I am not writing this blog entry to firmly say that absolutely everyone who has any depressive symptom or indeed any shit in their life whatsoever should take antidepressants. Nor am I saying that anyone who has taken them and found that they haven’t worked should keep taking every single brand until they find the magic beans for them. From the tone of the blog thus far, as you’ll probably have guessed, I’m also certainly not saying that antidepressants are a croc of shit that don’t work! Guess what I am saying? That the effects of antidepressants are so individualistic that it’s impossible to make sweeping “one solution for all” assumptions about taking them.
My opinion is as simple as this….
YOUR BODY = YOUR CHOICE!!
Thankfully (and about bloody time!) there’s a lot of coverage on mental health and stigma- including the stigmatisation of antidepressants, so I’ll only discuss that quite briefly. The thing that I then want to talk more about is the pro’s and con’s of antidepressants based on my own experiences and commonly cited experiences, and not on ill informed stereotypes of the people who take them, the doctors who prescribe them or the effects they have (placebo or otherwise).
It’s amazing how divided people are on the topic of antidepressants in a society that claims to be as liberal, open minded and empathetic as ours. The stigmatisers among us give a very firm nay with no room at all for manoeuvre, making me think that society is nowhere near as it should be on any of those fronts. Give yourself 5 points for each sentence that you’ve heard from team stigma:
- “You don’t want to be taking them, you’ll become addicted”.
- “I was brought up to just get on with things”.
- “Life is a little bit stressful, deal with it!”
- “They won’t do anything that exercise and a healthy diet can’t do”.
- “If you just got up early and went to bed early, you’d feel so much better and wouldn’t need them”.
- “They’re a massive money making con!”
How many of you have got the full 30 points? 25? 20? 10? I bet you’ll have come across at least 2 or 3, either directed at you or someone you know. I also bet that you’ll have heard some that I haven’t included. Please put them in the comments section.
In response to some of these ill informed and hurtful opinions which make us feel even more isolated, even more inept and even more like we’re “getting all upset over nothing”, than we already feel (these comments make us realise that, yes, THAT IS POSSIBLE)…
- “Addictive” claim… (For the scientist readers (or people who are just more scientifically skilled than me, without being scientists), please forgive me for being a bit amateur with this bullet point and feel free to comment any other information). New antidepressants and new chemical formulas are coming from the labs regularly, which means that the addictive substances (and other negative substances) are being more and more isolated, and subsequently removed, from the chemical formulas. Addictive substances tend to be benzodiazepine based tablets such as diazepam and triazepam, and doctors are hugely reluctant to prescribe these at all, and if they absolutely have to, they’ll monitor your intake very closely, and only give you small amounts to lessen the risk of addiction as much as possible. The most commonly prescribed antidepressants are serotonin uptakers (SSRI) antidepressants which enable the serotonin neutotransmitters in your brain to produce more serotonin (the ‘happy’, or should I say ‘balanced’ chemical in your brain), which your brain is not producing enough of either due to prolonged stress, a traumatic event (or several), or purely biological reasons. They do not give you an instant fix like benzodiazepine based tablets, sedatives, alcohol or recreational drugs – so you don’t crave that instant gratification. The effects are very gradual (often over several weeks), and so, in my opinion, very hard to get addicted to!
- Weren’t we all just brought up to get on with things?! No one is brought up to think “when the going gets tough, hide under the duvet until you get severely dehydrated and have no choice but to move, and at all costs, avoid the terrifying world where everyone is out to get you; lose friends; cry everyday or feel too numb to cry; feel confused by even the smallest things; have crippling panic attacks where you can’t breathe or sleep; sleep constantly or don’t sleep at all for several days, and above all, make sure that you have suicidal thoughts!” This is what happens with depression, and just as you wouldn’t deny a severely diabetic person insulin, nor should you deny a severely depressed person antidepressants which, rather than making them bounce around like a delirious Tigger, will make them function.
- Yes, life is a bit stressful, and at times in my life when I am well, I am very aware of this and am able to take the rough with the smooth far more resiliently- even if having AS makes my ability to tolerate stress lower than those without it. However, when the proverbial black dog strikes, you’re ability to do even the simplest things, leave alone handle stress, is severely damaged (but not beyond repair for those battling depression that are reading this).
- Yes, exercise and a healthy diet do make you feel better- but believe me, when you’re so low that you feel as though you’re wading through treacle in big wellies, exercise and diets are the furthest from your mind. Nor do exercise and healthy dieting stop the paranoia, the panic attacks, the numbness or the worthlessness, and if they do, they only give momentary relief. They help if you have enough serotonin in your brain to fight the negative emotions, in which case, but not if you’re lower than rock bottom.
- Some people are naturally nocturnal (like me) and some are naturally morning people. Don’t assume that what makes you happy makes someone else happy. Regardless of how my mental health is, when I get up early in a morning, I am so miserable and grumpy that people very wisely avoid me!
