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November 02, 2021

Lane Johnson shines a spotlight on anxiety disorders and the drugs used to treat them

The Eagles star experienced withdrawal symptoms when he stopped using an SSRI, a common type of antidepressants

Mental Health Anxiety
Lane Johnson Anxiety SSRIs Kate Frese/For PhillyVoice

Eagles tackle Lane Johnson.

Lane Johnson has opened up about the anxiety disorder that prompted his three-week departure from the Eagles this fall, pushing to the forefront a mental health condition that many people – and NFL players – quietly combat.

On Sunday, Johnson acknowledged that he has suffered from an anxiety disorder throughout his nine-year NFL career. For years, he had hoped his on-field accomplishments would make him feel better, but he said they only aggravated his anxiety. And he never spoke publicly about his disorder because he was ashamed. 

"In this league, in the NFL, where it's a gladiator-type sport, it's something that's not often talked about but it's often felt throughout the league," Johnson said in an interview aired Sunday by FOX Sports. "We need to talk about it. But yeah, man, I was living in hell for a long time."

As the NFL season started, Johnson was experiencing withdrawal symptoms caused by his decision to cycle off his medication – a selective serotonin reuptake inhibitor, or SSRI. By Week 4, Johnson said he could tell his was nearing a breaking point. He hopped in his car and drove to his Oklahoma home, saying he needed to get himself right before he could focus on football.

"I went from, I guess, a very mediocre dose to nothing," Johnson told reporters after Sunday's game in Detroit. "And so, the side effects — it's almost like you have the flu. Lot of nausea, lot of vomiting. And it's something that stays with you. It doesn't go away. And that's really what I was dealing with."

SSRIs, the type of medication Johnson used, are the most commonly prescribed antidepressants, according to the Mayo Clinic. They include brands like Prozac, Zoloft and Celexa. The drugs increase the level of serotonin – a hormone that stabilizes mood – in the brain by blocking its reabsorption into neurons.

These medications generally cause fewer side effects than other antidepressants while treating moderate to severe symptoms. That combination has made them the first-line medications for anxiety and depression over the last three decades. They're also less costly.

"It makes it easier for the patients to be medicated, not only by psychiatrists, but also by primary care doctors," said Dr. Mario Cristancho, of Penn Medicine's Mood Disorders Treatment Center. "In terms of safety and tolerability, SSRIs are easier to use. And they, I will say, are very effective."

Some research suggests older antidepressant drugs – tricyclic antidepressants and monoamine oxidase inhibitors – are more potent, Cristancho said. But tricyclic antidepressants are considered less safe than SSRIs and MAOIs require a specific diet. 

Another group – serotonin and norepinephrine reuptake inhibitors, or SNRIs, treat anxiety by blocking the reabsorption of both serotonin and norepinephrine, a chemical messenger tied to the fight-or-fight response. These medications sometimes can be useful treating symptoms that SSRIs cannot, Cristancho said. 

Finding the most appropriate SSRI can take time. People can respond differently to the same medication based on their symptoms and other health conditions – and SSRIs differ in their potencies, experts say. It may take several weeks before an anti-depressant is fully effective.

Some people won't feel any side effects, but others may experience them for several weeks. Common side effects include nausea, vomiting, headache, drowsiness and insomnia.

"These SSRIs take a little bit of time in order for them to achieve their antidepressant or anxiolytic effect," Cristancho said. "That's a little confusing for patients. Sometimes they start feeling that these aren't working, they stop the medication and they experience, of course, a little bit of frustration."

Because anxiety and depression are chronic conditions without a cure, many patients remain on SSRIs for long periods of time, Cristancho said. These medications not only get people out of mental health crises, but they also help prevent their symptoms from recurring. 

Still, halting their use, as Johnson did, isn't uncommon. In such cases, psychiatrists consider several factors, including the frequency of previous episodes and their severity, Cristancho said. They usually lower the dose gradually and sometimes recommend psychotherapy. 

SSRIs are not addictive, but they can prompt withdraw symptoms, including uneasiness, nausea and dizziness, when stopped abruptly or after several missed doses.

"If we stop a medication that the patient has been taking for some time, the body is going to sense that there is something not there that used to be there every day," Cristancho said. "It's not an addiction ... It's the response of the body not having the treatment there."

Johnson said he stopped using his medication because he saw it as a "crutch." He added that the support he has received since returning to the Eagles, including from teammate Brandon Brooks, who has missed several games in his career due to anxiety, could not be better.

"The real message is, just don't bottle it up," Johnson told reporters. "It's easy to do that. The bad news is that I think a lot more people have it than what meets the eye. I think it's easy to put on a poker face. ... I remember hearing a stat at the combine that 40-50% of people in the NFL have some sort of condition. (The game) can do a lot of things for you, but a lot of times it can be detrimental."

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