I wasn't very surprised to see this week that a meta-study had come out doubting the effectiveness of SSRI antidepressants like Prozac for anything other than severe depression. Journalistic coverage has, as usual when it comes to medical science and things slightly more complicated than the TV pages or George and Lynne, been rather simplistic about the whole thing, as Obsolete records. The story is something a little more complex: yes, SSRIs aren't much more effective than sugar pills for mild depression; but they still are useful for more severe depression.
I have a little experience of this. I take Fluoxetine and have been on antidepressant drugs since 2003. Have I been kidding myself? Are these tablets little better than the laughable non-science of homeopathy? Have I mistaken a regression to the mean or a placebo effect as being evidence of the effectiveness of tablets? Well, I'm not sure about that. But as someone who has experienced severe and suicidal depression for the best part of 30 years, what I can tell you is that GPs and the health service haven't always been perfectly helpful towards me - dismissive, patronising and insulting at worst, fobbing me off with pills at best. Is it a failure of the system or have I just been unlucky? I do have my own theories, which I'll come to later, but for no reason other than it's a good time to talk about it, I'll talk about it.
I first became incredibly depressed when I was about 14, suicidally so. It takes a lot of courage to go to the doctor and talk about things when you're a shy and awkward teenager anyway, let alone someone who is experiencing tremendously complicated emotions completely out of the blue - I'd been fine up till then - and a dreadful feeling of depression and worthlessness. But I made an appointment and went to the family doctor, whom I'd been seeing for years for various ills and ailments. The doctor knew me well. But with a cheery smile he told me not to worry, it was just 'growing pains', it would go away, don't panic, and patted me on the head and sent me on my way.
It didn't go away. I struggled along through my teenage years but felt increasingly hopeless and constantly I was ravaged by thoughts of suicide. I was still registered at the family doctor so there was nowhere to go, I thought. At university I discovered cannabis, speed, LSD, cocaine and ecstasy, which managed to obliterate the miserable black feelings for a few hours at a time and even provide an enjoyable existence - and alcohol too, of course. (Later, I was to be told this is called
What I really wanted was to be able to talk to someone about things. I spoke to the Samaritans but it was difficult as they're trained to be fairly neutral helpers, useful in a crisis but can't help you get to the source of your problems. So I went back to the doctor - who again told me there was nothing wrong, just pull your socks up, do some exercise, lose some weight and you'll be fine. It was nearly the final straw.
After university, I quickly got a job at the local paper but I found myself relying on alcohol and, to a lesser extent, cocaine to keep my moods from swinging too violently: if I was incapable of movement then I was incapable of doing myself any harm; that's the way I looked at it. I just wanted to get obliterated.
As a final resort, I went to my new doctor (I'd moved away) and begged for help. I really wanted to talk to somebody about my problems. The doctor said that wouldn't really help someone like me, that antidepressants might be better, so I went on them and they helped for a while. I remember distinctly the doctor had a branded pen for the antidepressants she put me on. That still sticks in my mind. Probably just some stupid paranoid thought in my head, but I do remember it clearly.
The same routine carried on for the next four years. I constantly pleaded to be given some help that would really do some good rather than papering over the cracks. I had an assessment to try and get access to cognitive behavioural therapy, but was told the health authority where I lived didn't have the money for that in anything but the most serious cases - but there was, of course, the money in my GP's budget for antidepressants. I was constantly just given the latest antidepressant - I've tried fluoxetine, duloxetine, escitalopram and citalopram, all with various horrible side effects and health woes. I did exercise, running five miles a day - it didn't help. I was just a fitter depressed person. I tried quitting duloxetine, which was giving me tremendous headaches, almost migraines (bizarrely, it's used in the treatment of migraines), blurred vision and was making me bruise purple and yellow whenever I so much as bumped into something, and that led to a horrific state of violent depression, anger, constant anxiety and despair.
Finally, this year, after admitting myself to hospital after feeling completely at a loss, miserable and helpless, on the verge of a complete breakdown. At last I actually got to see a psychologist and talk about things I needed to talk about. Three sessions later, they said they could see the problems - I needed to talk about my problems. I said that was a good idea. They gave me a choice - be on a waiting list for six months to a year, or go private. Luckily I have the money nowadays (I didn't before), and now I'm undergoing psychotherapy. It's helping. I've even had a couple of breakthroughs. Things aren't perfect and they're never going to be perfect, but living and coping with that imperfection might just be easier. Writing this blog has helped a lot.
What angers me still is an incredible 'pull your socks up and get on with it' 1940s attitude to mental health from GPs, almost every one I've ever had. It was only once I was admitted to hospital that they actually took anything seriously. Until then, they were more than happy to chuck some worthless pills at me and send me on my way. When they stopped working, it must be because I needed to switch brands rather than do anything about it. It was a useless short-term fix. It was only by very good luck and sheer persistence that I managed to get any help at all from the NHS.
In my particular case, drugs were never really going to work for me anyway, although I will say they do appear to have had a positive effect on me. did have a positive effect initially on me (though that may be regression to the mean or a placebo effect). I feel just regret that maybe I didn't push harder for what just wish that doctors had actually cared rather than pushing drugs onto me, which was the last thing I needed.
I've thought about it a few times, and I do wonder why GPs seem ill-prepared for problems of a psychological nature. Is it because they look out for symptoms from the body, and don't compute when things are a bit more complicated? I'm not sure. But I sense that the average GP understands the concept of serotonin being responsible for happiness a lot more than they do the concept of a million different experiences, feelings and relationships with people dating back to childhood being responsible for it. One looks like science; perhaps the other looks like mumbo-jumbo. I don't know. All I do know is that antidepressants have helped me cope with things that I might not otherwise have been able to cope with; but that, all these ridiculous years, I have needed something more, something different - something which, perhaps, takes a few more resources out of one pot of money than another.
This week's news doesn't change anything. I think SSRIs have been a massive help to me and probably hundreds of thousands of other people with severe and long-term depression - maybe not the solution itself, but a way of coping with day-to-day difficulties. What I find unpleasant is the low-brow way in which this matter is now being discussed by journalists who clearly haven't a clue about how to tie their shoelaces, let alone understand the workings of the human mind. Too complicated? They can't be bothered? Requires a subtle, objective approach? Nah, fuck it, I've got to file this shit in ten minutes; heaven fucking forbid I'd actually think about it in the first place. (Chicken Yoghurt today has a perfect example of this wilful ignorance from journalists).
Prozac doesn't work, they say. People have been conned, they say. It's all fuel to the fire about malingering and 'scroungers' on benefits. The usual bullshit. And I have read, over the past couple of days, some things which have saddened me (and if you read me regularly, you'll know that my usual response in anger or sarcasm rather than sadness. But no, sadness). Witless, talentless twats of the journalistic nadir sagely nodding away - they don't need pills to make them happy. Those of us poor moronic fools who 'claim to be depressed' are just taking everyone for a ride; it's all in our minds; we should just pull our socks up and get on our bikes. (I may well deal with some of these braying bastards in a bit more detail over the coming days, if I can bring myself to read their arrogant, bullying muck one more time)
Stop sneering and thinking you know what it's like, because you don't. I won't pull my socks up. I won't give up. My experience of the world is entirely different. Not because I chose it to be so - who would want to suck themselves down to an inky-black sea of despair and gloom, their head only just above water? Who would choose to constantly contemplate suicide? - but because it is so. And if these tablets have helped me, and I think they have, then don't write them off - one day it might be your son or daughter who needs help. I just hope they find it quicker than I did, and they find it before it's too late.