One in three women will take daily medication for mental health issues at some point in their lives. So why do we have so much trouble swallowing this pill? Eleanor Morgan argues that it’s time to be open about taking antidepressants
What’s your opinion of me when I tell you this: I’ve been taking antidepressants for years to help with my anxiety. Do you think I am weak? I hope not. But these are the things that ran through my mind when I grappled with the decision, four years ago, to see if medication could help my mental health.
Which is ironic, really, given the numbers. A 2011 study by women’s campaign group Platform 51 found that one in three women will take antidepressants at some point in heir lives. In June this year, a report by the Health and Social Care Information Centre (HSCIC) found that the number of antidepressants prescribed to patients in England had doubled in a decade. And we’re now entering one of the most fraught periods of the year, with suicide rates among women rising by 3% directly after Christmas. Isolation and stress brought on by unrealistic expectations at this time of year can also affect people who suffer from anxiety and depression.
Yet we still find antidepressants difficult to discuss. They are whispered about in GP surgeries, hidden away in bedside tables and consigned to a mental folder marked ‘secret’. Indeed, the same Platform 51 study found that 18% of women kept their prescription for antidepressants secret from their family, and one in 10 didn’t tell their partner.
These days, we’re so open about our physical health that we’ll discuss our IBS symptoms with our colleagues and tweet about period pains. But we still can’t say the same about antidepressants. That needs to change.
It took me a long time to admit that anxiety was preventing me from living the way I wanted to. Back then, I was not functioning well. I was having panic attacks all the time, waking up each morning with the nauseating fear of feeling that strange swimming sensation at work, during a meeting with friends, at a social thing with my partner. I eventually accepted that I could no longer try and deal with it on my own as I had always tried to do. I went to my GP, my brain feeling like a swarm of flies, and told her I couldn’t cope. Sat there, in her uncomfortable chair as she wrote me out a prescription for a low dose of a selective serotonin reuptake inhibitor (SSRI) called Citalopram [after a conversation about my history and offering a referral for talking therapy], a faint, Ready Brek feeling of warmth spread through my gut. That feeling was relief.
Still, research from King’s College London shows that mental health stigma remains a key factor preventing people accessing the care they need such as antidepressants. Not only that, but a recent survey by the National Centre of Social Research shows that, although one in four adults has been diagnosed with a mental illness (from anxiety and depression to conditions such as bipolar disorder) a fifth of people think that “one of the main causes of mental illness is a lack of self-discipline and willpower”.
“Being perceived as ‘weak’, ‘lazy’ or ‘dangerous’ are common negative perceptions of people suffering from a mental illness,” says Dr Georgina Hosang, psychology lecturer at Goldsmiths, University of London. “These perceptions have consequences and may prevent people from deciding to take medication.”
A culture of shame
Here are some of the things I thought before taking antidepressants: they will make me an emotionally void, libido-less husk of my former self. I will basically become an addict. I won’t be able to cry. If people found out, they’d think of me, at best, as vulnerable, at worst: mad.
Stigma is a multilayered problem, but largely speaking, it stems from three things: misinformation, inadequate education and the way the media so often feeds our heads with complex issues in simplistic, reductive terms. Our minds, sadly, are easily influenced. The picture is getting better, but stigma can also come from those we seek care and reassurance from. “The doctor I saw in the early stages of my depression really patronised me,” says Rachel, 31, a copywriter. “I broke down sobbing in his office, clearly needing help, and he said: ‘There, there, you’ve got a nice job, you’re not ugly, and you’re healthy. No need to be so upset, you’ll be OK.’ I felt so ashamed and pathetic that I didn’t seek help for another five years.”
Then of course there are the headlines: “Antidepressants lead to sexual dysfunction!/Suicide risk!” “Antidepressants are no more effective than a placebo!” (These are all genuine headlines from respectable publications by the way). Another common rhetoric is addiction. Antidepressants are not addictive in the same way alcohol, nicotine and narcotics are (there are very different mechanisms at play). However, after a period of exposure the brain does adapt to the medicine. You should never stop taking antidepressants without talking to your doctor (it’s better to reduce the dose slowly to prevent any withdrawal symptoms).
When it came to my decision, taking medication for a problem in my mind rather than a tangible physical problem also terrified me. I was scared of the potential side-effects I’d read about (from ‘loss of sexual desire’ to ‘extreme drowsiness’), but also philosophically about what it meant for me to take antidepressants. But after a week of panic attacks so bad I didn’t want to leave the house, I knew I had to try something different. I stared at that first tablet like a cat at a sparrow, sizing it up. I had visions of taking it and throwing up or fainting. Instead, I felt nothing apart from a creeping tiredness setting in a few hours later, which was actually welcomed. For the first two weeks I felt a bit dizzy and had some colourful dreams, but nothing unpleasant. I am not unable to cry. I absolutely did not lose my sex drive.
The Royal College of Psychiatrists estimate that 50-60% of people treated with an antidepressant will see an improvement in their symptoms after three months, compared to 25-30% of those taking a placebo. Their effectiveness is clear, but we often still anguish over the decision.
