When the news broke that two million people in England are taking antidepressants for more than five years (as part of an investigation by BBC Panorama), I rolled my eyes. Another day, another negative news story questioning medication for mental health.
News reports like this can increase stigma for the eight million of us taking this medication – in my case, daily since 2007 for clinical depression. Ask anyone on antidepressants about the alternative remedies suggested by well-meaning people, and you’ll find a very long list. I’ve been told to eat more wholegrains, go vegan, take up running, get a dog, and move abroad; you might have noticed that people who do these things aren’t magically cured of their condition, otherwise the NHS would definitely offer vegan food and dogs on prescription. Yet taking a pill or two (currently, Venlafaxine and Lamotrigine) has helped to steady me.
It sounds bleak, but without medication as part of my treatment, I’m certain I would be dead. In my 16 years of being depressed, I’ve had two nervous breakdowns, plus a severe episode this year when I moved house at the same time as I changed jobs, and began having suicidal thoughts. Each time, my medication was gradually tweaked, and it supported my recovery. Mood stabilising medication can’t take away your problems, but it can reduce the crushing lows and the spontaneous crying. I think of it like having a warm winter coat; if people with good mental health always have their winter coat to rely on and buffer them from the weather, going unmedicated with my condition is like heading out into the snow wearing just a slip dress.
I’ll admit, the statistics on medication can look bleak – NHS England issued 22 million antidepressant prescriptions for 6.6 million people from October to December 2022 – but these tablets can be a lifeline for a range of mental health conditions, plus they are often prescribed for conditions like chronic pain, migraine and myalgic encephalomyelitis (ME). If you think you don’t know anyone on antidepressants, you’re wrong – it’s just that they don’t speak about it for fear of being judged.
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Whilst many people’s depression will be successfully treated and relieved in a short period of time, people like me with a deeper-set condition cannot manage day-to-day without antidepressants as part of the mix. At first, I was embarrassed about being depressed, believing I had no right to feel so low when I’d had a normal childhood and no obvious trauma or life events to cause it, much to the annoyance of some therapists. I later learned that depression runs in my family, though even if there had been no genetic link, you don’t have to earn or justify being depressed. If you’d told me in 2007 that I’d still be medicated, I would have been shocked, but guess what? Mental health conditions don’t have a time limit. Recovery isn’t linear.
I often read about people who say coming off antidepressants was the best thing they ever did, but mental health conditions are deeply personal, and the treatment that works for one person won’t necessarily help another. It has taken some trial and error to find the right combination for me - the worst drug, mirtazapine, caused a nine-day migraine, yet my friend takes it every day with no ill effects. The BBC report also discusses withdrawal effects from these medications. Slowly reducing the dosage, known as tapering, should always be done under supervision of your GP or psychiatrist. It’s important to remember that withdrawal symptoms are by no means exclusive to antidepressants, yet we rarely hear about the side effects for patients on other prescription drugs. When switching medications I had some slight symptoms, like insomnia when coming off a pill called quetiapine with a sedative effect, but nothing that lasted longer than a few days.
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Talking therapy is another part of a treatment plan for many mental health conditions, but it isn’t easily available. NHS provision of talking therapy can be patchy and often limited to a strict number of sessions (typically 6-12). There’s certainly a demand for these services; NHS England handled 1.24 million patients for its IAPT programme in 2021-22, an increase of 21.5% on the previous year. In Scotland, the Scottish Government has a standard that 90% of people needing psychological therapies should start them within 18 weeks, but more than four months is still an incredible delay if you’re depressed or anxious; in Wales, a report by Mind found that some people had been waiting two years for talking therapy. It’s also worth noting that each therapist has their own approach, and you might not gel with the person you’re assigned, or the type of talking therapy they offer – for example, I found it impossible to work with a counsellor who used the Freudian method of sitting in silence and waiting for me to speak. Equally, talking isn’t for everyone, as the Princess of Wales said when she visited an arts therapy charity earlier this year.
What’s more, private talking therapy is an extra burden during a cost-of-living crisis (and, unsurprisingly, the ONS found that rates of depression are higher among renters than owners, and those who struggle to afford energy bills or housing costs). If you’re facing private therapy bills, it’s worth looking for counsellors or therapists that offer subsidised rates. Because of this gap in care, it’s unrealistic to expect long-term antidepressant use to decrease – many of us need more support right now, not less, and medication provides that. I’ve tried several different talking therapies over the years, from counselling to Cognitive Behavioural Therapy (CBT) in groups and individually. I’ve also tried mindfulness, meditation and art therapy, with mixed results; my best combination has been CBT, peer support and yoga, with medication enhancing it all. If you know someone who takes an antidepressant long-term, be proud of them for managing their health. They need your support.
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