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 (Kate, 21, USA).

The biomedical model presents medication adherence as a linear process—take the pill as prescribed, and the body will respond predictably. However, digital ethnography in peer support communities reveals a far more complex relationship between patients and their SSRIs, one marked by improvisation, resistance, contradiction and necessity.

Routines: Negotiating Side Effects

Participants in Discord communities frequently structured their dosing schedules around bodily responses rather than clinical guidelines.

Many took their medication at night to avoid the drowsiness that interfered with daily functioning, while others paired it with meals to mitigate nausea—a practice noted in community discussions where users shared strategies for managing gastrointestinal discomfort.

The pill's physical presence shaped routines in tangible ways. Some kept it in specific locations—next to toothbrushes, in wallets, or at bedsides—as concrete reminders in lives already affected by the cognitive fog that many reported as a side effect.

These adaptive behaviors emerged organically through shared experience rather than medical instruction.

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—a phenomenon that generated extensive discussion about reminder systems and workarounds.

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.

Negotiations: SSRIs in Social Life

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 (Olivia, 51, USA).

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.

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.