Discursive of Tunbridge Wells
John McGowan
1252
Following last week’s BBC Panorama on the dangers of anti-depressants Clinical Psychologist Angela Gilchrist suggests we urgently need more balanced coverage.
What do anti-depressants do to help you? And can they do harm? These were the questions I thought might be addressed in the BBC’s Panorama programme last week. Informative and balanced coverage of mental health issues is desperately lacking in the media and I was ready for anything that might properly inform the debate. Really though, the lurid title, ‘A Prescription for Murder’, should have tipped me off that this might be one of the less helpful contributions to the public’s knowledge of psychiatric medication. The impression left was that drugs do all sorts of harm and any potential benefit is nonexistent.
Panorama was centred on one highly disturbed individual, James Holmes. Despite having had homicidal thoughts before he took any pills, it was strongly suggested that he became a mass-murderer because he had been prescribed Sertraline. There was no actual evidence of this, but no-one let that get in the way. Holmes was a man with a bizarre belief that he could add to his own value by killing others and, also not mentioned, his crime was only possible because of easy gun availability in the US. To bolster the ‘drugs turned him into a killer’ message, psychiatrist, Dr David Healy, stated that Holmes would not have become a murderer if he hadn’t taken anti-depressants. Just quite what he based this assertion on was never clear.
Selective Serotonin Reuptake Inhibitors (SSRI’s) are recognised to be associated with adverse reactions in some and these risks are reflected in warnings provided in patient information leaflets. It is recommended that they should only be used where strictly necessary and that people should be closely supervised – especially in the initial phases or when dosage is changed.
To be fair, the programme stated early on that many people take anti-depressants safely. But those who do so were not interviewed and this theme remained undeveloped. Instead, we were subjected to a one-sided view of Holmes’ life story that left viewers thinking that anti-depressants are likely to turn people into murderers.
Given that very few people with mental health problems become violent – on pills or off – and that those struggling with depression are more likely to kill themselves than others, this is a gross misrepresentation. Sadly, though, it is one that potentially affects the lives of thousands of ordinary people who have to deal with mental health problems on a daily basis. Overblown links between anti-depressant use and violence are likely to fuel discrimination and stigma, making it harder for those who need these drugs and other psychiatric medications.
I am not, of course, saying that pills will solve anybody’s personal problems or that they are a panacea for the social ills that make people depressed. We desperately need to come together to tackle inequalities and the deep injustices that can make life unbearably painful. We also need to be concerned about the possibility of over-prescription as evidence suggests that anti-depressants are less likely to be helpful for those who have mild to moderate depression (something reflected in current guidelines). Holistic measures such as exercise, good nutrition and stress-management tend to be under-promoted for the cases of mild or moderate depression that potentially benefit from them.
However, these things, and my own field of psychological therapies, aren’t ever going to be the whole story. People who haven’t been depressed can’t know how it feels to be too sad to move or speak; to not want to eat, be unable to sleep, concentrate or find any point in living. For them, medication is a matter of life and death. Their own! As well as linking drugs with violence, then, it’s almost equally worrying when some (including some in my own profession) consider taking psychiatric medications to be a lifestyle choice rather than a lifesaving exercise.
All drugs are potentially dangerous and come with risks. Good, insightful media coverage which draws on service-user experience as well as professional expertise can potentially go a long way to help educate the public. The Press has a right and a responsibility to ask questions, but there is a huge focus on anti-depressants which fails to acknowledge that they probably prevent many deaths and improve many lives. While a failure to acknowledge the limits of medication is clearly unhelpful, a one-sided attack drugs also does a profound disservice to those who seek help.
The journalist has changed her position since the tweetstorm, which is good, though som edamage has been done. If you could edit this a bit to bring out that depression isn’t simply a result of social ills that would be great: this belief stops a lot of people seeking help because they can’t think of anything in their lives to account for their mood, and we both know psychological as well as physical treatments help these people too.
Hi David, Thank you for your comment – My position has not changed since the tweetstorm on the night of Panorama. I have always said that the programme was based largely on the Holmes story and that gun availability was a much bigger issue than the availability of anti-depressants. Those were the two points I made in tweets on the night of the Panorama programme and they are reflected here. I’d also be the first to agree that depression is a multi-factorial problem.
Nice to see a more balanced view on antidepressants. As a fellow psychologist, I share your concerns about antidepressants being viewed as a lifestyle choice and the current debates that appear to be re-running psychology verses psychology. Why can’t we embrace both? I am on antidepressants and as far as I’m concerned they have helped save my life. Did they cure my depression? No. Did they slightly improve a desperate situation where every minute and hour was a fight to stay alive and I was unable to engage in therapy? Yes.
