“When did you decide to go on antidepressants? I am nervous about taking SSRIs for mild depression, but my friends in their 20s on them. It surprises me because the people who are on meds I wouldn’t have thought were depressed. I am seeing a therapist, which I think has been really helpful, and try to eat healthfully, exercise every day, see my friends, work on hobbies and projects. All these activities really help me get out and about. And yet I also struggle with low self-esteem and self-confidence, which is really frustrating, because if I just didn’t doubt myself so much, maybe I could just feel better and be more productive. I really want to achieve more in my life, but constantly sabotage myself and put myself down. I don’t believe I’m seriously depressed, but I can’t seem to feel better about myself and wonder if going on medication would help me? Do you think I should take antidepressants?” – Question on depression forum
It is impossible to write about depression and not mention antidepressants.
Some people believe that antidepressants are a little like a life vest or inflatable arm bands; they keep you from drowning while you learn to swim.
The life vest will keep you up while you learn how to float and to use breathing techniques and swimming strokes to move yourself through the water.
But the life vest feels safe and comfortable and you might be wondering if learning to swim is really what you want to do now. You could just continue to let the life vest buoy you up.
You don’t have to make the effort to learn how to float or move yourself through the water. There’s no real need to do that, is there?
The life ring will keep you from drowning (unless the seas get very rough).
This means you’ll have a limited experience of the water, without all the fun games you could play, exploring coral reefs, even challenging yourself to go faster and further. If you learn to swim you’ll have greater ability to explore the watery world, deeper below the surface.
You may need a good teacher to help you build your confidence and encourage you to let go of the life vest. If you practice what you’ve learned, you’ll be swimming like a fish, with the fish, before too long! What a wonderful experience.
Let’s say the water is life. A good life, a contented life, a life of purpose and joy and one which you design. It’s a life which you are not experiencing right now, not with your persistent low mood sucking all the enjoyment out of life.
So you visit the doctor and he puts you on antidepressants.
Antidepressant Medication: Your Life Vest in a Capsule
In an ideal world, on antidepressants, your negative thoughts will disappear and your emotions will be regulated to cheerful and sad and neutral where appropriate. Before you know it, you’ll be sleeping better and transforming your diet to one filled with fresh fruit and salad, rather than the junk food which seems to be increasingly on the dinner table because you just don’t have the energy to cook.
With a better mood, you’ll feel able to deal with the stress at work and cope better in meetings with your new demanding boss. Or maybe you’ll change career and retrain to be the horticulturist you’ve always wanted to be. You’ll have much more energy to help little Johnny with his homework and be happy to take part in the school working bee next weekend.
Life will be grand!
In reality, there’s no instant relief. After a while the strong negative emotions may seem to have turned down. But you notice that you’re having strong headaches most afternoons and the thought of going to counselling sessions as suggested by the doctor doesn’t appeal so much. You’d rather have a nap.
Anyway, with the horrible thoughts that had previously plagued you and the sessions of weeping seem to have gone away, so things are not really so bad now, are they? Sure, you’re pretty lethargic most of the time and have that weird dry mouth feel, but in a few months you’ll start to feel better and recover some of that lost energy and zest for life. Every day it’s getting better and better.
Tomorrow is another day…
Are you asking yourself, ‘Should I take antidepressants?…everyone else seems to be on them.
I was, for about eight years, on and off. I finally went to the doctor when I was experiencing one of my lowest points and she gave me a prescription for citalopram (celexa, cipramil). I was so relieved. The effect was immediate. Or was it?
I really don’t know now. I had no side effects. I had what I felt was instant relief. That very day. Within hours. I don’t think antidepressants are thought to work like this. I believe the manufacturers say they take 4-6 weeks to take effect.
But I felt re-energised almost from the get-go and started the psychological counselling suggested by the doctor.
Suddenly, I had a name for what I was feeling, I had hope.
I enjoyed meeting the psychologists, a very funny woman in her mid-50s. I don’t remember doing any actual therapy. She’d put the kettle on and offer a couple of chocolate biscuits and we’d natter away like a pair of old friends catching up on the neighbourhood gossip.
I walked my dog more vigorously. I even started dance class again, salsa this time.
