This is a topic that is very close to my heart and just seems to be one of those things where life leads you and you cannot really understand why certain things have happened in your life until later. Sometimes, when we get a little older – hopefully a little wiser – we realise certain things in life. One of the lessons I have had to learn is that not all people who have letters after their names are actually “gods,” or even people who have special powers to know things about us that is more important than we can learn about ourselves, about our own bodies, and our own minds. Blindly following what someone says we need to be doing for our own health (mental or physical) and well-being just because they have a white jacket on (so to speak) is usually not in our best interests. I believe it was Dr. Bernie Segiel, author of Love, Medicine and Miracles who said that those patients who took the most active involvement and who researched their own care and recovery were the ones who time and again tended to go into remission from cancer.
Let me first clarify my position on all of what I am about to say in this article so that there are no misunderstandings:
- I am not saying that people should not listen to their medical professionals, but I am saying that most of the time those who heal need to be actively involved in their own healing and research and learn as much – if not more – than their so-called “specialists.” This is the only way we can make true informed choices about our own health and well-being, and about what is right and what is wrong for us should we ever need help or “treatment” of any kind.
- I am not saying that all of psychiatry and that all psychiatrists or doctors are to blame for what has happened and what is happening in the world today. There are many fantastic doctors and psychiatrists who understand what is going on and are doing their best to help. Unfortunately there are also many who are oblivious, ignorant or even arrogant and will not listen to what their patients are telling them.
- I am not saying that people should NEVER take or be on anti-depressant medication. There certainly may be a time and a place for them, and a need when people get severely debilitated by depression, and if they become suicidal. From that point of view, one could say that sometimes these medications can save lives. However, what I am going to talk about here is the far-too-many cases where antidepressants have been prescribed prematurely for anxiety, phobias, post-natal depression, a divorce, a job loss or any other “normal” life event that causes normal human sadness and grief but then they go see their doctor and the first thing that happens is that they are offered medication.
I don’t speak about these things only as a psychologist and someone who has been interested in anxiety and depression for most of my career (and life since around 19 years of age) but also as someone who has helped hundreds of people with their anxiety and depression over the years. I also speak about these things from deep personal experience. I have written an article on Mad in America which attracted over 89,000 views since 2013. I have had hundreds of people writing to me from every corner of the world sharing their plight, their anguish, their pain and desperation to get off these terrible drugs. People in their twenties through to people in their sixties. People who has just started on them and people who have been on them for over 20 or even 30 years!
I believe that in time we will eventually see the use of some of these medications as being as insane and barbaric as we now see treatments like ECT (electro convulsive therapy) or worse, such as trepanation – the drilling of holes in people’s heads to let the demons or black bile out – that used to happen in the 19th century.
A mild panic attack at the age of 23, just after completing my master’s degree in psychology and receiving my thesis back with lots of red pen all over it, was not a good reason to be put on an antidepressant. The psychiatrist at the time said I had GAD (general anxiety disorder) and said I would feel amazing with this new drug called Ciprimal (citalopram). Anyway, that is a long story that has already been discussed elsewhere, but I will share more of it here over time.
Today, I want to really put down a challenge and hopefully start a wave of awareness and protest against a multi-billion dollar industry that is probably destroying more lives than cancer, heart disease and AIDS put together. I know that is a bold statement, and I do not make it lightly. The reason I say destroying more lives is because it is so unrecognized; not only for what these medications do that changes people forever while they are on them, but also because depression is still so stigmatized in society that no one really wants to talk about it. In some cultures they still do not believe it is real or even exists, and members of that culture or society are actually shunned if they show signs of mental distress, especially depression. Absolutely ludicrous in the world we live in today. The other reasons include the ongoing lack of recognition by the medical community (largely fueled by the big pharmaceutical companies) that there is no such thing as anti-depressant withdrawal. Whenever a patient tries to go off their medication, no matter how slow or what tapering process they may use, they will experience a withdrawal reaction just as you would from any other mind/brain altering drug. The pharmaceuticals vehemently denied this for decades, until finally forced to acknowledge something they euphemistically called “anti-depressant discontinuation syndrome”! Let’s call it what it is people; it’s a drug withdrawal issue. The patient goes back to the doctor and says they have stopped their medication, and feel anxious or depressed again. The doctor invariably says, ‘well that’s your depression coming back so you best just go back onto your anti-depressants.’
