(Still) taking the tablets

Not so long ago, I asked my current doctor how he thought I would have been over the last 20 years if I hadn’t stayed on antidepressants continually. He said he thought I would have had at the least a period of in-patient care. When I asked my other half, who has known me for nearly 30 years, and remembers life before and after I had medication his response was simple.

‘You would be dead.’

Since I last somewhat reluctantly shared my views on antidepressant medication a year ago, (before that I’d kept my head below the parapet) there has been a continuing debate about them both on twitter, where I’m quite active, and in the media. My blog was paired with an article written by a fellow psychiatrist who has very different views from my own, who told the Daily Mail she wouldn’t take antidepressants even if she were suicidal. I was pleased our contrasting views went out together. Others have questioned me directly with comments such as ‘I can understand why you take them if they’ve helped you, but why do psychiatrists still prescribe them when they don’t work?’ and a little more personally: ‘well you would say they help because you’re a psychiatrist.

When I joined twitter, I expected there would be primarily a view that medication was unhelpful and shouldn’t be prescribed. I guess that’s because that’s the message that the media often seems to prefer. There are several eminent mental health professionals who share this view and write about it frequently. Many of them are involved in the Council for Evidence Based Psychiatry and are active on social media. In fact, what I found, as well as people who share their views, was a substantial section of people who were willingly to talk of how medication has helped them. Some of them, like me, have also had psychological therapies, but many others have unfortunately not been able to access them.

NICE (the National Institute for Health and Clinical Excellence) is about to start a new review of the evidence, but its current advice is that antidepressants should not be used in milder depression, should be offered as option in moderate depression, and should be used in addition to psychological therapy in severe depression. That’s why I prescribed them when I was still practicing and most other psychiatrists and GPs, still do. But unfortunately the difficulty in accessing psychological therapy makes it hard in practice to follow the NICE guidance as we should. Many people do not get offered evidence-based treatment. If this happened in cancer it would be a national scandal, yet untreated depression, as we know too well, not only causes great suffering but can also be lethal. There are people who wouldn’t benefit from antidepressants who end up on them unnecessarily and only experience the side effects. There are others who feel there is no other choice open to them without a long wait. In severe depression, treatment which doesn’t also include psychological therapy is incomplete. Medication alone is never the solution.

I’ve stayed on tablets because, as my doctor and husband agree, I don’t think I could have managed to live the life that I’ve been fortunate to have, if at all. It’s been a productive one, but it hasn’t been easy. I’ve still had relapses: I was unwell earlier this year again and am now recovering. I didn’t cope with work stress well at all, although latterly Cognitive Behaviour Therapy helped me to find new ways to manage that; and I know that I still react badly to loss events. I have a family history of mental illness, and one first degree relative was hospitalized. My early life almost certainly contributed to my susceptibility. I’ve written at much greater length about this in my memoir, which will be published this autumn. However I haven’t been as low or completely unable to function as I was prior to taking medication. Psychotherapy helped me earlier in my life, but couldn’t prevent me having more severe episodes in my mid-thirties. Each time I’ve relapsed, my medication has been changed. Sometimes things have been added in. I’m on a combination now once more. I know there will be people who will say my recoveries are due to the placebo effect, which can be very powerful, but last time, as previously, I’ve begun to recover in the time scale predicted by the evidence. This time it was around 3 to 4 weeks. It certainly was not immediate, in fact as sometimes happens, my mood continued to deteriorate after I started the new treatment.

Medication has some truly vile side effects; I’ve experienced many of them and still do. I’ve had withdrawal symptoms too. Some people cannot tolerate them, and others feel much worse. Fluoxetine made me so agitated I had to stop it. In young people that effect can lead to increased self-harm. Medicines can help, but they can also be dangerous too. Its always about balancing the risks and potential benefits.

To suggest I would only say medication was helpful because I’m a psychiatrist devalues my experience as a service user. Perhaps it’s not easy to be seen as both at the same time. But I know others have found medication helpful too so I’m not alone. When writers suggest antidepressants shouldn’t be used, those of us who have benefited find that very scary. We know we are not weak because we need to take them, but sometimes it can feel like others honestly think this of us. All I am asking is that those who don’t want to take them respect the choice of those who do and continue to allow people who may possibly benefit (and have potential problems on them too) to make a fully informed choice. As I said previously I have never forced anyone to take them.

I have been suicidal, and I chose to start taking an antidepressant. At that point I was still sufficiently ambivalent about death to try anything that might help.

I’m still here.