I’m all for a debate about side effects and use of antidepressants as first line intervention for mild to moderate depression. I say this whilst embarking on the daunting challenge of coning off antidepressants now that I’m in a stable, far less desperate place, looking to start a family. Something I couldn’t have dreamed of without the combination of psychotherapy (which I continue to receive, having the immense privilege of being able to access privately, long term) and the antidepressants which got me to a place where I could sit still in a room and engage in the therapy (still severely depressed).
We need to acknowledge the social context people operate in and address poverty and injustice. We need to acknowledge that people suffer unspeakable trauma. Some people find antidepressants useful, others don’t. I’d love it if we could get to a place where everyone on all sides of the debate could respect this.
I thought the Panorama programme was very difficult to watch from the psychiatric survivor perspective, having been prescribed Venlafaxine in 2002 after being clinical depressed when coercively drugged with Risperidone, following a menopausal psychosis and voluntarily entering Stratheden psychiatric hospital, Fife. Without thinking it through I swallowed a bottle of Venlafaxine on impulse and was rushed in an ambulance to Ninewells Hospital Dundee, on oxygen. No-one had said about suicidal impulse being a side effect of this drug. I didn’t know until around 2013 and for all these years I was ashamed at having tried to kill myself, although it was more of a cry for help. I’d never done such a thing before or since. I eventually managed to taper a maximum dose of Venlafaxine and 800mgs/day Lithium to zero, in 2003/4, making a complete recovery from the Dx label Schizoaffective Disorder which was in my “notes”. It’s still there.
I’ve warned my sons not take antidepressants as I think they are riskier than even antipsychotics (these drugs depressed me), because of my own personal experience. And I’ve heard from other people, one a good friend, of their negative experiences, trying to take their own lives when tapering antidepressants. Fortunately I was able to advocate for and support my sons in and out of psychiatry, for all 3 of them experienced psychosis after leaving home for university in the big city. I took my sons into psychiatric wards and had to advocate for them at meetings, helped them taper drugs, did my best to advise and protect, when they asked me to.
However my youngest son was physically and mentally abused in the locked seclusion room of Stratheden IPCU in February 2012. This has been the toughest experience yet. The flashbacks were hard to cope with, he lives with me, has done since before 2005 when first engaging with psychiatry. They made him into a revolving door patient until the 2012 abuse when I contend they did their best to make him retaliate as other patients have done in the past, ending up in medium or high secure forensic psychiatric wards. I can name some of these men and know their stories. [I have know one Mother since 2003, who has stood by her son for over 25 years, many of them as a Stratheden Hospital inpatient, broken bones, inhumane treatment. It has taken its toll on her, she’s now in her 70’s, recently had a fall, her son is 49.]
I think that psychological therapies need to be on offer more, that therapists and psychologists need to develop more skills, be allowed to practise them more, to work with mentally distressed people so that less antidepressants will require to be prescribed, reducing risks of self-harm due to the drugs. This will mean improving cognitive interpersonal approaches, using a variety of mediums, to listen and engage with people who are anguished or in extreme emotional states or psychosis. Helping them through rather than blunting the feelings with drugs which in some cases, maybe rare or uncommon, isn’t effective and makes things much worse. Antidepressant prescribing is continually on the increase, even the fish in the sea are now showing traces of them, according to research. We are a nation of pill poppers it seems and this Panorama programme raised a number of questions which rather than dig trenches could help us all reconsider how to manage or work better with people who are depressed or disconnected or suicidal.
Dear Chrys, thank you for your comments which make an important contribution to this debate. I am truly sorry to learn that you and your family have had such a terrible time. I completely agree that psychological therapies need to be on offer more. I also agree that therapists and psychologists need to develop more skills so as to work with mentally distressed people so that fewer antidepressants need to be prescribed in the first place, with the result that risks will hopefully be reduced. I would never suggest that drugs are a solution in themselves, but perhaps something that may be helpful sometimes, in some cases. I do think that more help is needed to help people taper off them so as to reduce any withdrawal difficulties. Ultimately, the only real healing comes from within.
You mention anti-psychotics which are, of course different to anti-depressants and prescribed for very different problems. I would very much like to see survivor-led initiatives including the use of ‘safe houses’ where people experiencing psychosis can be helped through their difficult experiences. Soteria is a case in point. Again, I’d suggest that medications might be helpful at certain points along the healing journey, but will never be a solution in themselves. The voices of survivors such as yourself, are very important in informing this process.
Thanks for responding Angela and for understanding my survivor perspective.
I too would like to see Safe Houses with choices of therapies, respite, a place for healing of the mind and body, creative activities and caring listeners. It’s what I’ve tried to provide for my son after his negative experience of February 2012. It’s got easier, fortunately, and during these years I ended up experiencing another psychosis myself, following a physical and mental breakdown in August 2015. I’d run out of steam after years of campaigning. Glad to have got through it this time around avoiding psychiatric treatment.