I felt great!
Many people do have good experiences with antidepressants, but I am appalled by the number that do not. A brief internet search will turn up story after horror story of serious and dangerous side-effects and totally ineffective treatment and the nightmare of withdrawal.
Sure, people tend to talk about awful experiences, but in my opinion, there shouldn’t be any, should there?
No awful experiences. If depression is a biological illness these drug should point themselves to the biological cause and dispense with it.
But therein lies the rub. No scientist knows why antidepressants appear to have a positive effect on some people and a truly horrific effect on others.
Yet they continue to be prescribed in greater and greater numbers. Oddly enough, the statistics on the numbers of people diagnosed with mood disorders is also increasing.
OK, maybe some of these people are genuine sufferers who in the past were reluctant to come forward, but could there not be something else rather more sinister going on?
Maybe antidepressants are just not as effective as we hope?
How Do Antidepressants Actually Work?
If you’re asking ‘Should I take antidepressants’ you’d want to know how they work in the brain, wouldn’t you?
Well the answer is that nobody knows.
Nobody knows how they work, why antidepressants work for some and not others. Why they take so long to take effect (if they do at all); why they stop working. Why they have side effects.
Nobody really knows the answer to these questions.
They have ideas about what might be happening in the brain.
But the simplest explanation, ‘Your brain chemicals are unbalanced and these drugs will help balance them again’ is an absolute guess.
The chemical imbalance theory is still widely given to the general public, through mental health websites and by general practitioners, but it has been discarded by the American Psychiatric Association, some 30 years after it was first promoted.
Instead, antidepressants are thought to work on brain chemicals by keeping them in the little gaps between brain cells. These little gaps, called synapses, are where neurotransmitters are released by one neuron, or brain cell, and received by the next neuron and transformed into electrical signals.
Some antidepressants, known as ssri (selective serotonin reuptake inhibitors) are thought to prevent the neurotransmitter serotonin from being sucked back into the first neuron. This would allow more of the serotonin to be passed onto the next neuron, thereby ‘activating’ that pathway or region of the brain.
So the theory now is that antidepressants don’t provide more chemicals or encourage the brain to produce or release more chemicals, but rather, they are believed to allow the chemicals to hang around longer in the tiny spaces between neurons in order to be picked up and passed on.
But is a lack of neurotransmitter in the synapses really the cause of depression?
Most doctors view illness in the framework of the medical model, which makes sense really. They are doctors after all and their job is to observe, diagnose and treat.
Many GPS and certainly most psychiatrists, see depression the same way, through the medical model. Hopefully, though, most will also encourage their patients to take exercise and eat better (mine didn’t). If your doctor is of the view that depression is a biological disease, it makes sense for her or him to offer you a pharmaceutical solution, drugs called antidepressants.
There is plenty online about the development and marketing of antidepressants.
What did your doctor tell you about what depression is? How did he explain to you how antidepressants work? How long they’d take to work? Did he inform you about side effects? Did she explain how to taper off? Did she suggest you’d be taking them for the rest of your life?
I wonder if people actually ask doctors, ‘should I take antidepressants?’ or whether they get handed a prescription. I really wonder why GPs hand out prescriptions so often.
Do doctors not read the research on how helpful taking exercise is? Or making social connection? Or eating well? Or getting adequate, good quality sleep? Why are these activities not offered as ‘treatments’?
After all, they’re safe (find the type of physical activity that suits you; take a friend not an axe murderer), free (parks in my town are free; I don’t expect your friend charges by the hour), there’s no waiting list (you need to make the time and arrangement to meet your friend) and you can do them in the privacy of your own home (dancing round the living room with your friend can lift your mood too)!
Antidepressants Do Appear To Work Well For Some People
“Zoloft has worked effectively for me. It has got rid of my terrible anxiety which caused the depression. It was rough getting through the initial side effects but I pressed on. There are some remaining side effects, but they’re not so bad now. I don’t think Zoloft has changed the person that I am. It does let me do more during the day rather than staying in bed worrying and crying and hating life. I eventually went on meds after suffering for years and it was the best option. There are some moments when I feel kind of numb, but mostly I feel more optimistic about the future and much happier”. -A comment on an article about antidepressants.
