On Saturday I am close to tears for the first time in weeks. I can feel them blooming behind my eyes as I watch, of all things, the season one finale of Ugly Betty. "Somewhere" from West Side Story swells as Betty’s sister, Hilda, learns that her fiancé, Santos, has been shot. She collapses in sobs on screen while I valiantly well up, focusing on my tear ducts. I know I can do it. I can feel the brimming of emotion that always gets me during melodramatic moments; my cheeks and eyes feel swollen and my forehead is dramatically crinkled. Eventually, as Hilda’s sobs echo around the school hall, I feel myself blink out two distinct tears from each eye.
My wife, unperturbed by the dramatic performance on the sofa next to her, doesn’t notice until I wildly, enthusiastically, throw a balled up sock at her.
"Babe, look! I did it. I cried!"
I’ve always been a crier. Tears would spring to my eyes unbidden for the silliest reasons: a deliberately emotive ad for a bank featuring a queer couple; a puppy tripping over its paws in the park; seeing friends on Zoom for the first time in less than a week. I am an advertiser's dream. My feelings are always on the surface or ready to rise to it, and they can absorb me in seconds. I recognise how ridiculous it is to be swayed so easily – especially by media that is designed exactly to catch suckers like me – but it is an integral facet of my being. I am someone who is moved deeply by innocuous things. There’s a catharsis to being so absorbed by a feeling (whether it is joy, anger or sadness) before it dissipates. More often than not, I feel renewed.
But in recent years my tears have been less innocent. When I first got absorbed by anxiety (which turned out to be OCD) in 2019 I couldn’t understand why I was feeling such panic. I became increasingly terrified of my own thoughts and the fear and doubt that encircled me would make me sob in terror. This escalated until at its worst I was having what I called anxiety attacks almost daily – a thought that would once have seemed innocuous now felt paralysing and I would feel trapped in a spiral of panic which I could only express in deeply overwrought sobs. Even when I was coping, balancing on the precipice between obsession and normalcy, my eyes felt like overfull buckets that could tip at a moment’s notice. I went from feeling my emotions at their fullest to feeling too much. It was a constant overflow.
Crying went from an innocuous expression of emotion to an indication of despair. It was no longer cathartic; it didn’t allow for healing for myself or anyone around me. The tears were symptomatic of a much larger problem: my inability to separate my thoughts from my feelings or recognise how my thoughts and feelings actually interacted with reality. I would cry at every therapist session as I explained how recently I’d had a sobbing panic attack. Some days I’d wake consumed by fear and spend the best part of the morning fighting the urge to give in and let the tears flow. Other times I would end up collapsed in a corner in my flat, trying to rein myself in, knowing full well that whatever was consuming me had no bearing on reality. Back when we worked in the office, I would steal away to the bathroom to attempt to calm down and wipe the evidence from my reddened cheeks; while working from home I would often have to take breaks to practise breathing and stem the flow.
In almost every instance, the scale of my distress was an overreaction. But the nature of OCD is that the pattern of obsessive thought and anxious response was being ingrained into my psyche. It would take much more than rationality to break the hiccuping, sobbing cycle.
My propensity for crying was now directly linked to my OCD and it was all-encompassing. I could well up at a memory or the reminder of a person or some other invention from my own head but I would also be caught up by the most obvious reality TV machinations designed to jerk tears. I wouldn’t know why I was crying as often as I would. If it was suffocating for me it was overwhelming the people I love, too – I had no room for anyone else’s emotions, no space to respond calmly. At its worst it felt like these tears were an inadvertent weapon to bring focus back to me. While I can say this was never my intention, when I was at my worst I was so in my head that I couldn’t always see those outside it.
Throughout this I was incredibly lucky. I had the financial support of my parents, which allowed me to go to private therapy, something I could not afford on my salary alone. Through diligent work with my therapist on understanding how my brain functions and disengaging from its most destructive patterns, the periods of time between panicked sobbing slowly lengthened. They went from daily to weekly to fortnightly and after two and a half years they were happening barely monthly. But they were always looming just beyond my direct line of vision. Tears lingered beneath the surface at any given time.
I worked hard to get better. I went to therapy regularly and practised my CBT every day. I cut out drinking which could exacerbate obsessive, anxious patterns and I took up meditation, which acted as a daily reminder to disengage from my thoughts and not be consumed by them. Slowly, over the course of a year, I came more into myself again. But the overwhelming emotionality that was an inherent part of me and the worst aspects of my OCD lingered. My eyes felt overfull, ready to spill at a moment’s notice. I felt a constant emotional pull in all directions. I’d tell my therapist that despite feeling better I still felt trapped by the potential to be sucked in again. I may have turned the corner but I sensed that it wouldn’t take long for an overflow of feelings to catch up with me, no matter how hard I worked on myself.
