As the debate around antidepressants ramps up, we asked a Community Pharmacist to dispel some of the biggest myths.
In the debate around antidepressants, good advice is increasingly hard to find amongst the onslaught of hot-takes and opinions. We asked a Community Pharmacist to dispel some of the biggest myths.
Starting an antidepressant course for your depression or anxiety can be a weird and daunting prospect; kinda like jumping into a portal to an alternative self. Visions of disturbing side effects, loss of character and medical dependency may be bombarding your psyche, and worsening your angst ten-fold.
Will my precious baby-making tools rot and fall off? Will I be numb to the world? Will people still recognise me after I’ve gained five stone and cultivated a continuous film of sweat?
Many patients prescribed antidepressant medication will often shun their prescription amidst crippling fears and misconceptions. Although mental health is being talked about more than ever, our healthcare system is struggling to support its population. It’s important we expand our discussion of antidepressants to reflect how widely they are prescribed: 64.7 million antidepressants were dispensed in the UK alone in 2016. Recently, Johann Hari has shed light on the need for us to redistribute our focus from chemical solutions to more holistic solutions, but has also been accused of stigmatising users. We can’t turn away from the benefits that can be found in antidepressants.
I come into contact with patients newly started on antidepressants almost on a daily basis as a Community Pharmacist, and at times I am shocked at the lack of vital information passed on to patients by their prescribers. Whether it’s due to poor patient engagement or lack of GP time, many patients have a perturbing fear of starting their medication.
The truth is, new antidepressants, such as the SSRIs (selective serotonin reuptake inhibitors) Sertraline, Fluoxetine and Citalopram are safer than the older Tricyclics (Amitriptyline), and prescribers are more aware of their effects than ever before. Although the success of these drugs is still up for debate, many people still feel the benefits of antidepressants.
However, this information doesn’t always land at the protagonist: you, the patient. There are still truths and myths about these meds that aren’t reaching every corner of the population.
“I’ve heard they are no more useful than swallowing a blue Smartie.”
Truth is, the science around why antidepressants work is a little hokey. Much of it was based on the Serotonin Theory; the idea that a person has low levels of this “happy” chemical in their blood. The solution? Increase it.
But this is now seen as far too simplistic – it doesn’t consider things that are going on around us: our jobs, our family, our upbringings, that weird, orange testicle-looking thing in the White House.
Scientific evidence has further helped discredit this theory. Studies have revealed antidepressants to be only marginally more effective than, or even equal to placebos. However, these studies aren’t without their flaws. For example, most studies use what’s called the Hamilton Depression Rating Scale, a questionnaire that results in scores ranging from 0 (the happy baby from the Teletubbies) to 52 (severely depressed).
Questions have been asked as to whether it accurately represents a person’s mental health. For instance, a patient will score the same amount of points for having already attempted suicide as someone experiencing severe loss of libido and noticeable weight loss. The truth is we can’t say for sure using graphs, charts and numbers how well these drugs work.
On the other hand, there are a shedload of people who have really benefited from taking antidepressants: a common thing people report is that they helped turn down the “noise” in their head, giving them room to then start tackling their condition.
“I’m worried I’ll become addicted or labelled a drug addict.”
People don’t become dependent on antidepressants the same way you might with other meds that can be used to treat anxiety, such as Valium (Diazepam) or even recreational drugs like alcohol, weed or coke.
You won’t need increasing doses to get the desired effect. You’ll be started on a low dose, the same as anybody else, and this won’t change for at least the first 3-6 weeks. The dose may be increased based on your response, any side effects experienced and any change – positive or negative – to the severity of your condition.
But you can’t come off them whenever you like.
Immediate and unplanned withdrawal may result in relapse, or withdrawal effects such as flu-like symptoms, insomnia, rapid weight loss, nausea and a whole load of pretty nasty stuff.
