to pay the psychiatrist again, who was also located far away, I did not consult her again.
One morning, about 10 days in, I did not take my morning pill due to the above concerns. I had noticed that the pills lasted exactly 24 hours, and each morning I woke up, I had felt sharp and bright again before taking my idiot-pill, so that day I just didn’t take it. I was right back up to speed again at work. It was great.
Except my crippling social phobia also returned exactly as before, whereas on the drug, I was a new comfortable outgoing personality, one not crippled by exhausting physical nervousness or problems with eye contact.
Calling my psychologist about this, he suggested I should henceforth take Sertraline as and when needed only, to get the social benefits of it when needed, while maintaining my capacity in my job.
I proceeded to take the drug for periods of several days on, and several days off thereafter. For example during this period I had to cover for a more senior colleague at work when she was on holiday. I stayed off Sertraline then, and was warmly congratulated for my good work.
It was the last time I would be.
On the Friday of the week that my colleague had been away, I went for a drink with colleagues in a local bar, and wanting to be sociable, took a Sertraline pill for the first time in 3 days before going out, to assist me socially (though alcohol had anyway always loosened me up).
It was the first time I had mixed Sertraline with alcohol.
No going back
Moments after taking it I knew something was up. I felt “flat” again, as I always did when on it, but now I felt like a gear had changed too.
It had been tough decision to take the pill, because on the high of congratulations for a week well done, when I had stood in at higher level, I was contemplating not taking medication ever again. But I hated my socially-phobic self, so I did.
I left the bar early, feeling behind on the conversation, and looked forward to next morning when I would wake up sharp again.
I did not. On that occasion I woke up entirely the same. Fair enough, I had a hangover too, so it was hard to tell, but by the evening nothing had changed, and when I went to work on Monday, I was humiliated in a meeting in which I failed to grasp any of the backstory of the prior several months’ work.
In fact nothing has changed since. Three years have passed and it appears the drug has since that date had a permanent effect on me.
I only took sertraline for 5 weeks. I remain in a condition as if still taking the drug, though I have not taken it since, with both the positive and negative effects remaining.
Being unable to sift problems became typical of my remaining 6 months with the firm, during which time I was moved away from serious work until my contract was up and I was not kept on.
Since leaving my trainee job I have failed every attempt to get back into that field and have traveled sporadically since, and been employed back in my old industry in temporary jobs.
I feel I have remained in the same insulated, though less euphoric state, Sertraline put me in, with the major detriment being to memory.
Psychological tests have shown that knowledge I had remains intact, because I can recognize and be prompted to bring out any particular fact with enough help, but unprompted I cannot achieve recollection.
My capacity to reason remains as before, which is why family didn’t initially notice too much difference in my conversation, but short term memory, useful for reasoning with, is not something available as before.
I have been seeking an explanation for the changes that occurred in me, whether psychological or neurological for 24 months. With expert help we’ve concluded they are neurological and only now do I feel I have enough perspective to put my account on to this website as a warning to others.
Multiple exposure to these class of drugs in a lifetime it seems can cause permanent effects. By stopping medication for days at a time, in effect I was self-medicating. Note, no warning of any kind that breaking medication briefly before resuming it may cause harm, appears on the drug data sheets I had.
Also be aware that 50mg is basically the lowest prescribed level of the drug, so “tapering” dosage. You stop or start by simply forgetting to take a pill.
I’m advised also that while alcohol probably slowed the wearing off of the drug the last night I took it, it probably did not interact in any way with it to “fix” the effects of it, as I have experienced.
My warning then is this:
Sertraline can cause permanent memory problems, particularly if taken irregularly, even at minimum dosage, wrecking careers and friendships.
I mention friendships, because inevitably, relationships with some old friends have changed, because I have changed.
Without the ability to draw on relevant examples of things I want to say in conversation, or on things I may have recently read, detailed discussion can be difficult.
Whereas I used to be highly politically motivated, I’ve found I’m politically apathetic now, and don’t wrestle with issues in the news.
This is a really huge change in me. I find it impossible to feel militant about nearly anything for long. I’ve also found my career ambition has evaporated. Friends I used to engage with in these ways are slipping away.
Regarding the memory problems, after long reflection, I think that when I try to remember something I am in fact distracted from being able to by some other process going on simultaneously.
