Some use scissors. Others prefer a sharp knife. My own weapon of choice was a nail clipper.
Over the six months or so that I took to come off antidepressants, I found that the easiest way to halve and then quarter the pills was to raid the bathroom cabinet. My bedside table became a small pharmaceutical workshop. Eventually, there was nothing but white powder, which I would suck up with a straw when no one was around to avoid looking like a drug addict.
Ironically, I used other drugs, chiefly tranquillisers, to ease the process and reduce the anxiety of withdrawing from antidepressants. Using drugs to come off other pills was not ideal, but it was the way I managed a frightening period. I was terrified that I might fall ill again without medication.
Nearly a decade later, I have avoided becoming so. I have found ways to manage my own depressive tendencies without prescription drugs. But for the seven million Britons who are on antidepressants, research this month made for difficult reading.
A report in The Lancet Psychiatry found that coming off antidepressants can take months, and doctors must not rush patients into stopping. Otherwise sufferers can risk debilitating withdrawal symptoms, such as low mood, dizziness and anxiety. For some, the side effects from withdrawal are sufficiently bad that they stay on the drugs.
My argument here is not to ignore medication. A major meta-study last February reviewed trials of antidepressants, finding that all 21 drugs worked better than placebo, in contrast to earlier studies. But the research, from Oxford and other universities, said the drugs’ effects were “mostly modest”, and reports failed to make clear some of the study’s limitations, such as the variable quality of the trials included. All I know is that when you are suicidal you take the drugs.
Yet in an ideal world, I would have rather avoided the side effects of antidepressants, sleeping pills, anti-anxiety medication and the feeling that I had to rely on drug-taking over a long period. I would also have liked to have known more about the scary process of coming off the drugs.
The Lancet report is a reminder of how often a patient’s experience is different from the textbooks: the current National Institute for Health and Care Excellence (Nice) guidance says that for most people “withdrawal symptoms are usually mild and self-limiting over one week”. Its advice is to reduce drug doses gradually, a process that should normally take four weeks, though the guidelines acknowledge that some people take longer, and Nice is drawing up new advice on antidepressant withdrawal.
In addition to drug prescription, the second established treatment on the NHS is a course of cognitive behavioural therapy (CBT). Over the years, I have warmed towards various counsellors who have tried to help me by talking sympathetically and listening to my problems. And I have undoubtedly been helped.
So conventional treatments have been of benefit, for those that can access them, (which is another story given long waiting lists and a lack of hospital beds and expert help). My lesson is not to dismiss either drugs or CBT. But I do increasingly feel there is a third element to my own current sense of calm and well-being, and that is a belief in my own agency.
A sense of self-empowerment is at times neglected in the mental health world. It is all too easy to become dependent on others, whether psychiatrists or therapists, especially once you have received a diagnosis of a mental health condition, which can feel like a life sentence from which you will never recover.
I know feeling passive and powerless to do anything about my condition was part of being depressed. The more I discovered my own ability to take action, the better I felt. This insight is the basis for my approach to managing my own mental health. Every day I remind myself that I can make a difference. This begins as soon as I wake up.
The first thing I do is to make my bed – the white duvet perfectly aligned and my pillows plumped. A small gesture to be sure, but one that reminds me that if I take control of small decisions in this way I will feel my own power to affect larger decisions.
As my day progresses, I can take care about what I eat, be mindful of my stress levels, ditch my inner critic and dismiss my imposter syndrome. I have to believe I can make a difference – because I can!
This perspective has also been shaped by my experience running well-being workshops for various mental health charities and in schools and universities. In these workshops I share the kind of lifestyle changes that research has found can help those with anxiety and depression. In my experience, the people who believe in their own agency are those who will benefit the most. Yet often sufferers have been robbed of this sense of their own power after years of conventional treatment.
That is why I have written my first workbook for people who are looking for a way out of depression. The book has practical steps you can take, be it writing an appreciation letter, cooking with your mental health in mind, or composing a poem to process difficult feelings.
In the future, my hope is that we will believe we can affect our mental health in the same way we take responsibility for our physical health. Had I done so earlier, perhaps my own story might have been different. I might have avoided spells in hospital, heavy medication and the battle to come off the drugs. My nail clipper might even have stayed in the bathroom cupboard.
Rachel Kelly is an ambassador for Rethink Mental Illness and SANE. Her latest book, “Singing in the Rain: 52 Practical Steps to Happiness”, is published by Short Books
This article appears in the 20 Mar 2019 issue of the New Statesman, State of emergency