15 thoughts on “(Still) taking the tablets”

  1. Hello Linda
    Well I for one am very glad you are still here. I’m so glad that as a friend of Carolyn’s I was introduced to your blog on FB. Your blogs are therapy for me – we appear to have similar experiences – nit the same obviously – I had childhood illness – TB – so was in a sanatorium for a while (that doesn’t help early relationships) plus I have suffered abuse. I won’t go on….but like you ADs have saved me – I don’t stay on all the time but need a crutch every now and then – I had a bad dip recently but pulled through without ADs on that occasion.

    Thank you for being so open about your own battles with the black dog – I am only just ‘coming out’ as it were and when I admitted it on Twitter recently I had to trun back in my biz fir a while as I felt so vulnerable and exposed – this just goes to shw hiw much stigma is still, around because I was worried about what my wider networks would think…

    I look forward to your memoir. You are a very, very brave woman.


  2. Thanks for sharing this. I’m 3 years down the road with psychiatric meds and I still regularly question the need for them, despite the fact that a trial period off them last year went spectacularly badly. I hate the side effects, and the fact that I still experience episodes (in in the middle of a wicked dip right now) often makes me think they’re not working at all. I guess I need to work to remember how much harder it would be without them. For what it’s worth, my husband’s response to the question you put to yours was exactly the same.

  3. Thanks so much for this piece. You sound like a very thoughtful practitioner. I agree that appropriately prescribed medication can be vital to successful treatment. I’d like to share my experience of treatment with and without medication,not for depression but for anxiety/panic.

    I have suffered from anxiety and panic attacks since my mid 20s. I found it increasingly difficult to leave the house to get to work and I woke up many nights with a pounding heart and acute panic. My poor husband had many disturbed nights trying to help me calm down. I was referred to a psychiatrist – not quite sure why the GP didn’t even try to offer any advice or support. The psychiatrist diagnosed panic disorder and didn’t force meds on me when I said I’d like to try managing without them. However, the few sessions of rather inadequate talking therapy didn’t really make me feel much better as I’m not someone who easily opens up to people, and I don’t really know what I could have told him anyway! The only coping advice he offered was a deep relaxation routine, which at the time made me even more anxious. During this time I discovered I was pregnant, and although I didn’t really feel any better, I decided to end the sessions, which seemed a bit directionless anyway, without sharing the information about my pregnancy with my psychiatrist.

    I managed to muddle through my son’s early childhood, always with anxiety not quite as much in the background as I’d have liked, but with some better spells where I coped pretty well. However, eventually I was back at the stage of being unable to leave the house alone – even thinking about it made me anxious – and I went to my GP, a different one this time. As someone who dislikes taking even paracetamol, I was wary when he prescribed paroxetine. I cried throughout my consultation which led him to suggest I was depressed, but I was simply frustrated that the panic and anxiety were stopping me living my life. Other than that I had no kind of low mood. Reluctantly, because I was desperate to regain some quality of life and be a more functional mother, I took the pills. They literally gave me my life back and I was able to do things I hadn’t been able to do comfortably for years, even simple things like going to the shops or travelling on trains! My husband said it was like having the old me back. The main side-effects for me were weight-gain and, initially, insomnia. I also had occasional ‘time-lapses’ where several minutes passed that I was not aware of, and my memory of certain events during the period I was on meds is poor to non-existent, but I never felt that they ‘numbed’ me as some claim. I was on and off the tablets for a few years – a family tragedy came at a time I’d been managing well without them and threw me right back into full-blown panic attacks. I have now been off them completely for 6 years, largely, but not entirely, anxiety-free. I have good and bad days, but have so far resisted returning to my GP. I still feel anxious sometimes, but can often prevent it from spiralling into a panic attack. But if I ever get anywhere close to the stage I reached before, I would take medication again without any hesitation. Non-drug therapies can certainly be useful, but I know that I needed to have the severity of symptoms reduced first before I could focus on developing different coping strategies.

    I’m sorry this post has turned out rather longer than I intended. If you’ve read to this point, thanks!

  4. Thank you for reading! I didn’t mention anxiety, but I experienced mixed anxiety and depression so I understand what you are talking about too. No worries about the length of the comment either!

  5. I haven’t followed all the arguments but I truly believe that I would not be here were it not for medication either. And that is coming from someone who, whilst not ever anti-medication, definitely did not credit brain chemistry with having as much impact on people’s mental state as psychological factors and childhood experiences for a large portion of my life.

