The Argument for the Anti-Depressants

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Article by Ellen Scott for the Metro UK.

Whenever I write about mental health medication on the internet, I can guarantee I’ll get at least one comment, message, or email telling me how the pills I’m putting in my body will ruin every part of my life.

‘Pills are not the answer, except for Big Pharma’s balance sheet,’ wrote one commenter on my article about finally realising I need to get help. ‘This is the mistake of the almost ‘shamanic’ imaginary magic bullet for very real and very human issues of suffering, trauma and deep emotional pain.’

‘Drugs are merely escape, a postponement of the inevitable,’ wrote another.

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‘The brain needing extra serotonin complete rubbish there has never been any proof that depression is caused by lack of chemicals.’

I’ve received messages from mates from secondary school and great aunts, advising me to turn down the Fluoxetine and try running, talking, and ‘natural Chinese herbs’.

They nearly always come with a horror story of how one person took medication and it left them addicted, shakey, and miserable.

One old friend reached out to tell me that she’d made her boyfriend stop taking his meds entirely, and advised me to do the same.

‘I’ve made him stop taking his prescriptions because growing up with a sick mother who was given prescriptions instead of curing her, which is now chronic, they kept giving her higher doses,’ she wrote.

‘Her body now requires it because it’s used to it.

‘I would advise you to talk about it and get help without putting anything in your body. That way you can get straight to the root of why you’re having these panic attacks instead of hiding them with prescriptions.’

Add in to that the endless headlines and Pinterest quotes telling us how antidepressants will destroy our sex lives, make us braindead zombies, and even turn us into murderers, and it’s no wonder so many people get put off taking medication that could save their life.

Spend a day traipsing through mental health forums and Facebook groups and you’re bound to see memes declaring that pills are NOT THE CURE (usually paired with a picture of a forest that, apparently, is the cure), or another person talking about their experience and being met with shouty responses about why medication is very bad – usually listing off potential side effects or the experience of coming off meds as though they’re all medication can possibly cause.

I can’t imagine the same reaction towards drugs for physical illness.

Chemotherapy has a lot of nasty side-effects – pain, vomiting, extreme fatigue – but few people would advise people with cancer against using it.

I was curious about why some people seem so determined to stop people from taking medication for their mental health, and what motivated them to message strangers telling them to steer clear of antidepressants.

So I asked them.

First off, a Twitter user who’d prefer to remain anonymous, who tweeted in response to one of my articles about antidepressants with: ‘Depression is like smoking, YOU have to be the change, use your own will to overcome it. Big-pharma meds are wiping people out.’

Describing my article as ‘a casual discussion about taking drugs to lift your mood’ and a ‘classic hippy “get high to forget your worries” article’, he summed up my experience as: ‘Oh I was feeling a bit down & couldn’t be bothered to exercise or make myself a meal, so I decide to take drugs to feel better.’

Right then.

To me, this kind of tweet is a classic response: A completely misunderstanding of depression (it makes it significantly harder to exercise or make a meal, mate) paired with a slam against drugs as ‘getting high’.

I gave him a DM to find out why he was so determined to give me a telling off for my ‘classic hippy’ attitude of trying to use medication to stop me wanting to kill myself.

I was surprised to find out that, apparently, he’s actually taken meds before – so he’s not just the usual ‘I read this thing or saw this thing’ antidepressants critic.

‘Personal experiences from watching life long friends deteriorate into zombies and, in one case into an early grave,’ he told me. ‘Then my own case, where I’ve been close to sticking a knife into the side of my skull (thanks to anti-depressants).

‘This was around 10 years ago now. I stopped taking the meds completely.’

I asked him what techniques he used instead to help him with his depression without taking pills.

He said he’s been helped by walking his dog, exercising, learning languages, and doing woodwork.

‘I filled my day up and in turn I realized it was the emptiness that was leaving the door open for the negativity and feeling down all the time in the first place,’ he explained.

Which is completely reasonable. Doing more activities and exercising will absolutely make you feel better – it’s just tricky getting to the point that you’re able to get out of bed and do that.