Even if you manage to taper off the drugs there is no guarantee that you won’t experience some major withdrawal symptoms, including increased anxiety, agitation and anger, crying spells, depressive thoughts, electric shock-like sensations in your brain, vertigo, flu-like symptoms, and potentially a few others as well. What this does is often push the person to start taking the drug again to get relief from the withdrawal. If people aren’t made aware of the withdrawal they will believe – falsely – that their original “condition” of anxiety or depression is returning. I am astounded at how many doctors and psychiatrists will agree that this is the case and that the person just needs to go back onto their medication. Family and friends – having witnessed the destruction that can occur in their loved ones life when they do try to come off anti-depressants – will unwittingly be supporting the doctors’ and psychiatrists’ assessment, and encourage their loved one to go back onto their medication. And so an awful vicious cycle continues. Sometimes, unfortunately and very sadly, it can lead to the person paying some hefty prices in terms of relationships, jobs and health. Sometimes even the ultimate price of taking their own lives.
And many, in mental agony and pain, are forced back onto the same medication or a different one, and the cycle goes on and on. I believe that, unfortunately, the longer you are on these medications the harder it may be to come off them. This may not be entirely true but it seems that way, at least to me. Having said that, I have had people write to me who have only been on them for a few months, try get off, and have major withdrawal problems. Another woman wrote to me recently saying that she had started having seizures after being on a particular anti-depressant for only a few months!
One of the biggest issues we are facing is that we just do not know the real long-term damage that these drugs may be doing to people. We do know that there is a possible link to heart disease as well as many other health problems the longer people are on them, some of which I will detail later on.
People are crying out for help; Marriages are breaking down, careers are falling apart, and the quality of people’s lives is being severely compromised. I had one man write to me saying he had been on anti-depressants for 20 years, from 40 years old to 60 years old, and during that time he had lost both his parents and had been UNABLE to grieve their loss. Why? Because whilst anti-depressants may be preventing people from feeling the very negative emotions of anxiety and deep unrelenting sadness, they also prevent people experiencing the normal range of sadness and love and joy and ecstasy that others just take for granted. It is an extremely painful realisation to think that you have lost part of your humanity because your ability to feel deeply about anything has been taken away, the good and the bad. So what are we becoming then? It raises questions of what it means to be human and if emotions are taken out of the question I don’t believe we are truly living.
I know this is deeply controversial and I know that there are many who will say that anti-depressants save people’s lives. And again let me repeat that I am not disagreeing with that, but let me put forward a potential solution to this world-wide epidemic. I highly recommend that anyone who is interested in the story of how these medications began, how they developed and where they have led us should get a copy of Robert Whitaker’s fantastic book called Anatomy of an Epidemic. I contacted Robert immediately after reading his book and he asked me to write my story for his website. There are now two parts to that story online. The third part is in the making as I continue on this path. I have written my own book about my views on anxiety, depression and all the tools that I believe are the best tools available to help without needing to resort to the medications. The book covers a range of topics such as cognitive behavioural therapy, acceptance and commitment therapy, meditation, exercise, goal setting, and mindfulness practices as well as chapters on dealing with emotion and letting go of our fears.
For the majority of medical ailments and diseases, the disease was discovered and then the epidemiology (underlying causes and history) first studied and then once fully understood through medical and scientific proof, successful cures were developed. This was never the case with depression or anxiety. Experiments with such wonderful substances such as jet fuel and clothing dye led to products which were tested on lab animals and then theories were created about why the mice or rats acted in a certain way when given these “calming” drugs and then human tests inevitably followed. After that, the psychiatric community and pharmaceutical companies got involved and the rest is history. A very sad history for the human race or at least for the poor souls who have suffered because of the neglect of the primary principle of the Hippocratic Oath that all doctors and I presume psychiatrists (and alright I will include psychologists too!) would have sworn to when they qualified in their degrees: “FIRST DO NO HARM”. This has clearly and unfortunately not been the case when it comes to some of the results from using psychiatric medication in the treatment of anxiety disorders and depression.
I will always say anti-depressants should be a last resort and only used when people are being debilitated by their condition and are not able to function normally in their world in terms of working or looking after themselves and/or other people in their lives. No-one should have to be on anti-depressants for the rest of their lives. That old story that people who need anti-depressants are the same as a diabetic who needs his or her insulin is just plain and simply not true. Talk to most doctors or psychiatrists and they will most likely tell you something along the lines of: “People with depression and anxiety need to take medication just as a diabetic needs to take insulin.”
