Post 49 – More thoughts on medication


There has (again) been much talk in the media, mainstream and on social media about antidepressants, specifically SSRI (selective serotonin reuptake inhibitor) I have posted before about my experience with the SSRI Citalopram (posts 14 & 15) and before going further it’s important for me to restate here, these thoughts are my experience. Any medication treatment and decisions MUST be taken in conjunction with a trained prescriber.

One thing that has disillusioned me recently is the very binary approach taken within media reporting. Over the first few months of 2018 there was the heavily reported and marketed book Lost Connections by the journalist Johan Hari, which heavily questioned drug treatments. This was based on Hari’s own experience of antidepressants plus research he undertook. He made a strong case for the social and environment reasons for depression. For headlines like ‘Is everything we know about depression wrong? ” were too much. Hari used limited research, quoting self help books at time and his views around the non-biological influences are not new, although good to see that part being discussed more. His previous record of plagiarism and erroneous reporting plus the very aggressive marketing of the book left me cold.

There was much debate around the Hari book in the media, the neuroscientist and author Dean Burnett wrote some very balanced articles in response.

More recently we have had what has been quoted as the biggest research study into SSRI which again lead to some ridiculous headlines. One UK paper talked about how it was safe to take happy pills. We have had the Royal College of Psychiatry make statements which contradicted information on their own website. As an aside the phrase ‘happy pills’ really annoys me. One the opposite of depression is not being happy. Two they don’t make you happy, in fact for some people they can initially worsen or numb their emotions.

Within the medical world there seem to be two views-those who advocate the safety and effectiveness of SSRI and those who question that. Interestingly or actually more confusingly they sometimes use the same studies to support their points. It’s worth noting that the majority of studies and research are from pharmaceutical backed research.
In the mainstream media the debate is often broken down to do or do they not work. That is too simplistic. It has to be about clear facts so that those taking and prescribing can make informed decisions, to determine if it will help the individual.

‪The discussions (especially in media) can become too entrenched & simplified. It’s not binary, it’s complex, just as depression is. Is it any surprise, given that depression impacts people differently that treatments can vary by individual? There can be much damage done by those entrenched views – people taking medication feel even more stigmatised by those saying they don’t work & feel they have been misled. Or even worse that they are not suffering or ill. It may lead to people stopping their medication or from seeking help. ‬

The opposite view has its own dangers, if it does not recognise that medication is a choice, not suitable for all, brings side effects/withdrawal symptoms, especially it would seem in long term usage. Alternatives may be better for the individual.

I am not a scientist or a medical researcher. Like the majority of people prescribed SSRI I take it based on the medical advice of my GP. As I wrote in the previous posts I had concerns when first prescribed, around addiction, side effects and how they worked.

That last one is an interesting point. You can read widely how the SSRI works biologically, but how that actually helps with depression can seem vague. Some people have found them helpful, indeed would describe them as life saving. Some people less so and have had to try different types of SSRI before finding one that works. Some people will quote long term side effects that they believe the SSRI caused. There are also well grounded concerns around the prescription to children and young people.

So where does this leave the person suffering from depression, who at the crisis point has sought help and are being offered SSRI ? There is a desire to make an informed and balanced decision, but that is incredibly hard to do against this backdrop. And at the point of being prescribed it’s bloody hard to make any decisions. It’s often been a big one to even go to the GP and at such a vulnerable time we need to have faith in what we are being told.

It’s also very important to note that medication is not the only treatment. Talking therapies are effective , with less risk (if done with an accredited professional) of side effects and as a long term treatment. There arises another issue – how quickly the provision of therapy can be made to the patient, which may leave the GP little option in the immediate term other than medication.

I said the two points of view seem to agree on findings in the recent study, but use them differently. My reading is that SSRI are found to be effective in the short term but for a lower percentage of people than previously thought. The side effects following withdrawal may also last longer than previously thought and have the risk of being interpreted as a relapse rather than withdrawal symptoms. It doesn’t appear to address the long term usage concerns, possibly as the research evidence isn’t freely available.

Against this background and under guidance from GP I have this week taken the next reduction in my medication, down from 20mg to 10mg, following a reduction from 30mg to 20mg in November. Like then I am having the side effects of a very intense headache (not like a usual headache, but a severe stabbing pain behind eyes, with acute sensitivity to noise ), muscle aches like flu and the restless legs at night go into hyperdrive. Last time these lasted about ten days before calming down.

So where does that leave me. ‬

Do I think they helped ? Yes, I believe they did help me, in the short term. Do I feel fully informed ? No. Do I feel confused ? Yes. Am I concerned? Yes. Do these thoughts and worries surface every night as I remove the little white pill from its package to take ? Yes. Am I ashamed to take medication? No. ‬

One last thought- please, please respect that behind the statistics, the studies, the strong opinions, that there are people, suffering and confused, who often don’t know what to believe but just want to be helped in the best way. That may or may not include SSRI -but it has to be an informed decision based on the individual circumstances. And that is the saddest thing, it’s difficult to feel informed. ‬

Chris

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