A fourteen-year-old boy walks into his GP surgery; “Doctor, doctor, I think I’m depressed”… “Well son… I’m struggling for a punchline for that one to be honest, but here are some pills. Take them forever and you’ll probably be OK”. This was a dramatization of the first time a GP prescribed antidepressants for my struggles with low mood.
Reading a recently published Cochrane review of ‘interventions for relapse and recurrence of depression in children and adolescents’- which found nothing even bordering on conclusive, other than the inconclusiveness of the review – I was slightly startled to see just how murky our understanding remains of how best to help brighten the long-term future of teenagers with depression. The authors did tentatively suggest that antidepressants might maybe possibly be useful, and likewise psychological therapy, but they also acknowledged that the review was fundamentally flawed by the poor design of the studies it analysed. Ultimately, they concluded: ‘Currently, there is little evidence to conclude which type of treatment approach is most effective in preventing relapse or recurrence of depressive episodes in children and adolescents’ .
Reading between the lines of the prose so dry it dehumidified the room I was sitting in, I was reminded of my own experience. At the age of fourteen my parents noticed that I had become withdrawn, irritable and quiet- even more than the average fourteen-year-old that is. As a result I was given Citalopram- a standard SSRI antidepressant favoured by many drug companies, I mean GPs. I was also referred to a counsellor, who, looking back now, took primarily a CBT approach. I remember noticing she had placed a tissue box on the table beside me and being convinced that she was going to make me cry- ‘What’s she going to do to me?!’ Luckily I would never crack under questioning. I do think that she taught me some useful stuff that has stuck with me, like ‘Don’t take everything so bloody personally’ (not her actual words) and ‘It’s ok to be angry’; so she was most definitely a goodie in the story of my formative years.
When these sessions came to an end after a few months, though, and things had improved, my GP suggested that I continue with my antidepressant for a while longer in order to ensure I didn’t ‘slip back’. Fair enough I thought. The problem was, throughout my teenage years I never really went more than a few months at a time without ‘slipping back’. When this happened, generally the only approach taken was to up the dose of Citalopram. I was a scared teenage kid being told that this medication was helping me to feel better than I otherwise would. Why would I want to doubt it?
Interestingly, thirteen years down the line I can say with a reasonably strong degree of certainty that actually antidepressants have never really helped me. I carried on taking Citalopram right up until I finished uni at twenty-one, at which point I only stopped taking them because things had become so crap that the doctor I was seeing at the time (in a non-romantic way)fancied trying something else. An enthusiastic psychiatric onslaught then ensued. Over the next two years I became a walking drug trial; Fluoxetine, Venlafaxine, Fluoextine plus Venlafaxine, Parnate, Parnate plus Lamotrigine, Parnate plus Lamotrigine plus Risperidone. That’s enough to tranquilize an elephant- trust me. After noticing no discernible improvement in mood since commencing this legally sanctioned substance misuse, I finally decided to take over the reins myself and try life drug-free, which I accomplished very gradually over the course of three months at the age of twenty-four.
Since then I have discovered two things: none of the medication ever really helped me to feel any better and actually, I have felt at my very best, most alive, when drug-free. Partly, this has to do with living free from any physical side-effects- which included lethargy to the extreme of falling asleep during the World Cup semi-final (normally the most awake you would ever find me), insomnia and a permanently dry mouth- but it feels like something else has changed as well. Although I never felt that medication improved my mood, comparing my headspace now to how it was over the many years I was taking antidepressants, something feels fundamentally different. A few months after detoxing myself entirely three years ago, my mind, although still prone to bouts of depression, felt much sharper, much less foggy. I actually feel like my ability to process information and think clearly has significantly improved since eliminating the artificial introduction of neurotransmitters into my brain. For me this has even extended to the physical; I have felt physically sharper, with better reaction speed when playing sport for example (although I’m admittedly as clumsy as ever- clearly part of my core personality). It actually feels like quite a profound distinction: even not knowing exactly what the likes of Citalopram and Parnate were doing to me, it’s great to know that I am now thinking purely as myself, without any outside chemical influence. This may sound a bit melodramatic, but for the first time in my adult life, I felt I was finding out exactly who I was. That’s something worth finding out, I think.
I am certainly not saying people should never take medication for depression. To do so would be absurd. Clearly many people find it incredibly useful, lifesaving even, and only you can ever know whether it helps or not. I also have nothing against drugs per se; if, for example, a new, unprecedentedly successful antidepressant appeared on the market, I would not rule out giving it a go if I felt desperate. What I am saying, though, is that, from my experience it’s important not to unquestioningly accept the advice of GPs and even psychiatrists when it comes to medication; it’s worth remembering too that the entire multi-billion pound antidepressant industry is predicated on large multinational drug companies cherry-picking supportive data out of a highly mixed dataset. I personally found that trusting my own feelings about my reaction- and non-reaction- to meds (that no-one else could ever truly understand given the nature of first-hand experience) was crucial in finding out for myself exactly what they were doing for me, and what I could actually be without drugs. And to my pleasant surprise, I rather prefer myself without them.