Why do we think of antidepressants as a last resort when our mental health is failing?

Posted by for Mental Health

You wouldn’t hesitate to go on medication for a physical illness – so why do so many of us wait until we’re at rock bottom before asking about antidepressants? 

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. 

I was 14 when a cognitive behavioural therapist asked me if I’d noticed a monthly pattern with the low moods I was experiencing. “No,” I said, resolute. 

Navigating the onset of a mental health condition was bewildering to say the least (50% of mental health problems are established by age 14), but I was infinitely sure that what I was going through was not just PMT or teenage hormones running riot. “It’s not that.”

Six years later, I was 20 and feeling lower than I’d ever felt before when I first sat in a GP’s room to talk about my mental health. My mum had suggested that we book an appointment a few days earlier. Initially, I’d been adamant that I didn’t need one. Going to the GP for my mental health had seemed so extreme. It didn’t occur to me that if I’d been having a recurring problem with my physical health for six years, going to the doctors would have been a no-brainer. But eventually, I relented and let my mum take me to the surgery.

The appointment was quick and painless. I emerged after twenty minutes with a green slip of paper in my hands, which I exchanged for 50mg of sertraline in the adjoining pharmacy. For the next seven months, I took one of the little white tablets every morning.

Like me, London-based Jess, 22, struggled with her mental health for years before she reached out to get the help she needed. 

“I always thought I could find a reason every time [I was] sad, like I’m just sad about exams or I’m just sad because I fell out with a friend. But I started to realise that no matter where I am, who I’m with, or whatever’s happening, I always just feel like shit.”

As Jess is on the contraceptive pill and thyroxine, she was initially averse to the idea of going on yet more medication. “I was sick of taking medication so I kind of kept looking the other way from antidepressants, telling myself that it would go away or that I’d get therapy.”

Jess adds that she tried to get therapy through the NHS as she couldn’t afford to go private, but unfortunately it never materialised. This is, sadly, unsurprising: NHS counselling sessions are like gold dust given that a meagre 11% of NHS England’s total budget goes on mental health services.

Linda Gask is a retired consultant psychiatrist, emerita professor of psychiatry at Manchester University and the author of Finding True North: The Healing Power Of Place. She believes that it’s best to go on antidepressants after trying therapy, but she also stresses that therapy is not always accessible, as Jess found out firsthand. “The problem is talking therapies still aren’t as easy to get access to as they should be,” she says. “Some can’t get access to the right kind of help they need.”

After failing to make any progress with getting therapy, Jess decided to take the plunge and start a course of sertraline in September last year – five years after she first noticed the onset of depressive symptoms. “I really do think they have helped,” she tells me. “I do have my down days but I feel like my lows are less low than they were before.”

One thing is abundantly clear: she wishes she did it sooner. “I think I definitely could have done with it during my second and third years of university. I do regret the lost happy moments that I could have had,” she says. “But I guess I have to look to the future.”

A depressed girl
We need to take the time to process our own emotional needs.

My experience is painfully similar to Jess’s. Four weeks after I took my first sertraline tablet, I amazed myself with how calm I was. It was like I’d been living underwater my whole life and had only just come up for air. But I couldn’t help but wonder: is this how everyone else feels – all the time? Because if that were true, then it would mean that I’d suffered for large chunks of my adult life seemingly for no reason. And that was – and still is – a bitter pill to swallow.

So why, like me, did Jess wait so long before speaking to her GP? “I think I was mostly scared of the side effects,” she begins. “I was also worried that it would not make any difference.” Jess also adds that the stigma surrounding antidepressants and mental illness made her reluctant to seek help: “I also avoided thinking about antidepressants all this time because I just didn’t want to admit to myself that my mental health was a problem I had to really face up to.”

Gask agrees that there’s still a lot of stigma surrounding antidepressant use. “Some people, including even therapists, suggest it’s an ‘easy option’ to take antidepressants [and that] we should be experiencing the pain of feeling very low, and ‘working through’ our suffering, not looking for something to ease it. I personally think that’s very judgemental,” she tells me. “My worry is that some people wait far too long before getting that help because of the stigma around antidepressants when they would help them to recover.”

Like Jess, it took me so long to get to a point where I felt ready to ask for help because I was ashamed to admit that I was struggling. When I look back now, it’s hard to believe just how desperate I was three years ago. I couldn’t sleep, eat, or wash myself. It got to the stage where derealisation kicked in and I stopped recognising the person in the mirror. At my lowest points, I felt as though I just wasn’t ‘cut out’ for all the ups and downs of life. Everything stopped feeling worth it.

It’s painfully obvious in hindsight that I urgently needed medication to stabilise my moods, but the stigma surrounding antidepressants made me think – even in my darkest moments – that going on medication was still a step too far. And yet, as Jess says, it should be “just like taking paracetamol to fix a headache.”

So, when should people raise the subject of antidepressants with their GP? “If they aren’t feeling any better despite trying therapy or self-help, or beginning to feel much worse. When you get severely depressed and it really affects your ability to function every day,” Gask says. “This is when you should definitely be having the conversation about alternatives – and antidepressants – with your GP.”

Jess still takes sertraline, but I came off antidepressants two years ago now. I would be lying if I said I wouldn’t hesitate now to go to my GP to ask about going on medication again – albeit largely due to unpleasant side effects, rather than stigma this time – but it’s safe to say that I will never let myself get as low as I did when I was twenty ever again.

Nobody should get to a stage where they feel as though they physically can’t go on anymore. It’s difficult to reach out for help, but you owe it to your future self to act sooner rather than later. Don’t deprive yourself of any more happy memories than you’ve lost already.

If you, or someone you know, is struggling with their mental health, you can find support and resources on the mental health charity Mind’s website and NHS Every Mind Matters or access the NHS list of mental health helplines and organisations hereIf you are struggling with your mental health, you can also ask your GP for a referral to NHS Talking Therapies, or you can self-referFor confidential support, you can also call the Samaritans in the UK on 116 123 or email jo@samaritans.org.

In Stylist’s new digital series Women and 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 digital.commissions@stylist.co.uk with ‘antidepressants in the subject line

Images: Getty/Ponomariova_Maria

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