Why? Because, supposedly, just as it is a lack of insulin causing the diabetes, similarly, it is a lack of serotonin that causes depression and anxiety. However, a closer look at the research shows that this is just not true, and has never been conclusively proven. The research that the pharmaceutical companies rely on to prove the deficiency theory is usually paid for by the pharmaceutical companies themselves. Important bits of information are either adjusted or ignored altogether such as the fact that in some of the trials, there was no clinically significant difference in serotonin levels between the depressed and non-depressed people. Another issue is that for the FDA in America to pass a drug it only needs to show it has been effective within a few weeks and there is no systematic follow-up as to how these patients fare of the longer term. Do their lives continue to improve and do they stay happy and well? Unfortunately, most of the time the answer is no.
Let me add a caveat to that as well. I am not saying that serotonin doesn’t play a major part in how we feel, and it is well-known to be the mood chemical in terms of helping us feel happiness and joy. But, many people don’t really know how an anti-depressant actually works. What it does is effectively blocks the “re-uptake” of serotonin in the brain which basically means that when you have a thought, your brain sends an electrical signal between two neurons. In order for the two neurons to communicate chemicals are released in a tiny micro gap between them. Chemicals float across the gap and connect to receptors on the other neuron, and off the signal goes. Now, if there is not enough of the chemical getting through, some of what is left in the gap is taken back or reabsorbed into the first neuron. Add in an anti-depressant and what it does is block or stop the re-uptake of the serotonin chemical (hence the drugs are called SSRI -selective serotonin re-uptake inhibitors). With more serotonin available in the gap – more floats across and fires the signal off for happiness and joy etc.
Wonderful isn’t it? And that’s all we needed to know right? Pop a pill and problem solved, you’re happy again. Or are you? As the years have gone by and more and more side effects and issues has arisen over time with people taking the drugs, we are learning more and more that is just isn’t that simple and that playing around with the brain and the body’s chemistry can have some debilitating and life altering impacts. Some of these include:
- lack of libido
- loss of motor control and facial tics (I had one client come to see me who had been put on such high doses of Zoloft for so long that she had an embarrassing and highly distressing condition of legs and arms shooting out uncontrollably whenever she tried to relax!)
- increased anger and irritability
- difficulty accessing emotions both positive and negative
- delayed or lack of ability to orgasm (leading to major issues in marriages and relationships)
- ongoing and sometimes even worsened anxiety and depression whilst being on the drugs
- major problems with trying to stop taking the drug even when the actual situational factors that may have caused the depression have long since passed and people are now ready to go off and resume their lives and just want to be who they were before they started taking the drugs
- major problems with short term memory (this was even detailed as far back as 1999 in Dr. Joseph Glenmullen’s book Prozac Backlash)
- issues of the drugs just ceasing to be effective – known as the “poop out” effect (unfortunate terminology) – which is basically when the drug just stops working. And so people are moved from one drug to the next in an endless human experiment. I am sorry to say this but psychiatry is about as close to a science as black magic at this stage in our understanding of how the brain works.
If these drugs are truly the answer to anxiety and depression, answer me one little question: Have you ever been tested for a serotonin deficiency? Have you ever gone to a doctor and had a test that came up with a result saying yes indeed my friend you are deficient in serotonin and this much medication will correct the problem and you will be A okay for the rest of your life? No? Why not? Because it is extremely difficult to measure serotonin levels in the brain and body. As far as I am aware, the only way to measure serotonin levels is through your cerebral spinal fluid and even that is not a direct measure of actual levels as it is more about what is wasted or taken away by the body and then doctors would guess from that how much you have. How would we even know what the “correct” amount of serotonin would be for each individual? The medical community, only in recent times, has identified that serotonin not only resides in the brain but it resides in the stomach too. So we are playing around with people’s brains, people’s minds, and people’s quality of life in ways that we just don’t fully understand. My very real and serious concern is the impact this is having on the lives of millions of people all over the globe.
My own further research found that there are natural products that can actually help the body produce more serotonin naturally, rather than artificially increase the levels with dangerous drugs with major side effects and extreme difficulty in ever stopping them. These supplements include the well-known ones like St John’s Wort, which is the most-prescribed in Germany as they are one of the few countries trying to avoid the overuse of anti-depressant medications. Others include the natural amino acid called 5 HTP (5 Hydroxy-tryptophan). This is the basic building block that your body and brain use to make/create serotonin and dopamine. Why aren’t doctors and psychiatrists trying these methods first along with all the other known methods of relieving anxiety and depression such as exercise, meditation, yoga, counseling, CBT, ACT etc.? This is just a sampling of potential natural methods that can and absolutely should be tried before medication is indicated.