Surely he could be sympathetic to knowing that exercise will help, but sometimes meds are needed to lift you enough to lace up your trainers?

Not really. He thinks it’s all up to the individual to sort themselves out without drugs.

‘The power was always mine (like it is yours) to fix you. Turn a negative into a positive! It’s all a trick of the mind.

‘Make yourself live better and do better, don’t give in the part of you that wants to hit the snooze button.’

He did state that he’s not ‘anti-antidepressants’, but instead wants people to find what works for them, but seemed to struggle with the idea that someone may feel they need meds. His advice boiled down to ‘come off the pills while you can’ and doing exercise.

So yeah, not exactly sympathetic to people’s struggles to do the things they know will make them feel better.

Like my school friend and a bunch of commenters, he’s one of the people who’s had a bad experience with antidepressants, blamed pills for their low point, and now advises others not to take them.

That’s dangerous, to be clear.

A lot of the low points people describe in these stories is often down to coming off antidepressants, rather than being on them, the side effects of sudden withdrawal being read as the fault of the drugs.

Other times, a bad reaction to one type of drug and dosage ends up with all medication written off. If medication doesn’t work and someone experiences a low point, the antidepressants get blamed and thrown out, instead of the kind of pills being taken getting discussed with a doctor.

It’s fair enough for bad experiences to put people off medication. What’s worrying is when they use their experience, or that of a friend’s, to convince other people that it’s a terrible idea to take meds.

But it’s not just the casual commenter with an anecdote contributing to the ‘DON’T TAKE PILLS’ brigade.

Noted experts in fields of health and psychology have been loudly bashing antidepressants for years, with their quotes being repackaged and used over, and over again by people hoping to warn people of medication’s dangers.

Professor Lennard Davis has written multiple times on why people shouldn’t take SSRIs, and is adamant that antidepressants simply do not work when it comes to treating depression.

‘There is very little evidence that antidepressants work,’ Lennard tells metro.co.uk. ‘In the gold standard clinical trials – double blind, randomized – antidepressants do as well as placebo.

‘The only category in which they show an effect in these trials is in the case of severe depression. The majority of people who take the pills have mild to moderate depression.’

He also warns of ‘a significant correlation between violent behaviour, suicidal behaviour, and taking antidepressants’.

This is a common suggestion – the BBC even aired a show about antidepressants ‘making people murderers’.

But even a cursory Google raises significant doubts about the link between antidepressants and violence.

Yes, a 2015 study noted a possible link between the use of SSRIs and violence in young people. But the researchers were hasty to state that there’s no undeniable proof that the SSRIs caused the violent behaviour.

In fact, the researchers noted that the young adults who took lower doses of the medication were more likely to be violent than those who took higher doses, perhaps pointing to violence borne out of depression itself and frustration at pills that didn’t seem to be effective.

One of the researchers, Seena Fazel, stated: ‘It may be that it’s actually a lack of treatment [and] and it could be residual symptoms that are driving the link’.

That’s really not enough evidence to confidently state that antidepressants cause violent behaviour – especially considering that the researchers found no link between SSRIs and violent behaviour in people over the age of 25, as well as the many, many people currently taking antidepressants who aren’t violent at all.

The suicidal thoughts link, however, is worth discussing.

Previous research has shown that antidepressants can cause suicidal thoughts, and every antidepressant you take will come with a leaflet listing suicidal thoughts as one of the side effects.

Studies note that in the majority of cases, suicidal thoughts happen when antidepressants are prescribed for problems not actually caused by depression or serotonin imbalances, such as anxiety.

Suicidal thoughts are a potential side-effect, and they’re one to watch out for closely. But I don’t believe this is a reason to avoid medication entirely.

Without pills, I had thoughts of killing myself on the reg. Without them, those thoughts don’t stick around.

Were I to experience an increase in suicidal thoughts, I’d go to my GP ASAP and ask what to do – whether it’s changing my meds or upping the dosage.

We should be doing more to explain that suicidal thoughts are a possible side effect that can be sorted – not using this link as a way to convince people antidepressants are terrible, which could lead to people feeling they have no way to deal with what’s going on in their head.