- Who are they conning? Doctors? Patients? The NHS? People research these tablets just as they do tablets for physical illness, and you wouldn’t for one second think that tablets for, say, high blood pressure, heart disease, or other physical conditions were a con, would you? Come on folks, a bit of thought please!
Now onto the second part of the blog….
Antidepressants are, as far as I’m aware, divided into some of the following groups… SSRI and SNRI antidepressants which help your brain to boost its own serotonin levels, and tricyclic antidepressants (I don’t actually know how these differ from SSRI’s- anyone who knows, please comment below). I have tried lots of different types of antidepressants, some of which have worked better than others, and some of which have worked more effectively at different times in my life.
Commonly prescribed SSRI’s are fluoxetine (a type of prozac), sertraline (also known as zoloft) and citalopram. These work on the neurotransmitter in your brain that controls depressive symptoms or the neurotransmitter that controls anxiety, and not both simultaneously. SNRI antidepressants include Venlofaxine and Duloxetine, and these simultaneously work on both neurotransmitters . These differ from The tricyclics which I have heard of are dosuplin (very sedative based) and lofepramine. (Comment anymore that you know of).
Upon taking ones that worked well for me, I remember having a miraculous moment of thinking “I feel like the bubbly, slightly crazy, fun loving girl who appreciates humour that I was before I was depressed”- and that wonderful feeling continuing for a long time. Sertraline and citalopram especially helped to regulate my sleep, feel less paranoid, feel motivated to get out of bed, feel like I have something to offer the world, have less panic attacks and have less suicidal thoughts- or ones that gradually became less and less frequent and less and less overpowering and intense. They also helped me to more adequately assert myself in situations where someone said something to annoy or upset me so that I could resolve things calmly and tackle them head on, rather than running away from my problems and crying or just quietly feeling worthless. They helped me to stop hiding from the world and to feel capable of being and inclined to be an active part of it.
However, they do not work in solitude. Talking therapies are also hugely important for understanding where your thoughts come from, for helping you to put traumatic events from the past behind you, and for realising your self worth. Tablets can’t give you coping mechanisms, nor can they tell you things like “you’ve achieved x, y and z, be proud of that”, “anyone who has bullied or underestimated you doesn’t dictate who you are or what you’re worth”, “you’ve overcome a lot”, “don’t worry about what you haven’t achieved yet, you still have time to achieve them”, and “your family and friends love you very much”. Sometimes antidepressants are needed to give you enough serotonin levels to be able to face talking therapies, but antidepressants won’t help you to overcome all of your barriers- only the ones that strip away your motivation, concentration and replace them with abject fear, despair and apathy.
Antidepressants also have side effects- different people report different ones. The side effects of fluoxetine and venlofexine were so severe that they stopped me from being able to feel the benefits. Fluoxetine made me feel as though I had severe flu. It was only when I wondered why I’d had “flu” for a whole month that I made the connection. Venlofexine made me feel extremely sick and dizzy.
Sertraline and Citalopram, however, had the benefits cited above, but did have some side effects. It was really a case of trading some feelings for others. Both made me feel a dramatic decrease in my sex drive. I remember someone else telling me this before I tried taking them, and me thinking “it’s impossible for that to happen to me”, but low and behold, it did! During times of being single, this has been a fantastic form of chemical castration, so to speak! During times of being in a relationship, I didn’t appreciate this side effect so much!
Sertraline made me feel very sleepy a lot of the time and massively increased my appetite. I also found it fantastic for soothing my anxiety and preventing panic attacks, but while the anxious part of my brain which tells me that DISASTER IS IMMINENT was silenced by sertraline, the depressive part which tells me that things are pointless, that people don’t like me, that I’m just too exhausted to even think, let alone do anything other than eat crap, get fat and hide from the world, was too strong for sertraline to shmite down!
Conversely, citalopram is hugely effective for disabling the depressive part of my brain, as well as making me notice that I am far less greedy with eating. I found that the very anxious part of my brain was still very much giving me grief, but that I feel more able to control it.
Times when I’ve been consistently low or consistently having panic attacks have been times when antidepressants made me remotely able to function. However, times when it is my difficulty in tolerating distress, going through a stressful time or trying to quash down negative emotions and embrace positive ones, I have not found them effective.
So, it very much depends on how well I’m functioning and what exactly I hope to feel or to achieve as to how well they’ll work.
Don’t think that side effects that I have will be the same for you. Everyone is so biochemically different that it’s impossible for one tablet to have the same effects on everyone. Whether or not antidepressants are for you is something that only you can decide. Don’t feel pressured either way.
Although this has never been an issue for me, make sure that you discuss with your doctor which antidepressant you can take with other medication so that they don’t clash, which ones you can still take if you’re pregnant, and how much to take (regardless of the previous factors). Also make sure that you have regular medication reviews with your doctor, and if you’re not satisfied with or feel dismissed by one doctor, see a different one. Don’t suffer alone.