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31 May 2024

Our mental health crisis won’t be solved by pills alone

The number of people taking antidepressants has doubled since 2011, but the side effects of long-term use are broadly unknown.

By Rachel Kelly

One night, more than 20 years ago, I began to feel distinctly odd. My shoulders tightened and my breathing became shallower. I was sweating heavily. I felt sick. My heart was pounding, as if it might jump out of my ribcage. I began to hug a pillow against my chest like a shield in the face of an unknown enemy.

My mind raced, my fears worsening, my thoughts going round and round, as if I was a skater carving ever deeper and darker circles on a frozen lake. I was worried about trying to work (I was a newspaper reporter at the time); trying to be a good mother (I had two small children); trying to be a good wife (my husband worked in finance) – all of which would be impossible if I couldn’t sleep.

It turned out this was the start of my first major, anxiety-driven depressive episode, one that led to a brief stay in a psychiatric hospital and a cocktail of drugs: anti-anxiety medication, sleeping pills and antidepressants. Drugs were the only option I was offered. I was desperate to get better and felt I had no choice but to take them. The question of side effects never occurred to me. Nor did the issue of coming off them in due course, and whether that would be difficult.

During this first serious depressive episode, I took the antidepressants for nearly two years. I had another bad episode a few years later, and this time I took the drugs for more than three years. As time went on, I wanted to come off the pills. I was sleeping, my racing thoughts had subsided, and I had returned to work as a freelance journalist. This might have been a result of the antidepressants, but their effect is hard to judge because, as one doctor said, I might have recovered with time anyway.

The drugs made my body balloon. But the side effect I minded most was the numbing of my feelings, both good and bad. I no longer wanted to be robbed of the full range of experience.

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I became a kitchen chemist. Using a pair of nail-clippers, I sliced and diced the small white citalopram pills, until only traces of powder remained. (This weaning-off process might have been easier for me today, as citalopram now comes in drops, although doctors often don’t prescribe them, meaning some may still feel pushed to improvise with different dosages.)

My anxiety soared. I worried that if I stopped taking the drugs altogether, I might fall ill again. Ironically, I used other drugs, chiefly tranquillisers, to reduce the anxiety of withdrawing from the antidepressants. I also kept a supply of sleeping pills close, because my depressive episodes usually began after a bout of insomnia. I managed, just. The process of slowly taking myself off medication, largely without support, took nearly a year.

The experience made me increasingly interested in other approaches to mental good health, be they therapy, exercise, the healing power of poetry, nutrition, or mindfulness – all of which I now use to manage my ongoing battle with anxiety.

My interest in alternatives has only increased as studies have raised concerns about the long-term use of antidepressive drugs. First, such use may be associated with physical risks. A 2022 study from Bristol University on more than 200,000 people found that long-term use could double the risk of heart disease. A second problem is the one I faced myself: the longer you take the drugs, the harder it can be to come off them.

My withdrawal symptoms were relatively mild. Others – thought to be a minority, but the exact numbers are disputed – can have much more severe symptoms. Patients suffer debilitating withdrawal symptoms such as low mood, dizziness and anxiety.

In the years since I first took these drugs, there has been an epidemic of prescribing. Data released by the NHS Business Services Authority last year estimated that 8.6 million patients in England were prescribed antidepressants in 2022-23, a number that has almost doubled since 2011. I worry that many of these patients may, like me, have no idea about the long-term implications of taking these drugs, or how hard it might be to stop.

The high patient numbers, and the associated costs for the NHS, were recognised this May in a new all-party parliamentary group (APPG) report that I helped launch, titled “Shifting the Balance Towards Social Interventions”. One of the report’s key recommendations is the need for drug de-prescribing services, as well as a national withdrawal support helpline. It also calls for a boost in the provision of social prescribing and community resources, and a reversal in the rate of unnecessary antidepressant prescriptions.

The APPG’s report feels hugely timely. Our system isn’t working; I know this from my own experience, and because of my work as an ambassador for mental health charities including SANE and Rethink Mental Illness. I believe we need a radical overhaul of the way poor mental health is managed in the UK: a move away from its over-reliance on the biomedical model and psychiatric drugs, and towards a more holistic approach that tackles the social, economic and psychological determinants of mental health.

I’m not alone in calling for change: the World Health Organisation and the United Nations are also arguing for systematic mental health reform, again emphasising the importance of psychological and social support, and corrections to address the rise in prescriptions.

I can never know for sure whether this kind of approach would have saved me from years of relying on medication. But I am certain it would have helped me – and could help millions of others.

[See also: The government is launching an all-out assault on people with anxiety and depression]

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