A Little White Pill

A little white pill. Every night. Just one of the six pills I take every day. I now understood the pill burden I was taught about when considering what medication regimen to prescribe for my patients. When I started my SSRI almost four years ago, I had no idea what kind of commitment I was making.

What comes to mind when you hear the word "withdrawal?" Drugs, alcohol, addiction. Unavoidable consequences of trying to make a change. Dependence on a substance to the point where your body cannot function properly without it.

The thought ran through my head: "I've felt better for a while now. Do I really need to take this anymore?" I had been warned about the effects of stopping an SSRI, but, as some of you may know, doctors make the worst patients. I decided I was too tough for a taper, confident that I could overcome whatever was in store for me.

So, I stopped. It seemed so harmless. One less pill. How bad could it be?

Well, it was far worse than I had anticipated. The worst part was that the effects did not manifest all at once. Instead, I was taken on a rollercoaster of physical and psychological changes with no foreseeable end. I never thought this was something I would have to go through; yet there I was, nauseous and dizzy, trying to blame the symptoms on COVID-19 or the stomach bug.

Two weeks went by. Feeling like I had vertigo for most of the day. No appetite. Trying to figure out what was going on and how I could fix it. Eventually, the symptoms subsided, and I thought I was in the clear.

Wrong again.

The next week I started to notice old feelings reappear. Self-doubt. Irritability. Sadness. Anxiety. I chalked it up to a stressful day of work and kept moving along like I always do … until I couldn't any longer. The anxiety turned into panic attacks, and I finally realized what was going on. This experience, formally referred to as "discontinuation syndrome," was no longer just a warning on a pill bottle label. My body and mind had been stripped of the serotonin they had been relying on for the last four years and no amount of willpower or mental toughness was going to change that.

Long story short, I reached out for help and was flooded with support from friends and colleagues, again made thankful for my choice in residency program. They helped me establish care with a new psychiatrist and I restarted my little white pill, feeling more like myself in a matter of days.

Depression is a silent disease. "We are a sad generation with happy pictures" is a phrase that embodies this concept. Hidden behind a smile, depression can break you down as much as any physical ailment ever could. Social media is a facade, and we live in a world full of stigmas and reasons to avoid being upfront and honest.

My goal as a physician has always been to break down the hierarchy and remove power imbalances from my interactions. There is immense value in humility to facilitate shared decision making. I will continue being open with patients about my own struggles and doing my part to create a safe environment for them to share their stories with me. You would be amazed how far a little honesty can go.

Samantha Leite, MD, is a second-year obstetrics and gynecology resident at St. Luke's University Health Network.

Disclaimer: The thoughts and opinions in the Frontline Voices initiative reflect experiences of individual ACOG members and do not represent official organizational opinions of ACOG.