Sometimes the drugs do work
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.