Let’s talk about depression

Markie Robson-Scott’s excellently researched and insightful article for the Independent, ‘What if the drugs don’t work?’, raises some interesting points from both sides of the debate over the effectiveness of anti-depressants. Having endured a fractious relationship with the happy pills on and off for the best part of a decade I felt the urge to comment from my own experience.

In her article, Robson-Scott speculates if we are in fact dealing with a placebo. Research into anti-depressants increasingly suggests little clinical impact besides the side effects that are universal among the myriad forms of medication. In fact Professor Irving Kirsch, associate director of the programme in placebo studies at Harvard Medical School and author of The Emperor’s New Drugs: Exploding the Antidepressant Myth, says there is no evidence to suggest that depression is caused by chemical imbalance, thereby rendering Selective Serotonin Reuptake Inhibitor (SSRI) drugs entirely ineffective.  “Depression is not a brain disease, and chemical don’t cure it.”

Are pills the solution?

I was prescribed the SSRI Seroxat-Paroxetine when I was 17 and continued taking it in varying dosages for the next six years and found it anything but ineffective, though how positive the effects were is debatable.

I’d felt like there was something wrong with me my whole life; an impalpable sense of dread that would arrive intermittently and without warning. In my teenage years, and the maelstrom of hormones this periods brings, the problem began to manifest as wild oscillations in mood. I could be on top of the world one day then barely able to get out of bed the next. The drugs really helped to restore the balance that I was so badly missing, something which I don’t feel can be attributed to placebo effect.

Therein lay one of the major problems with treating mental health with drugs – I went from extreme emotions to feeling nothing. Medication didn’t fix me, it made me numb. And then there are the side effects – lethargy, lack of enthusiasm, insomnia, the decimation of libido.

Kirsch believes these symptoms are a factor in the placebo effect. When we take an antidepressant we expect to feel better, therefore we do, and the side effects make us believe the drug is working.

Whilst at university, under the guidance of a brilliant GP, I changed my prescription to a different SSRI, Citalopram. My experience of anti-depressants didn’t fill me with great hope, but the difference I felt was immediate and powerful. I felt alive again; my enthusiasm and confidence returned. Since I didn’t expect to feel better, how could this just be a placebo effect as Kirsch supposes?

Ultimately I decided the side effects were too great and two years ago I became medication free for the first time in eight years. Since then I’ve tried to combat my issues in more natural and sustainable ways by improving my diet, reducing my alcohol intake and doing more exercise. I’ve honestly never felt better. I still have bad periods, but I’m learning to recognise the reasons for this and work through it. This works for me now, but in the past it may not have done.

My point is this: anti-depressants will work for some people and not for others. Psychotherapy isn’t suited to everyone. Some people may feel depressed for a short time following trigger moment, like a bereavement or relationships breakdown for example, so medication may not be the answer. For some people, like me, depression is a long term reality, something that is simply part of who you are.

A course of anti-depressants can work – it helped me to control my mood swings – but it should be seen as just one avenue to explore. It’s not for everyone, but it shouldn’t be dismissed.

The real problem is the ongoing and unnecessary stigma attached to mental health in this country. Having lived with it for most of my life I feel comfortable talking about it in the same way I would talk about having any other condition. I’ve been lucky as I have great support from family and friends, but others aren’t so fortunate. There is no shame in having asthmas for example, so why should there be with depression? Many people develop a long term dependence on anti-depressants because they feel shame and are reluctant to talk about their problems to professionals. Drugs are an easy fix. They’re anonymous and provide piece of mind in the midst of confusion.

The debate will rage on, but the truth is that until mental health is tackled with more dignity and frankness, people will continue to rely on anti-depressants without the understanding to challenge their health issues in other ways.