When Sarah Thompson told her friends about the wonders of antidepressants, she discovered that most of them are already on them. How did pill-popping become so routine?
By Sarah Thompson
8:00AM BST 15 Jun 2014
I think my GP was as relieved as I was when I finally asked about antidepressants. I had begun to plague him with visits, convinced I was suffering various obscure diseases and syndromes. He always politely reassured me, while trying to disguise the look on his face that said, “You used to be so normal.”
Hypochondria was a symptom of the anxiety that had crept up on me since having children. Once a happy-go-lucky kind of girl, I had begun to live in my own personal disaster movie, seeing catastrophe at every turn. I had panic attacks when I drove, fearing I would lose control of my hands at the wheel and veer into oncoming traffic. Once, on a railway platform, I became so scared of falling – or involuntarily jumping – in front of a train that I looped my bag around my ankle and attached myself to a bench.
I went crazy for safety, certain something terrible would happen if I didn’t unplug all the home appliances every time I went out. Darker than this was the worry that I might accidentally harm my children. I wasn’t depressed and I wasn’t suicidal – quite the opposite: I was desperate to stay alive – but I was in a state of abject terror. On top of the fear came the self-loathing, and the despair that I didn’t recognise my own mind anymore. It was dark in there. I wanted the lights back on.
Like many people, I had always seen taking antidepressants as cheating – the mental-health equivalent of liposuction. But my GP assured me that my request was perfectly valid. He diagnosed me with postnatal anxiety and gave me a prescription for citalopram, one of Britain’s most commonly used antidepressants, or SSRIs (selective serotonin reuptake inhibitors). Other popular SSRIs include fluoxetine (Prozac) and paroxetine (Seroxat). They all differ slightly but work on the same principle – boosting levels of the feel-good chemical serotonin – and, although we call them antidepressants, are used to treat a range of mental-health disorders, including anxiety, OCD and phobias.
Four weeks later I was cooked to perfection: wonderfully light and deliciously blithe. If my husband tried to have an argument I would burst out laughing at him. If the children wanted to spend the day in their pyjamas, that was absolutely fine. We had discos in the kitchen. It was bliss.
26 Oct 2012
01 May 2014
28 May 2014
With wide-eyed enthusiasm I started telling friends who I knew were struggling how great these pills were, urging them to get some too. It was then that I realised I was a little late to the party. Turned out it was already quite a bash. From the friend who didn’t love her husband but stayed for the children, to the one with the stressful career, the single mother struggling to make ends meet and the colleague who had been on Prozac for 20 years – suddenly it seemed as though every woman I knew was propping up her mental health with pills. In a straw poll of 10 immediate female friends, I discovered eight of them were taking or had taken antidepressants.
Where once our coffee mornings had been all bitching about husbands and discussing plans for the evening meal, they became a sort of antidepressants drop-in clinic. None of us was judging anyone – how could we? – but the scale of use astounded us all.
Was this a local phenomenon? Was the town where I lived facing an epidemic of middle-class misery? Apparently not. According to the Health & Social Care Information Centre, prescriptions for antidepressants stood at about 28 million in Britain in 2003. By 2012 the figure was 50 million. Meanwhile, a survey by the charity Platform 51 found one in three British women had used antidepressants. (Figures for men are harder to come by, but anecdotally they are nearer one in 10.) So it wasn’t just me and my friends.
Why then? What was happening that we felt we needed pharmaceuticals just to get through the day? The reasons were many, but underlying everyone’s story was a sense that life hadn’t turned out how we had expected. There was a disconnect between our expectations and the reality of our daily grind.
Emma, a nurse and mother of two, felt the pressure after having her first child: “I thought there was a right way to do things and if I didn’t do it that way then I would mess up my kid’s life forever. I gave myself no room for error. When my daughter couldn’t breast-feed I felt like a failure. I thought that was motherhood, and life would be misery from there on. Taking antidepressants lifted a veil.”
Friends without children were also buckling. Sophia, a civil servant in London, found herself unable to get out of bed one morning: “I’d been working long hours, holding down this big important job, looking to all the world like a high-flyer, while trying to manage quite a destructive relationship at home. I just imploded. I couldn’t stop crying. Antidepressants made me feel the happiest I’ve ever been. I worry because now I’m trying for a baby and I’m not sure I should stay on them, but I really don’t ever want to stop.”
Certainly it’s not news that today’s women are facing enormous pressures: to have a brilliant career, a meaningful relationship and perfect children, while curating a capsule wardrobe, saving the planet and doing naked yoga. The confusing thing, says Cosmo Hallström, a consultant psychiatrist and a fellow of the Royal College of Psychiatrists, is that life – on the surface at least – is better than ever for most of us. “Services are better, education is better, we have comfortable homes and plenty of entertainment,” he says. “But, as the standard of living has accelerated, our expectations have grown. We are bombarded with messages about how great life should be and feel like failures when things don’t turn out like that.”
But then haven’t there always been pressures, as any family gathering involving a grandparent or two tends to suggest? Our modern woes, with their emphasis on unrelenting happiness and personal fulfilment, seem rather vain and self-obsessed in contrast with those of women in the past. Have we simply lost our backbone? Are we a generation so cosseted that we’re no longer able to cope with normal human trials and tribulations?