It feels like this constant messaging uses the same channels as those exercised to recall memories or access to organized constructions of facts I’ve built in the past when studying and learning.
Thus recall of words or facts I want is just interfered with in the moment of recollection, maybe by ‘pleasantness’ continually fired in my brain.
I have described this inability to recall facts on demand as feeling as like having a record player whose needle is unable to get into the groove, and just hovers ineffectually over the spinning record underneath.
I suffer particularly when put on the spot by someone for information – what was that word I wanted? What was the name of that person? I forget constantly things I told myself to do 2 minutes earlier. Remembering lists is almost hopeless and I also entirely forget stories I’ve told people before and repeat myself.
Studying again (learning a language) has been more difficult than previous studying. My attention span remains good and I go about it in the same way as before and I suspect I’m learning the information as efficiently as previously, but bringing out what I’ve learned is problematic.
Further, many people seem to describe feeling “flat” or “empty” after taking SSRIs, or the feeling even of “becoming stupider”. In connection with this I believe that sertraline took from me my capacity to “ruminate” – the capacity to ponder – the constant ticking over and consideration of problems at a low level, below active conscious verbal calculation.
In a way this was as intended, in that my former circumstances were such that all the many elements of social London city were accumulating in my mind to cause me extreme stress, preventing sleep etc.
However as low level thinking is normal, I believe this deficiency could also explain both increased scatiness – forgetting all kinds of minor tasks to do unless physically in front of you, and inability to appreciate context of circumstances, as sensitivity to more distant facts is less and I hold onto them for short periods.
I think the constant messaging in my head drowns out, stops, or prevents being able to hear low level pondering.
Formerly I was aware I used to rely heavily on my capacity to be considering things in the back of my mind when they were not foremost in my mind, for work, having at some stage in my life realized this was what I was doing and that it improved decision making. So I always asked for time to give an answer for difficult decisions.
I feel I experience life now in a pathetically linear way however without being able to “ponder”, and without be able to put information into the context of larger constructions of information I’ve learned.
Instead I focus one task at a time; decision making or opinion forming must all be done at a higher level, on demand, with less depth to consider at a low level for longer.
This amounts to a loss of personality which changes the experience of being me. The world has gone “quiet”. Manufacturers of these drugs have no idea what they are messing with.
Psychiatrists have not the least clue how SSRIs actually work. Incredibly, it is not the concern of their profession to do so. They are concerned only with effect of these drugs on mental states as they define those and so they miss the side effects as I’m here describing.
Or something else
Four months after writing the above I have been unable to complete the report, because I think I’m unable to actually distinguish or characterize the effects that I complain of, as my temperament has changed so much after sertraline, that I do not know if the difficulties of memory I have are a function of being emotionally different, or a discrete memory problem.
I’m still job hunting, and I still live in temporary accommodation, which I think is a product of my differed outlook, which I want to iron out.
The initial report focuses entirely on difficulty of recall I noted during, and permanently after, taking sertraline. But it now looks like permanently changed temperament and emotions, which I think serve to prevent a consistent, coherent perception of self, or an undisturbed self-interested analytical chronological appreciation of history or stored information.
With a muddled incoherent appreciation of external events and people, and a more blurred appreciation of self, one is unable to draw upon relevant information in a situation, and apparent problems of recall can be complained of.
I used to be fiercely independently minded, but after sertraline I find myself more uncontrollably emotional, talkative and frequently indiscrete, prone to persuasion by emotive arguments, overly bodily-comfortable and harmfully divested of all personal ambition.
Given these enormous changes of personality, I think it can also be conceived how recall, or the energy to locate detail and fact in conversation, might also be affected.
Im desperate to move my life on now, but come up against my changed, weaker self in trying to move on, at job interviews and at work etc.
Would anti-serotoninergic medication help? Could that ‘reverse’ the effect of the SSRI, if excess serotonin is the reason for this emotional, ‘distracting’ element of being able to remember?
I’ve frequently tried using Gingko Biloba 500mg pills for a temporary performance boost. They help recollection, but they have a “super caffeinating” effect, which have made them unhelpful, e.g in job interviews, and when balanced reflection is simultaneously required.
I have guessed they function only to speed up mental processes, so perhaps achieving memory retrieval, before the emotional counter effects I complain of, kick in.
All ideas welcome.