Whilst I am certainly not saying that I am an expert in the field by any means, I do believe that there are some things that the medical fraternity and government health authorities should be taking into account in terms of the prescribing of anti-depressant medications.
Here are some important questions all doctors, psychiatrists and government health authorities should be asking themselves before the prescribing of any anti-depressant medications:
- Does this patient have a psychological condition that is severe enough to warrant psychiatric drugs that may alter his or her personality, relationships, career and quality of life in general?
- If so, is this patient mildly, moderately or severely anxious or depressed? How do I know this? (In my opinion and this is in agreement with Dr. Joseph Glenmullen’s conclusions in his book – only those who are severely affected by anxiety or depression should be put onto these medications and even then for only 4-6 months until they are able to resolve their psychological issues with a therapist).
- Have I informed my patient of the 4-6 week period of adaption that may cause some significant distress to the patient and that they may need an additional anti-anxiety medication to assist with the increased agitation and anxiety until the anti-depressant “kicks in”?
- Have I warned my patient that they are more than likely to experience difficulty withdrawing from the anti-depressant, and that they will need to taper very slowly off the drug and possibly switch to one of the longest-acting anti-depressants, such as Prozac, in order to successfully come off the drug?
- Have I warned my patient that he or she may experience any or all of the following:
• Decreased libido.
• Delayed orgasm/failure to achieve orgasm.
• Increased agitation/anger.
• Difficulty accessing his or her emotions and thus ability to empathize with others.
• Potential memory loss if taken for a period of years due to the chemicals effect on the hippocampus in the brain (the brains memory site).
• (…and other side effects that I have already been mentioned earlier)
- Have I arranged to follow up with the patient and his or her counsellor to assist them in getting off the drugs as soon as possible once the patient is feeling better and has resolved the primary situational and psychological issues that led to the anxiety or depression in the first place?
The sad reality is that many doctors do not even know that a patient can experience withdrawal reactions. I had a client come to see me with his wife once, extremely worried about the fact that he had been experiencing electric shock-like sensations in his brain and legs, as well as vertigo, after suddenly stopping an anti-depressant. I asked him if he had discussed coming off with his doctor and he said he had and that his doctor had agreed he could just stop taking them. When I informed the patient that this was a normal reaction and that he needed to either try to handle it – as he had not been on them for very long so it was likely he would be fine – or to go back to a lower dose and taper off, the look of relief on both their faces was amazing. He told me he thought he was either going mad or dying!
There should be much stricter controls over when a person is given these drugs and who gives it to them. There should be a formal assessment of how depressed a person really is, using a valid and reliable depression tool such as the Beck Depression Inventory and not a 10-question form filled in at the doctor’s office while the patient is in tears and feeling at their very worst. Obviously, if the person is reporting suicidal thoughts and appears to have some ideas of following through, some immediate action must be taken including letting the patient’s family know, and potentially getting an acute care mental health team involved. Starting anti-depressants for a patient such as this may be the very thing that is needed, but, once again, I question for how long? Forever? Who takes control to oversee how the patient is fairing in a few weeks, months, or years, and then assists them to taper off when the time is right? I believe this is a very important missing link in our health system, not just in Australia, but around the world from what I have gathered from the hundreds of people who have written to me over the past 3 years.
As I have mentioned, there are many tools and techniques that can be learned to help people get better and stay better, many of which I have detailed in my book along with descriptions of exactly what I believe anxiety and depression are and how they differ from stress or situational anxiety and low mood.
It is my mission to continue to talk about and help people with these and other issues in terms of living the best life they can, having the greatest quality of life mentally, emotionally, physically and spiritually. As a wise author once said: I am not saying to you that I am on the top of the mountain, all I am saying is that I have been climbing it a bit longer and I can hopefully point out some of the pitfalls and pathways that you may be encountering as you climb too.
To those of you who are struggling out there, know that you are not alone, there is a growing number of people speaking out about what has been happening to them and more people learning alternative ways to get better and stay better. I would recommend joining up with sites such as Surviving Antidepressants as well as keeping abreast on what is happening on Robert Whitaker’s Mad in America.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.