The severity and likelihood of withdrawal differs depending on meds and the individual, and the intensity of a withdrawal is eased with gradual reduction and review from your prescriber. The current thinking is: the longer you’ve been on them, the longer the withdrawal period is likely to be – always check in with your GP if you’re not feeling right after stopping your meds.
“I’ll become a huge walking zombie, cut off from the world and sexually inept.”
With all good things comes the bad: after the drink comes the hangover, after the sugar comes the weight gain, after the five-hour Netflix binge comes the remorse-ridden existential angst, and after medication come the side effects.
You will experience side effects upon taking an antidepressant; these will vary from person to person. Most people who continue taking antidepressants find their side effects mild enough to stay on their medication and find the benefits outweigh the negatives.
To take Sertraline as an example, manufacturers use the following categorisation to represent the likelihood of side effects: Very Common (affecting more or equal to 1/10): Insomnia, dizziness, headache, nausea, diarrhea. Common (between 1 in 100 and 1 in 10): Erectile dysfunction, constipation, feeling agitated/anxious, loss of libido. Uncommon (less than 1 in 100): Apathy, cold sweat, irregular menstruation.
All of these together sounds like a total fucking bummer, but you’d be very, very unlucky to experience them all. Some people may try as many as 3-4 different medications before finding the one that suits them best.
In cases where side effects are too severe, another drug or drug type can be used. There are also MAOIs (Mirtazapine) and SNRIs (Venlafaxine), which may agree with you better.
“If I take them and they make me happy, I will be on them forever or never be happy without them.”
If you’re taking medication and you start to feel better, it’s advised to remain on your medication for another 6-12 months depending on your original diagnosis.
All in all, taking a tablet a day won’t make you see the world through a warm and fuzzy lens, and it won’t guarantee you the ability to charmingly fumble your way through life’s problems with the inconceivable proficiency boasted by the cast of Friends. A holistic approach is the best bet – this may mean supplementing your treatment with non-medical therapies such as Cognitive Behavioural Therapy (CBT).
CBT is available to everyone on the NHS and, despite aforementioned long waiting times, it is widely regarded as the most crucial antidote to issues around mental health. Meditation, a decrease of internet and social media use and a healthy lifestyle of clean eating and moderate exercise are further vital paths to a clearer head.
At times it feels like we’re tip-toeing closer to a dystopian Charlie Brooker-esque nightmare. Re-engaging with the community, family members, interacting with nature and carrying out meaningful and rewarding tasks will help draw us back to our roots.
Finally, a reduction of alcohol and whatever powders and plants you keep in your bedside draw may be a necessary step in the right direction.
A combination of these things to varying extents can be enough to keep someone in a stable mood and free from medication. If you feel confident and comfortable in your mental state, after enough time you can discuss coming off your meds with your GP or prescriber.
“My GP and Pharmacist look at me with the same hopeless, duty-bound glare they may have when taking their bins out in the morning.”
You may feel like you are an inconvenience to your nearest healthcare professional, you may coyly tiptoe around them to avoid a snarled glare or a petulant sigh. But, they are there to help, and a lot of them are happy to. Pharmacists, are very well suited to talk through your medication and are always available to offer advice. It’s important to confront your reservations over medication to get the most out of your treatment.
We need a major change in how we tackle depression, socially and medically. This will never happen overnight, and there needs to be an increased or re-distributed funding to mental health, as well as a progressive and candid attitude towards mental health in our society.
As we now know, antidepressants aren’t the final answer, and a nudge towards non-chemical solutions is needed. Although antidepressants are still an important aid, they don’t work as well as we’d like, and the side effects can be grim – but, if you find the benefits are outweighing negatives for you personally, there is still plenty of value in antidepressants.
There’s a pile of top-notch, safe and reliable advice online at NHS Choices, and the good people at Mind.org.uk are always around to offer a helping hand. The most important thing is that you receive all the vital information available to ensure you can make the best decision about your mental health.
Jonny Winship is a writer and Community Pharmacist.
The information in this article is intended only as a guide. Please consult your health provider before taking action.