Three weeks after I began taking Prozac I got up off the sofa and made a cake. I’d barely moved for weeks, wasn’t working in either sense, barely speaking at times, nor sleeping nor eating. The cake turned out not like a cake at all, but more of an oversized biscuit. My housemates peered at it and then me, cautiously, before eating a slice due to what I assume was a combination of hope – that this “episode” was over – and pity. I returned to the sofa the next day. It was quite the reprise, while it lasted.
I have been taking antidepressants since 2017, when my mind stopped working and my body followed suit. Propranolol, first, 40mg, 80 soon enough, to stop my heart trying to beat my chest wall down, then fluoxetine, more commonly known as Prozac – the one with all the connotations. A year after I was first prescribed it, I was weaned off again. I’ve been on 40mg of citalopram ever since.
You might assume, then, that right now I am not in my right mind. At least, not in my most natural state. I am fuelled, in part, by the things that my friends say they would “never take”, that they “don’t know what it might do to a person” and that some “just don’t believe in?” (it is inexplicable to me and always, inexplicably, framed as a question). These synthetic little things, that release little chemicals and come encased under alien names are part of my physiology now. Each morning I pop them out of their packets, knock them back and decide to be a bit better today.
While there has long been a somewhat frenzied conversation around antidepressants – around their effect, debate over exactly how they work, whether they work, what residue they leave behind – yesterday a new one began. Newspapers began to report that the Royal College of Psychiatrists (RCP) have called for an update to guidelines for patients coming off their drugs. While current guidelines suggest withdrawal should take place over a period of around four weeks, patients coming off them too quickly – especially those who have been taking antidepressants for long periods of time – could experience side effects that last far longer, they say. The guidelines are being updated to be “in-keeping with what [they’re] hearing from some patients – and GPs”, Wendy Burn, the president of the RCP said, “about the range of experiences of coming off antidepressants”.
The Daily Mail’s was the first report that came up on my feed this morning to inform of this news. “Antidepressants CAN ruin lives,” the headline read. “Major U-turn as psychiatrists say millions of patients MUST be warned over severe side-effects”. The paper smugly declared the news as a “major victory” for the Mail who have spent the last two years sharing terrifying stories about people ceasing to take antidepressants and the process that follows.
It is, without doubt, an excruciatingly serious subject. The number of prescriptions for antidepressants in the UK almost doubled from 2007 to 2017, to 82 million, according to one report from the RCP, which also shows that diagnoses of depression have increased. For a long time, the effects of reducing or ceasing a dosage appeared to be somewhat dismissed. While withdrawal can be a frightening thing – it might mimic the despair of acute depression, taunt its user with fear of recurrence of the disease that led them down this path to begin with – there is alarmingly little research on it. We are told to reduce slowly, never come off drugs that help the mind cold-turkey. It makes sense. Scaremongering does not.
The fear around antidepressants is unavoidable and affronting. It seeps into us by osmosis. The nineties “Prozac Nation” boom and the subsequent fear over mass consumption seemed to set into motion a narrative that, in some parts of the media, creates a sticky web over the facts and distorts reality. For many, it’s simple – more we are unbalanced about antidepressants, the less people will be open to their help. The irony of newspapers like the Daily Mail being so incredibly irresponsible with people’s lives – while accusing medical professionals of irresponsibility – should not be lost.
Many, including me, feel strongly about this because antidepressants are the reason they are still around. Do not misunderstand – antidepressants did not “save” my life. On Prozac, the side effects became another thing to deal with. My head itched constantly (interestingly, my mum had the same experience on them), my jaw clenched and tightened and I began grinding my teeth to the point that they chipped. By the time I came off them I was also experiencing restless legs – I couldn't stop moving them and it kept me awake at night. But inside my mind they nonetheless helped create an environment and a mindset in which I was able to help save myself, with the help of kind and patient friends and family, and NHS therapy.
Rejoicing, as the Mail does today, that their cause may help less encourage less prescriptions of antidepressants helps no one recover from severe depression in a way that suits them. There is no dispute that proper, responsible regulation over these drugs is a must – as well as increased, in-depth research – but it’s not that we shouldn’t take them, or even, arguably, that they should be prescribed less. It’s that more options should be available, more support should be available in general, more support should be given to those coming off meds if they want or need to; patients should be armed with facts, yes, but not fear. It comes as little surprise that, on the same news day, another tabloid is reporting that 24 million people in the UK are “self-medicating” with alcohol or drugs, with food (over or under-eating), too.
It is already scary enough to change meds – last year when I reduced down the Prozac over many weeks to smatterings, had a week of cold turkey before I started anew on citalopram, I felt uneasy and itchy and squirmy again. It was frightening, but it was controlled and monitored by my NHS GP, who called and checked and asked me time and again to explain, as precisely as possible, how I felt. It wasn’t easy; nothing about depression is easy. Nothing about it is pleasant. I did not think I would be taking pills to cope with the everyday onslaught of my own mind. But I am. Perhaps I’ll take them for many years to come, perhaps I won’t. For now, I’m here, and grateful. I don’t want other people to fear taking that chance.