Which is how I ended up finally taking antidepressants, two and a half years after I first sought help.
Antidepressants are increasingly contentious. In particular, the prescription of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) has risen steadily in recent years, with an estimated 7.8 million people in England issued at least one prescription in 2019-20. This, per the BMJ, is equivalent to one in every six adults, with prescription rates 50% higher among women. They are prescribed for a range of mental health conditions, though their primary use is for depression and then anxiety.
But as their prescription trends upwards, so too do questions about their usage, especially for depression. In November last year the National Institute for Health and Care Excellence (NICE) published new guidelines on managing depression in adults for the first time in 12 years, advocating that those with less severe depression "should be offered therapy, exercise, mindfulness and meditation before antidepressants". This was followed by a study published in the Drug and Therapeutics Bulletin which stated: "Much of the evidence of their efficacy comes from short-term placebo-controlled trials which tend not to include outcomes that are of greatest relevance to patients, such as social functioning or quality of life, but rather restrict outcomes narrowly to symptom measures. On such measures these studies do not demonstrate clinically significant differences from placebo for depression."
These questions about the efficacy of antidepressants focus primarily on their use case for depression, particularly as the side effects can be significant: nausea, disturbed sleep, weight gain and sexual problems are all commonly listed. If they are not actually aiding your mood then how useful can they be to help you get better?
But at least in my experience, their use for OCD seems somewhat remarkable.
If my brain before felt like an angrily scrawled, jagged ball of steel wool, fluoxetine (also known as Prozac, the SSRI most recommended for OCD) encased my obsessive, anxious thoughts in rubber. It was like my mind was wearing soapy gloves and could no longer grip onto any passing thought that triggered an anxiety response. Instead the thought would glide on through and my body wouldn’t shudder with fear as it passed. What was torturously hard now felt easy and as the dose went up (40-60mg is recommended for the anti-obsessional effects) I regained a sense of normalcy that I thought I’d lost forever.
There is far less research into the use of SSRIs for OCD than into their use for depression (mainly because depression is far more pervasive) but what research is out there indicates that "SSRIs are more effective than placebo for OCD, at least in the short term, although there are differences between the adverse effects of individual SSRI drugs." In particular, "fluoxetine is effective and well tolerated in OCD, placing it among the first-line treatments recommended by consensus conference guidelines."
But with that efficacy comes the one side effect I have yet to list: emotional blunting.
This is the term for the fact that, among other things, I could no longer cry. It felt like there were small sponges padding the inside of my eye sockets, absorbing tears before they could spill over. Emotional blunting also comes in more extreme forms, which I'm lucky to have avoided. People are unable to feel any emotion in its entirety, be it joy, sadness or anger. Some describe it as 'feeling beige' and it's believed by some to be not only a side effect of the antidepressants but perhaps a residual symptom of the condition (though this is only a hypothesis). As with the efficacy of the SSRIs themselves, there is limited research into emotional blunting in patients with OCD, though small studies have found "a syndrome consisting of apathy and indifference" reported among patients with OCD who are being treated with fluoxetine or fluvoxamine.
For many, myself included, this is the greatest and longest lasting cost of getting better. Is moving through the world with more ease really worth a sense of detachment? What am I missing out on by being unable to feel? It is surreal to have this tap that dripped so liberally and literally turned off.
Everyone has their own relationship with medication like this. I would never insist that others do what I do or take what I take. I hope that I do not have to remain on these antidepressants for much longer than a couple of years. But the relief of being able to think clearly, to not feel weighed down by your own head – it still makes me giddy.
I may not be able to cry anymore without deep concentration and the music of Leonard Bernstein. This is a cost to my life now. Crying has been, for better or worse, a facet of who I am and how I communicate with the world. I love to feel things deeply, to be swayed by a piece of music or sniffle at a video of a kid getting cochlear implants for the first time. I miss that freedom to be so freely and fully overwhelmed by feeling without fearing it will tip me into collapse.
If I’m honest with myself I didn’t lose that when I started fluoxetine. I lost its clarity long before, when these deep, cathartic cries were subsumed by panicked, uncontrolled, constant sobs, triggered by practically nothing.
I hope one day to get the tears back. To experience that emotive release of the first 10 minutes of Up, wringing you out and making you feel anew.
But for me, for now, the benefits far outweigh these costs. I may feel muffled at the most extreme ends of experience but I also feel unbridled joy again. The relief of no longer feeling like you are being chased by your own neurotic thought patterns is uncontained. One day, who knows when, this contentment won’t feel surreal and foreign but will once again be my normal. Perhaps then I can take steps to return to my absolute fullness, brimming with angry, sad, confused and joyful tears. Until then I will live in this strange, slightly muffled world where I can finally see clearly again.