    In my last episode I was stuck in a loop with my brain misfiring- none of the self-help strategies I had used in the rest of my life were working despite my ardent attempts to implement them, and it wouldn’t have been possible for me to engage with psychological therapy with a therapist. As an example, at one point I was having to do 3*30 mins of mindfulness meditation and countless repetitions of a panic app on my phone to get through the day without a major panic episode. Once we got the medication right I was released from the relentless anxiety and panic I could finally help myself and start the process of recovery.

    To help me get over my recent episode I was referred to a CBT therapist as well as being prescribed medication by a psychiatrist (I was lucky enough to actually receive the care recommended by NICE). I had a difficult time working with him because he didn’t believe in a state of mind where you can’t engage with psychological therapy. He once said to me that he thought mindfulness could put drug companies out of business! As I say, I haven’t read all the arguments and they are probably much more reasoned than this but I think that people often can’t handle the idea that at the end of the day our selves are reducible to the functioning of a whole lot of neurons and neurotransmitters. I’ve myself come to terms with that fact.

  6. Hi Charlotte!
    It worries me that there are psychological therapists who don’t seem to understand that there are times when people with severe depression cannot use therapy, because of difficulty in concentrating, problems with thinking, and just being too agitated or slowed up. It risks the person feeling even worse as they ‘fail’ at therapy, when they could almost certainly benefit from in the right circumstances. I was fortunate to see a CBT therapist who was a CP who didn’t question my need to be on medication, and left that to discussion between me and my psychiatrist. As a result was able to constructively work with him and gain a lot from therapy which I was able to put into practice. I wouldn’t have been able to do that without an increase in my meds at that time too.

  7. Thank you for sharing this. I don’t think I would be alive without the medication I take everyday but I seem “forced” to justify this to some people, even family. It doesn’t stop episodes and often have to go through changes when I get really ill. I am receiving therapy but it’s the combination of both which helps.

  8. I took anti-depressants on and off for a few years. I feel better for having discontinued them now; for me the side effects of various meds have outweighed the benefits during all but the darkest times. But my goodness, I am glad that the meds brought me safely through those dark times. How arrogant it would be for me to judge anyone else’s decisions based on my own singular experience!

    I take stimulant meds for ADHD symptoms as of now, and I consider myself to have made an informed decision that I am fully capable of keeping under review as time goes on and new evidence energes. It has been an immense struggle though, to reach this point of relative confidence, not just because of my personal difficulties but because of the additional burden of stigma and distress generated by warring professionals with such extremely forceful opinions.

    Thank you for sharing your own voice of reason. It feels so much easier to breathe around here! 😉

      1. Seriously, I think your perspective is great! I was reading some old twitter feeds the other night, on the ever popular topic of diagnosis vs formulation, and I found myself shouting out loud at the screen in exasperation at how the more reasonable voices were being lost in the crowd.

        It went something like: ” Nooo! Stop! Back up…. listen to what SHE said!!! No, not you again…. HER!” 😀

  9. I hear hope over science, belief over evidence and I don’t blame, or condemn, I’m just so sad that so many are at the mercy of a huge conglomerate alliance dedicated, not to helping humankind but to making money. There has never been any scientific support for the antidepressants acting on depression. They suppress emotion among many other things, and depression is a very strong emotion. The corruption surrounding the psychotropic drug market is being exposed more and more, showing faked results, and bribery of key personal in academia and medical & government authorities. The expansion into creating psychiatric disorders in children and marketing the associated drugs illustrates the cynicism of the big pharma/ psychiatry alliance. I’m sure that for some, taking these drugs for life offers some relief from their difficulties, for others they set up a lifetime of the cycle of addiction/ withdrawals, of sexual disfunction and loss of `normal feeling’ that destroys marriages and relationships, of metabolic disorders, suicide, birth defects, and the development of manic symptoms that can lead to a lifetime taking a plethora of other major neuroleptic drugs.
    Whilst you and the other commenters on this blog have expressed essentially benign reactions, for tens of thousands of others, especially children and adolescents, these medications are toxic and destructive. I think you need to be very careful that you have presented ALL the current knowledge before you recommend them.
    An overnight suicidal reaction to Prozac led to the destruction of my life as I knew it – I lost my career, my family and my future. I am far from alone.

  10. I am very sorry to hear about your experiences which sound terrible. As I’ve said in the blog- this is why I take them. I know there are differing beliefs to mine and there are a wide range of experiences, some of them very far from the positive ones others have written about. Thank you for sharing yours here.

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