How to Take This Medicine

The Unpredictable Reality of SSRI Adherence

I like it [escitalopram]. I had it upped [dosage increased] recently. But I have been on it for a while and had hardly any issues until this year. [...] I think 7 years [on SSRIs]. This year depression has been rearing its ugly head, and it ended up in me being suicidal and a mental hospital stay where the meds got upped. [...] No, it has been upped twice—once from 10 [mg] to 20 [mg] and then 20 to 30—but I forget when the uppage [increase] was from 10 to 20. [...] [After the dosage increase] I had more energy to do things I wanted to do. I didn’t want to stay in bed all day. [...] More emotional [now], easier to get to cry. [...] I still deal with it. Sometimes it is positive to let your emotions [out]. Other times it is negative because I am crying at very little things.

Female, 21 years old, USA

The biomedical model presents medication adherence as a linear process, take the pill as prescribed, and the body will respond predictably, with any alteration of that end as misconduct from the patient. However, there is a far more complex relationship between patients and their SSRIs, one marked by improvisation, resistance, contradiction and necessity. From structuring dosing schedules around bodily responses rather than clinical guidelines, to halving doses, skipping days, or changing to a different clinician. This search constitutes a complex, most often solitary, self-guided form of care.

Routines: Negotiating Side Effects

Participants in Discord communities frequently structured their dosing schedules around bodily responses rather than clinical guidelines. Adherence extended beyond medical compliance into social calculus. Participants described strategic non-adherence, skipping doses before important events, dates, or family gatherings to temporarily reclaim emotional range or sexual function. Others adjusted intake during periods of relative stability, accepting withdrawal risks for brief reprieves from emotional blunting.

For example, many took their medication at night to avoid the drowsiness attributed to SSRIs that interfered with daily functioning. Meanwhile others took SSRIs during the morning to avoid insomnia attributed to the the pill.

These adaptive behaviors emerged organically through everyday experience and experimentation rather than medical instruction. These negotiations rarely entered clinical conversations, existing instead as community knowledge shared through personal narratives and collective problem-solving. The gap between prescribed use and lived experience became a recurring theme in discussions about agency and self-advocacy in mental healthcare.

Challenges: When the Body and System Resist

Forgetting doses emerged as a common struggle, not merely from distraction but as a consequence of the very cognitive effects SSRIs could induce. Community members described staring at pill bottles, uncertain whether they had already taken their daily dose.

Self-adjustment practices flourished in these spaces.

Without medical oversight, users experimented with halving doses, skipping days, or modifying regimens when side effects became overwhelming.

Financial barriers compounded these challenges, particularly for those in healthcare systems where medication costs created impossible choices between treatment and other necessities, a reality frequently discussed but absent from official pharmaceutical guidance.

SSRI Odysseys

I’ve been taking antidepressants since I was 15 years old. […] I’ve been on probably about 12 different types of medications for from my mental health and I can’t remember them all, it’s been so many, right? But I will have to say that up until Cymbalta I really didn’t see a mark-up of benefits for me individually, you know, um, I did a little bit with the Celexa […] but it didn’t help with my anxiety

Female, 51 years old, USA

Most remarkably, living with SSRI can be marked by long lasting SSRI Odysseys, sometimes lifelong ones, of changing from SSRI to SSRI. This implies undergoing a process with one or multiple clinicians until either the person finds the “right” SSRI for them, they stop taking SSRIs or they compromise for the best SSRI they could find. These Odysseys of finding the right antidepressant are often met with uncertainty and suffering for those in the search of the “right” medicine for them.