Last week’s post looked my personal experience on taking medication to treat depression. I held over my view on whether they helped me to the end of this post.
The disclaimer is even more important here – this is my reading around the topic and I am obviously not medically trained or a mental health professional. I am not advocating or providing advice, any medical treatment should always be agreed and planned with professional oversight.
So the science bit. I take the commonly prescribed medication class of drug called Selective Serotonin Reuptake Inhibitor. SSRI is a catchy little title which in simple terms helps to keep more serotonin in the synapse between nerve cells, where serotonin acts a neurotransmitter. Serotonin levels can also be naturally influenced through other means, such as exposure to sunshine and exercise. There is also some evidence that meditation can also help with serotonin levels, as there may be a two way link between serotonin and mood i.e mood influences serotonin levels as serotonin levels influence mood. There are several versions of SSRI and patients can react differently to them, in terms of effectiveness and side effects.
In the UK antidepressant prescription numbers are rising. In 2016 64.7 million antidepressant medication items were prescribed. In 2006 the number was 31 million.
SSRI are seen as an improvement on previous medication, due to the reduced risk if used for an overdose. Medical guidelines are very careful around the prescription of SSRI to children due to concerns it may increase suicide ideation, which adults seem less prone to.
It’s worth highlighting that the development of anti-depressants came out of the development of another drug, where an increased level of mood was noted, leading to the promotion that these types of drug could be used to treat depression. Finding a medical treatment from research into something else isn’t uncommon, but there are some views this was seized upon by pharmaceutical companies.
It seems there is a scientific view on the mechanism of serotonin but not why it seems to help with the regulation of mood and feelings of well-being. This has however lead to a view that low levels of serotonin is one of the main causes of depression, often referred to as a chemical imbalance.
So here come a few problems and controversy.
Depression cannot just be said to be a result of a chemical imbalance, which a drug treatment will address. That is too simplistic. Trails show limited evidence or indeed contradictory results, to the extent that chemical imbalance is a challenged view, even though it is still referred to within the medical profession. My GP used it in my initial session.
It also takes time to reach therapeutic levels of the medication. Often 30 mg is seen as the treatment level, but given it takes about three months to reach that level it’s not an immediate solution.
There are also concerns that the withdrawal symptoms from SSRI can lead to symptoms that would suggest a relapse, meaning that the patient remains on the medication longer than necessary. The common withdrawal side effects are panic attacks, dizziness, increased emotional reactions, nightmares and impact to appetite – all similar to common depression feelings. There has also been research which suggests that once off the medication the serotonin levels drop below where they were prior to treatment.
So it seems we have a drug that brings with it side effects during and after treatment, with concerns around the premise behind which its prescribed for, but many patients describe them as life-saving.
As a patient who had the initial fears around medication that I described in part one this leaves me confused.
What is clear is that simply being prescribed the drug will not help on its own. Talking therapy (of which there are a number of different approaches) is key alongside it. There is evidence that in milder forms of depression that talking therapy could be sufficient on its own.
But there is a shortage of therapists, with limited availability and with quoted waiting times in some areas of 12 months or having to travel long distances to be seen. Talking therapy takes time (although medication takes time to start working too) and requires specialists, with individual sessions lasting around an hour. That comes with a cost and with its own challenges – the patient has to work with their therapist (you don’t just turn up and chat) and it may/will bring out very strong emotions and experiences which may be hard to handle initially. For someone with depression that can all be very challenging to undertake and handle.
So do I think they helped me ?
Around mid-March I noticed a difference in my head, which I cannot describe any better than saying I had more space around my thoughts. I had been on 30 mg for about six weeks (after starting off on 10mg back in December) and had been told to expect an improvement by then. However, I had also started therapy during late Feb. So…
Does medication help me? My BELIEF is that the medication did help as part of wider treatment.
Do I still have concerns about medication ? Yes
Can I be certain it helped ? No , it’s a belief, but an important one to my treatment.
Do the perceived benefits outweigh the side effects? In the short term, yes, I have coped with the leg twitching and appetite loss; more of a concern for me is what long term effects I will have.
Am I addicted ? Don’t know yet, until I start the withdrawal plan.
The big question is not if and how medication works, rather can I cope without them ? I believe I can and that in time I will… that will involve making that belief stronger than the belief that the medication is helping me.
But part of me is still scared I won’t be able to stop the medication and that is probably the worst thing of the treatment for me.
The treatment of depression is not one thing, it’s a combination of things which help. My feeling of more space in my head during March cannot be attributed to just the medication. My BELIEF is that it played some, undefinable part within a much wider, holistic approach.
I hope this, along with part one, has given an insight into medication. I will stress again, I am not a medical professional and this post is trying to help understanding and awareness. The real big point is this – it’s okay to talk about this and to seek the appropriate medical care.