Women in communities of colour are more susceptible to certain mental health issues. So why is antidepressant use still not accepted?
Welcome to Women On Antidepressants, a new series exploring the issues young women face around getting prescribed, experiencing side effects, dealing with relationships while on medication, and life after antidepressants.
The mental health crisis is often overlooked within communities of colour. Black women are more likely to experience common mental health problems – such as depression or anxiety disorder – compared to their white counterparts. Not only that, but other studies have demonstrated that South Asian women are more susceptible to certain mental health illnesses, including insomnia and self-harm. However, when it comes to reaching out for support, there is still a taboo surrounding taking antidepressants in their communities.
Dr Amal Lad is a GP in Birmingham and trustee of the South Asian Health Foundation — one of the UK’s leading British Asian health charities. She sees the taboo surrounding discussing treatments for mental health problems in her work, with the “strong stigma attached to mental illness” being “definitely greater” within the South Asian community.
In her experience, some people in these communities assume that once they start taking antidepressants, they will be “hooked” and take them for the rest of their lives. “This [assumption] often deters people from trying medication and reaching out for help,” she tells Stylist. “There can be a lack of understanding of the role of antidepressants in improving mood – many feel they are a ‘quick fix’ without any knowledge of the power of a combined approach with talking therapies and lifestyle changes.”
Someone who turned to antidepressants after hitting “rock bottom” is Nayma*, a 23 year-old living in northern England with Mauritian roots. “I could literally no longer function and was in so much emotional pain. I was even experiencing derealisation and depersonalisation – I just needed something to stabilise my mood,” she says. “I felt so uninterested in life and didn’t care about anything at that point.”
Coming from a South Asian family meant that her mum was initially in disbelief about her mental health problems. “My mum was in denial for so long about the fact that I was clearly suffering with depression and anxiety. That largely stemmed with her upbringing back home.”
She wasn’t happy with the idea of Nayma taking antidepressants either. “She was always so against it. It’s hard to say now much that stems from her upbringing in a South Asian family because she did often say that she didn’t want me to take medication after seeing the unpleasant side effects of SSRIs first hand in her job in the NHS.”
Her mum did come around in the end, but only after seeing her reach a “low and desperate” point. “Ultimately, I am glad she came round,” she says. “She has the best intentions for me even if she doesn’t always know best – she should have realised sooner that stabilising my mental health was a bigger priority.”
Nayma has been facing the taboo and stigma that comes with discussing mental health within her community for some time. “If you do ask for help, you might find that your immediate family tells you not to discuss your feelings with anyone, which only makes you feel more ashamed. Back in school, I remember my mum insisted that I shouldn’t tell anyone about the therapy I was receiving – it made me feel so embarrassed.”
Within some Black and South Asian communities, thinking of antidepressants as a last resort is a painfully familiar cycle. People from ethnic minority backgrounds are less likely than their white British counterparts to contact their GP about mental health concerns, which makes them less likely to be prescribed medication or referred to specialist mental health services in the first place.
This was the case for Sarah Harris, a 23 year-old British Pakistani who took the decision to try medication after her low moods were affecting her education and friendships badly, despite being unsure at first. “I was still slightly reluctant about beginning them because I had been warned of the side effects by my dad, who is a doctor,” she tells Stylist. “Even though my dad is a doctor, he was very reluctant when I first told him I wanted to go on antidepressants too. Not just because of the side effects, but also that in the back of his mind, he was still under the impression that mental health issues weren’t ‘real’.”
Though her family came around after a “few difficult weeks”, it’s not something she discusses openly with extended family because they might not be as understanding. “It’s taken a long time for me to be able to comfortably talk about my mental health issues with my family. I think a large part of the reason they’re more understanding now is because they’ve physically seen how much depression has plagued my life, even though I’ve tried my best to overcome it, through lifestyle changes.”
In her view, there is still a “huge stigma” attached to antidepressants, and medications in general. “Many from my South Asian community still heavily rely on herbal remedies, so they would only use medication if necessary. Then, that makes them feel like they’re a failure and not in control of their body.”