Lennard’s pointing to a few studies, rather than listening to the stories of people whose lives have been saved by antidepressants, means he’s quick to state that they simply don’t work.

‘Let’s not create a false story about how the drugs work (we actually don’t know), and let’s not use the serotonin hypothesis because it’s simply not true and no neurologist now believes it,’ he says.

‘And let’s not talk about correcting chemical imbalances when we don’t know what are the right balances.’

Noted antidepressants-basher Professor Irving Kirsch agrees.

‘The clinical trial data show them not much better than placebo,’ Irving told us.

He explains that while many people do see improvements from antidepressants, ‘most of the benefit is due to the placebo effect’.

Which may be true.

But when antidepressants are working to stop someone from considering suicide, the possibility that it might be down to a placebo effect isn’t really an issue.

‘I personally felt dead inside on antidepressants as they numbed all my feelings so I would disagree that it’s a placebo,’ Lisa, who’s been on Fluoxetine, tells us.

‘But even if it was – if they make you feel better, then what’s the issue?’

I was surprised that Irving agreed with that idea – to a point.

He stated that he wouldn’t recommend anyone who’s finding antidepressants helpful should stop taking them, even if the results are just down to the placebo effect.

He does, however, suggest that people try psychotherapy, physical exercise, and acupuncture before reaching for pills.

‘Antidepressants have a number of side effects and risks,’ Irving says. ‘These include sexual dysfunction, weight gain, insomnia, and increased risk of stroke, diabetes, and suicidal behaviour.

‘Also, many people experience withdrawal symptoms when trying to come off antidepressants. Finally, antidepressants can increase the risk of relapse and becoming depressed again after discontinuing them.’

I’m surprised to discover that a few of the people loudly slamming antidepressants on the internet are actually a lot gentler when you chat one-on-one, and seem genuinely concerned about side-effects and risks rather than concerns with the very concept of mental health medication.

I think what this points to is that there needs to be more information out there about what taking antidepressants can be like, without exaggeration or hyperbole.

People need to be prepared for potential side effects, as well as the very real difficulty of eventually coming off medication. They need to be chatted to about their longterm plan for tackling mental health issues, from how they plan to get accompanying therapy, to how long they’d like to stay on their pills.

Sarah Miller, who wrote an article of ‘reasons not to take antidepressants’, says she’s worried about the fact that people aren’t prepared for ‘what it’s like trying to go off of an antidepressant.’

‘It’s easy to research the possible side effects and risks of starting a medication,’ Sarah tells us, ‘but people rarely have the foresight to consider what it might be like someday when they want to stop taking it.

There are very real risks of antidepressants, they don’t work for everyone, they’re not a life-long solution, and they aren’t a magical cure-all for mental illness. That all needs to be discussed.

But the way to get that message across and make people feel better isn’t loud criticism of pills and the people who take them.

It’s not reductive advice to just get out there and go running.

It’s not comments in all-caps yelling about the pharmaceutical industry.

It’s about continued research into antidepressants, more information made widely available, and a greater discussion of mental health.

It’s down to doctors to fully prepare people for the side-effects they may experience, and to warn them that alongside medication, people should absolutely be getting some form of therapy to work through things.

I don’t believe that dramatic headlines and ranty comments are in any way helpful.

Instead, they put people off asking for help, making them feel that there’s no method to lift them out of the pit of depression. We need to open up avenues to getting better, not close them off.

We need to make people feel comfortable talking about antidepressants, asking for them, and asking for help if they’re not working correctly. Making people feel like they’re doing something wrong by taking medication in the first place won’t help that.

I get that the medication-bashing comments come from a place of concern and worry, from people who don’t want others to be stuck in damaging cycles or with terrible side effects.

But if you’re really keen to help someone struggling, listen rather than lecturing. Ask them how they’re experiencing medication. If they’re struggling, talk to them about the side-effects you’ve heard about and encourage them to talk to their GP.

If they’re doing better, let them go ahead and continue, because really, if you’re concerned about their wellbeing, you should be happy they’ve found something that works.

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