Before writing this piece, I asked on social media whether anyone would be willing to talk to me about their experience of antidepressants and 35 people got in touch. They ranged from people I’ve not seen since school to doctors, chefs, high-profile journalists and authors. Male and female. Not one person said the decision to take them had been straightforward. Phrases like “giving in”, “weakness” and “shame” bound them all – myself included. But they did say that antidepressants had been an overwhelmingly positive influence on their lives.
“After a long period of depression at university, antidepressants helped me just get day-to-day things done,” says Amy*, who works in marketing. “For example having a shower and popping to the shops – things that people take for granted. As time went on, the pills cut out the unpredictable highs and lows I had been experiencing.” She says she actually felt stronger after she started taking medication. “No-one should be ashamed of taking something that helps you regain control over your own life. Actually, it’s a very empowering thing to do. Being anxious or depressed is debilitating at the best of times, you really don’t need yet another thing to worry about.”
Many argue it’s time we started prioritising our mental health just as we would our physical wellbeing. “If you are a diabetic and you take insulin, does that make you any less of a human being? No,” says blogger Jennifer Mason, who has been taking antidepressants since she was a teenager. “Well for me, taking antidepressants is the same. As I see it, my body can’t produce enough serotonin, so I take a supplement. I eat healthily, I exercise often, I have a supportive family. There is no ‘proper reason’ why I should be on these tablets but I am. We all have struggles in life and none of us knows what is really going on for someone else. The more people talk about mental health, the more help we will all get. And that’s why I’m not ashamed to say I take antidepressants.”
So-called ‘wellness’ is an important factor to consider in conversation about antidepressants, too. Common phrases I heard while researching my book Anxiety For Beginners included: “I don’t want to take pills”; “I don’t want to pump my body full of chemicals”; “I shouldn’t need pills to make me happy.” This shift towards ‘clean’ health, our ‘real’, ‘pure’ selves plays a role in the rhetoric surrounding mental health treatments.
Finding a balance
It took me over a decade to be open with my friends and family about my anxiety. I carried it alone, like a mental backpack of shame. But when I began telling people, what I’d built up as a grand revelation was merely met with various inflections of, “Oh.” It was, in the best possible way, a complete anticlimax. People were sad I’d not felt able to be open, and responded to my BIG NEWS about taking antidepressants with a shrug. “Great,” they said. My concerns were not reflected in the reality of people’s responses. I am lucky. This is not the case for all.
It is impossible to truly quantify how my medication has ‘worked’, particularly as I’ve also seen a therapist for the past five years. I just know how I feel and how highly I function now. Five years ago, I had panic attacks every week. Now, I have them maybe three times a year. Ultimately, there is no ‘perfect’ or one-size-fits-all treatment for any mental health problem. ‘Success’ looks different for everyone. Antidepressants and talking therapy might be the best combination for one person (NICE guidelines state that antidepressants should not be offered to anyone without the option of simultaneous talking therapy), whereas another person might not respond well to it. Unfortunately, government cuts and a woefully under-funded and stretched mental health service means that GPs are driven to prescribe antidepressants more readily because they have no other options to help someone in distress.
I’ve found that my own stigma around taking medication has lessened since I started taking it. If people around me are prejudiced, it exists in their own minds. The key word we should always come back to when discussing mental health is ‘management’. Antidepressants won’t make us ‘better’, but they may help manage psychological distress. And the only evidence-base that really matters is the one that works for you.
A brief history of antidepressants
Brain chemistry is still largely unknown, but here’s how scientists believe medication works
Selective Serotonin Reuptake Inhibitors such as Sertraline, Citalopram, Prozac and Seroxat are mainly prescribed for depression, but can also help with anxiety and eating disorders. They are thought to act by blocking the reabsorption of serotonin in the brain and are widely prescribed as they are considered to have fewer side effects compared to ‘older’ antidepressants.
Tricyclic antidepressants (TCAs) such as Amoxapine and Doxepin are used to treat depression, bipolar disorder, PTSD, generalised anxiety and OCD. They are also effective as analgesics used to treat chronic pain. They are thought to act by inhibiting the reuptake of norepinephrine and serotonin in the brain.
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) are thought to ease depression by impacting neurotransmitters used to communicate between brain cells. They are similar to SSRIs but have a slightly broader effect and some people who don’t respond to SSRIs may benefit from an SNRI (although they have been found to cause more side effects). Brands include Duloxetine, Desvenlafaxine, Levomilnacipran, Venlafaxine, which have also been approved to treat anxiety and types of chronic and nerve pain
TO NOTE: Antidepressant medication is not effective for everybody and can cause side effects, including weight gain, dizziness, sexual dysfunction and very rarely, suicidal thoughts. They may make your symptoms worse before they get better and don’t start working immediately. Discuss anything you are worried about with your GP. For more information and advice visit mind.org.uk
*Names have been changed
Anxiety for Beginners by Eleanor Morgan (£16.99, Pan Macmillan), out now
Photography: Getty, Rex, iStock, Tom Jackson/News Syndication, National Library of Medicine