Within some Black communities, there is also a taboo about antidepressants, and discussing mental health in general. Yinka Ewuola, founder of Calla Success Systems, supports women in business while safeguarding their mental and social well being. She thinks that there is “absolutely a significant” stigma attached to mental health illnesses and their medication.
There are several reasons which prevent Black women from reaching out to antidepressants as a means of support, including shame and ignorance. “Many families would rather cover up the problem than admit it and seek help. Given the entrenched notions of family honour, the perception of mental illness and taking medication can have a negative social impact on all family members. Instead, religious explanations and some other remedies would have been sought for illnesses.”
Mistrust in the healthcare system is also a huge factor. Historically, once in contact with mental health services, Black and minority ethnic people are more likely to report harsh experiences of services and poorer outcomes.
According to a 2019 report by the Department of Health and Social Care, personal experiences within the mental health system show Black and minority ethnic patients are disproportionately restricted in hospital settings with physical restraint instead of experiencing outpatient and holistic mental health care.
“Black people have decidedly worse outcomes in our current health system than their white majority counterparts, in so many areas including mental health,” says Yinka. “There are additional complexities for communities of African origin given the weaponisation of their mental health through their interaction with western and white people both through enslavement, and colonisation.”
Naomi, a 24-year-old British Nigerian, had her first encounter with antidepressants a few months after giving birth. “After having my baby, the symptoms I had at the time displayed postpartum depression.” When she originally looked for help from her GP, the stigma from her family was glaring.
“I remember that I had to lie to my mother at the time, calling it contraception instead. There was this unspoken stigma that using them means that you’re weak, emotional or too dramatic – sometimes it was considered at attention seeking.”
Within her community, people tried to solve their mental health issues with prayers instead. “The concept of antidepressants is that they’re for ‘crazy people’ or white people only. They believe that such issues can be solved with prayers, as it is often attached to ‘spiritual attacks from the enemy’.”
However, after an incident which saw her taking her medication then falling asleep and not hearing her baby cry throughout the night, she decided to stop taking them. “I was overcome with baby guilt – I felt that I was just thinking about myself and not my baby.” After she stopped though, it led her diagnosis to escalate to emotionally unstable personality disorder (EUPD), which led to her getting very sick eventually hospitalised. “I knew I had to keep taking them again – not just for me but my child.”
Following this, the attitudes from her family got “a bit better” as they realised how dire Naomi’s situation was. “Seeing me hooked up to so many machines and being in constant agony meant that they had no choice but to support me in getting better. They didn’t want to lose me.” In her view, changing perceptions towards antidepressants started with reaching out to the elders of her community. “Though young people are trying to constantly have those conversations online, I believe we also need to have them offline with the older generation as they are the ones who are still very much against them.”
We still need to battle assumptions within Black and Asian communities when it comes to antidepressants. “There is still a big shame factor that prevents people from reaching out for support,” says Dr Amal Lad. “However, as a GP, I can assure you that we are here to listen and help if you are struggling with your mental health so please reach out to your doctor – you are not alone. It is much more common than you think.”
Yinka Ewuola advises people to “speak up” if something is not right. “Ask if you can have a therapist that understands your background and heritage. Reach out if you’re experiencing side effects of your medication too.”
The South Asian Health Foundation runs ‘Chai and Chat’ engagement events aimed at breaking down stigmas surrounding mental health in the South Asian communities. There are many mental health charities and therapy services aimed at helping women of colour too — including Time To Change, Black Minds Matter UK and more.
If you, or someone you know, is struggling with their mental health, you can find more support on Mind and NHS Every Mind Matters. You can also access the NHS list of mental health organisations here.
In Stylist’s new digital series Women On Antidepressants we investigate the myriad of issues that surround women being prescribed, taking and coming off antidepressants. For news, first-person essays and features check the dedicated hub daily. If you have a story about antidepressants to share email firstname.lastname@example.org with ‘antidepressants in the subject line.