‘My antidepressants work for me. I need them! I couldn’t get anything done without them. How dare you shame me for needing and taking meds.’ –Response on depression Facebook Group.
Once upon a time I’d have put myself in this camp. I was so relieved that my overwhelming and chronic negative emotions had a name that I told all my friends. Some were surprised, others concerned.
I bravely told them I’d started on antidepressants.
One friend told me she’d ‘have to think about it’. Whoa, my first experience of stigma as a depressed person.
To cut a long story short (read the full story here) I went on and off the antidepressants twice because I felt better and the third trip back to the doctor, I promised to remain on them…forever I guessed.
I just popped the little white pill every morning with my tea.
I was fortunate. I didn’t experience any side effects. I felt an enormous relief when I finally eliminated a monumental stressor from my life but stayed on the drugs because I didn’t then understand the connection between stress and ongoing low mood.
I went to China to teach English and right at the end of my time there, I went off the antidepressants because living in China I couldn’t get any more. I did try, but with little English and no desire to go to a Chinese doctor I just shrugged my shoulders and got on with my life.
A year later and that little nagging voice came back. I felt tense, tired. I found myself weeping unexpectedly, just now and then. My mood plummeted and my sleep became disrupted.
Not too badly though. And still feeling pretty good, I got angry rather than distressed by the idea of going back to depression and decided then and there to find and implement alternative ways of living, some of which I already had albeit without realising they were keeping me stable and productive.
So was it the antidepressants?
With hindsight, I think I was one of the lucky (?) ones who experienced a placebo response.
At the same time that I went on the drugs, I started psychological counselling and really enjoyed it, though it didn’t seem like therapy. The drugs are promoted by the companies as being slow acting; it couldn’t have taken effect that quickly. Going off the drug and finding the low mood returning was, I believe, entirely due to the fact that I hadn’t taken steps to improve my life, such as eradicating stress and changing my thought patterns.
So while I had a good experience, I didn’t make the changes which so many advocates of antidepressants suggest you make under their safety net.
While some people have a good result with antidepressants, for others, the drugs have no effect at all:
“I’ve been taking various anti-depressants for over 10 years and none of them have had a positive effect on my life and sense of well being, no matter how high the dosage. My GP says he’s run out of ideas but is the first to admit that doctors don’t get any real pharmacological training”. -A comment on an article about antidepressants.
For some people, they simply experience neither an improvement nor a worsening of their chronic low mood. There are numerous stories of psychiatrists trying one medication after the other in the hope of finding relief for the people who consult them.
It must be an agonising process, not to mention costly.
Some people end up with a diagnosis of ‘treatment resistant depression’. This blames the so-called illness, rather than the treatment. What if the person was just not ill?
While you’re asking ‘Should I take antidepressants?’ statistics show that you’re more likely to get a better outcome if antidepressants are used in conjunction with talk therapy and also lifestyle change.
Why not try talk therapy and lifestyle change first?
The problem is that you can’t tell in advance if you’re going to have a good or bad experience with antidepressants. It’s a bit hit and miss, a guessing game. Read the depression forums and you’ll find stories of people who have been through hell and back trying to find the type and dosage that gives them the most relief from their depressive symptoms while at the same time not inflicting any more pain on them through unwanted side effects.
If you do decide to try antidepressants, please be informed. Ask lots of questions.
If you are currently taking antidepressants and are finding them effective, that’s great. Don’t stop taking them because of anything you read on this website. Should you wish to try tapering off, do so only under medical supervision.
Some People Experience Appalling Side-Effects On Antidepressants
“On/off sertraline severe withdrawals every time. Couldn’t restabilise and dr switched me to Prozac. After a severe reaction to Prozac started withdrawal with more depression, thinking of suicide, wanting to self-harm…Put back on Sertraline to see if would help. No change and was admitted to hospital for the terrible rage and suicide threat, and given 50mg Lofepramine which took two weeks to decrease symptoms but now I have insomnia. Shrink stopped Lofepramine but I still can’t sleep”. -A comment on an article about antidepressants.