As my late grandmother always seemed to enjoy telling me, “Nobody said it was easy.” While the concept of mother’s little helpers is nothing new – our mothers had Valium, their mothers gin and low expectations – when you are confronted with the massive reality of it, when virtually every woman you know is on antidepressants, that’s quite a big deal, isn’t it? You can’t help wondering whether we’re taking them because we really need to or just because we can. Are we like children who, having opened a forbidden packet of biscuits, gorge away until a grown-up stops them or until they make themselves sick? Does the biscuit tin need to be placed on a higher shelf?
The Council for Evidence-based Psychiatry (CEP) certainly thinks so. The CEP is a body of leading medics, psychiatrists and academics who have come together to deliver a collective wake-up call, highlighting what they say are the potentially harmful effects of antidepressants and the “medical model” for treating mental-health disorders.
Dr James Davies, a psychotherapist and a co-founder of the CEP, thinks that as a society we are progressively lowering the bar on what constitutes mental illness. “More and more of our normal, natural, albeit painful experiences are being wrongly classified as psychiatric conditions – all of which leads to more prescriptions for powerful psychotropic drugs,” he says.
The comedienne and mental-health campaigner Ruby Wax, whose own battle with depression has been well documented, has characteristically strong views on the subject. As she puts it, “We’re all going to the doctors saying, ’Mummy, fix me,’ when we should be taking charge of our own minds, finding out how the machine works.”
Wax argues that we have lost many of the community connections that used to help us deal naturally with low mood – places such as church, and chats over the garden fence – and have become too reliant on GPs for our salvation. In her manifesto for mental health, Sane New World: Taming the Mind, she suggests drop-in centres where people can share their experiences, as happens at Alcoholics Anonymous meetings, and access talking therapies such as mindfulness and cognitive behavioural therapy (CBT). “How did they [AA] organise these get-togethers so well? They have meeting places on every corner – more than there are Starbucks – and these people are drunks!”
It’s a brilliant idea – I for one would be a regular at my local centre – but it would probably require the kind of investment from government that isn’t going to happen any time soon. However, “talking therapies” along the lines of CBT and mindfulness-based cognitive therapy (MBCT) are increasingly being seen as credible alternatives to prescription drugs: my local health authority in Dorset, for example, has recently launched its own talking-therapies scheme, allowing patients to self-refer without first having to consult their GP. Although slightly different in their approach, CBT and MBCT work on similar principles: encouraging an understanding of how our thoughts, feelings and behaviours interact and a focus on the present. The idea is that greater awareness of our emotions and thinking helps us manage rather than feel overwhelmed by them. (You can get started on MBCT on your own with a book such as Mindfulness: A Practical Guide to Finding Peace in a Frantic World by Prof Mark Williams and Dr Danny Penman.)
For Fran, a 45-year-old self-employed mother who has taken antidepressants in the past, CBT sessions offer the perfect mind-maintenance regime: “I feel happier knowing I’m learning the tools to deal with my anxiety naturally. It’s like doing yoga or Pilates for the mind. The pills numbed me to the experience entirely, whereas CBT helps me put things into perspective by myself.” But access to these therapies is patchy at best. Waiting times vary between local authorities and can be anything from a fortnight to a year – and even two weeks can seem like a lifetime when you are feeling low.
Jim Woods, a GP based in Devon, says that the long wait for counselling appointments is sometimes the reason why he prescribes antidepressants. “You take a holistic view and talk about how they can improve things,” he tells me. “But you also want to help, and there is often a long wait for CBT and counselling. If they need help and you can’t prescribe something that will work immediately, then you’re not really helping. And antidepressants do work.”
Just how safe the pills are and managing life after them are the other elephants in the doctor’s waiting-room. Google “side effects of antidepressants” at your peril – or only if you are on a very high dose of them and therefore couldn’t care what you discover – because the stories of collateral damage can seem terrifying: loss of libido and sexual function, headaches, memory loss, dizziness, insomnia, problems urinating… Prolonged use has also been linked to type-2 diabetes and, in extreme cases, suicidal thoughts.
Prof Jonathan Haidt, an American social psychologist, TED Talks poster-boy and the author of The Happiness Hypothesis, says that we feel uncomfortable and tend to moralise when people try to improve their lot, particularly if they do so with “short cuts” such as pills. But, he adds, that doesn’t mean it is wrong for them to try. “I think it’s misguided and intolerant to insist that everyone must only achieve personal changes through hard work, and not through something as simple as a pill. Many people find SSRIs help them be the person they always wanted to be and wish they’d discovered them 20 years earlier.”
It’s a dizzying picture. The rights and wrongs, the causes and cures – they’re almost enough to make anyone feel depressed. What is crystal clear is that many women genuinely feel unable to cope with the situation in which they find themselves. And while we would welcome more therapy and counselling, in a time of mental crisis we’ll take whatever we can get our hands on when such options are not instantly available.
As for me, I’m off antidepressants now, navigating life relatively anxiety-free. Medication restored my cheery disposition, but it also made me feel weirdly numb. I missed emotional contrast, the light and shade of life, which had been eclipsed by the dazzle of artificial sunshine. So I’m doing all the boring things, being more mindful and going gently through life. And it feels OK.