“I know from personal experience that anti-depressants can cause serious side effects and trying to come off them is an absolute nightmare. I believe anti-depressants can also seriously negatively impact relationships due to the “numbing” effect they have on your emotions”. -A comment on an article about antidepressants.
“The drugs made me feel emotionless and numb and unmotivated. I couldn’t pay attention to my studies. They affected my memory I couldn’t remember anything in lectures or when I read. Thanks to the meds, I had to give up my course. I hate the fact that I was lied to about the pills”. -A comment on an article about antidepressants.
Numbing the emotions means that people may feel more emotionally stable and therefore less low in mood. But this may have an unwanted consequence. If unpleasant emotions are eliminated or blunted, you don’t feel motivated to explore the cause of your depression and make any changes that might prevent relapse. You’re just stuck on the meds.
So, whether the antidepressants will actually make you feel better is questionable. For some people, they take the drug, feel no side effects and at some point, feel better. Others take the drug and feel no effect at all. Yet others take the drug and feel side effects so horrendous they are much worse than the depressive symptoms they were prescribed for, with little or no benefit to their depressed mood.
Finally, if antidepressants remove the painful feelings of depression (low mood, negative thinking), then how will you get the motivation and energy to change the things that need to be changed? If you muck about with your emotions, then you muck around with your neurobiological basis for change.
Entering the mental health system via the GP and regularly being put onto the anti-depressant merry-go-round. One after the other for years and years and years. If people are not thinking critically about their diagnosis and treatment, they may believe they are chronically, physically ill and end up a nightmarish journey through antidepressant hell.
Instead of asking ‘Should I take antidepressants?’ why not ask, ‘What are the alternatives?’
Antidepressants: Are There Alternatives?
“I am struggling with long term depression and anxiety and I can’t seem to find anything that works, even after at least 15-20 different antidepressants and antipsychotics mood stabilizers. I’m giving up on medication to improve my mental illness. Anyone got experience with ECT?” – depression forum post
It’s not fair or kind to suggest that people who choose antidepressants do so because they think it is the easy or fastest option. That smacks of stigma to me.
Most people choose antidepressants because they want relief from their overwhelmingly painful experiences. They feel really awful, sometimes for years and just want that pain to go away. They don’t want weeks of talk therapy. Quite naturally, they want relief and they want it quickly.
If the doctor gave you a prescription for ‘20 minutes vigorous exercise, 3 times each week’ you’d probably feel a bit miffed, but in fact, exactly this prescription has been shown to have the same mood lifting result as antidepressants – sometimes more so – and the effects are more long-lasting.
But for you to accept this, the doctor would probably need to spend time talking to you, about how you feel and your lifestyle, explain to you what depression is and how it can be treated.
And what doctor has time for that?
So what should you do? Should you take antidepressants?
Ultimately, you must do what you feel is right for you.
Read widely, ask lots of questions. If you start on antidepressants, how long will you need to take them and what kinds of side-effects can you expect?
Talk to your doctor about your lifestyle and what you want to achieve from being free of chronic low mood. Gather the information you need to make an informed decision about antidepressants.
Finally, have a good, honest look at your ideas of what depression is and whether there could be anything in your life right now that might be contributing to your low mood. Ask your doctor what other strategies you could use to feel better.
I didn’t learn to swim while wearing my antidepressant life vest. I made some changes, sure, but not in the knowledge that they would make me resilient to depression.
If you’re asking yourself ‘Should I take antidepressants?’ the very next question needs to be, ‘If the antidepressants make me feel better, what then?’
If the idea of making lifestyle changes such as incorporating more exercise into your life or eating differently or getting more socially active seem daunting, email me and ask how I can help you get started.
What you need is someone who can coach you along the road, because they’ve been through it too. I struggled with chronic depression for 21 years and have transformed my life. I can help you do that too.
Contact me today.
 All quotations used in this post have been edited by me to maintain the anonymity of the writer. The gist of the quotation has not been changed.
 Carlat, D, 2010, Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis, Free Press. If you’d like to read more about the development of the chemical imbalance theory of depression, try these resources… Whittaker, R, 2010 Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Useful websites include www.madinamerica.com, www.behaviorismandmentalhealth.com, www.psychologytoday.com/blog/science-isnt-golden and joannamoncrieff.com.