What first comes to mind when you hear the word “antidepressant”?
The word might sound quite harsh and intense to you. It is a word that may make many of us rather uncomfortable. I have found the word to be quite taboo, as if I should whisper it when talking to people. Between 10 and 12 per cent of the Irish population are currently being prescribed antidepressants. If this is the case, then why do we struggle so much with speaking to our friends and family about this topic?
I wanted to learn more about antidepressants and why we find it so difficult to talk to each other about them so I reached out to some professionals to gain a deeper insight into the topic.
I spoke to Martin Rogan, the CEO of Mental Health Ireland. Martin has over 30 years’ experience working in the mental health sector in Ireland. He noted that there has been a “pendulum swing where everybody wants to talk about mental health”. However, he added that “everybody wants to speak about lighter stuff” and tends to avoid speaking about medication. Several people have approached Martin to discuss their loved ones making excuses about what their medication is for. He said that people will hardly ever “describe it as being related to a mental health need”. Many people have opened up to him about the difficulties in telling people that they have been prescribed antidepressants: “Most people taking psychotropic medications will quietly take them, feeling a sense of defeat”.
Between 10 and 12 per cent of the Irish population are currently being prescribed antidepressants
The pandemic was tough for all of us. Each of us had to do something we had probably never done in our lives before. We were forced to essentially remove ourselves from society. We sought out solace in our phones and television screens. We tried to keep ourselves occupied with a million and one hobbies. It was draining. After an extended period of anxiety, I went to see a counsellor. I was not feeling myself and felt as though my brain capacity was diminishing. She was genuine, open-minded and very helpful to me. This period was followed by regular GP visits and eventually being prescribed lexapro (escitalopram). Lexapro is a Selective Serotonin Reuptake Inhibitor (SSRI). These medications inhibit the reuptake of serotonin, leading to a higher availability of serotonin, a neurotransmitter often associated with happiness and the regulation of mood.
While daunting at first, antidepressants made a hugely positive impact on my life. I was no longer operating on autopilot. My mind was no longer shrouded by catastrophic thoughts. I did not feel a sense of impending doom at almost every second of every day. I had more energy, became more confident and had a bigger appetite. My vision was not going blurry from stress. I felt like myself again. When my GP switched my medication to an SNRI, effexor (venlafaxine), it lifted even more of the stress off my shoulders. Yet, despite all of this, I continue to tell people that my medication is “for my acne” or “anti-inflammatory medication”. It still feels awkward telling people and it absolutely shouldn’t be.
Rogan told me about the huge progress that has been made with mental health medications. He added that SSRIs “are very focused as to what neurotransmitter they target and have less side effects”. This brings me to another common misconception surrounding antidepressants: the “happy pills” notion which suggests that taking antidepressants makes you happy all the time. In addressing this, Martin points out that “they can be very effective for a person with depression. They are not so effective for someone who is unhappy. People often conflate the two. If you’re unhappy, you need to make difficult lifestyle changes”.
I spoke to Prof Brendan Kelly about the stigma associated with mental illness and mental health medications. Kelly is a consultant psychiatrist and professor of psychiatry in Trinity. He described the stigma as “a preventable tragedy”, adding that “the stigma associated with mental illness is generally related to a poor understanding or limited experience of the issues involved”.
While daunting at first, antidepressants made a hugely positive impact on my life. I was no longer operating on autopilot
“There is strong evidence that stigma has negative effects on the physical and mental health of people with mental illness” and also “has a deleterious effect on help-seeking behaviour”.
Kelly has had countless patients speak to him about “difficulties discussing antidepressants and other treatments with people”. When asked about the stigma related to mental health medications, he said “Often, psychiatric medications such as antidepressants (used to relieve “psychiatric” pain) are viewed very differently to medications such as analgesics (used to relieve “physical” pain)”. He added: “If you have a leg injury, it is perfectly acceptable for your doctor to try a pain medication and, if that one does not work, to try another option. Eventually, one will work. With pain medication, this process unfolds without much psychological drama and without deep philosophical examination about why you need this medicine to begin with, what it does or does not say about you as a person, and why the first medication did not work but the second one did.”
Kelly believes that this stigma “will continue unless it is continually addressed through honest public dialogue about suffering, treatment and recovery in serious mental illnesses”. For this to happen “greater discussion about psychiatric treatments, in particular, is vital”. Sadly, as professor Kelly pointed out, “there is still deep cultural denial about severe mental illness requiring psychiatric care and, on occasion, medication”.
My own GP, Dr Padraig McGillicuddy, has always been very insightful and open when discussing mental health medications with me. He thinks that “we have become much better at acknowledging and accepting” when asked about the stigma attached to mental health drugs. McGillicuddy believes information or lack thereof is at the root of the problem. He highlighted that “spotting the symptoms in other people and being aware of it as a possibility in others is still something that people could educate themselves on”. Patients have often opened up to him about their fears surrounding being on medications “as they fear it might adversely affect work reviews or relationships in general and be perceived as a sign of weakness or instability”. He remains hopeful and is sure that this stigma can be tackled “through ongoing information, education and communication. Not just by the organisations involved in managing these issues but by all organisations and bodies who deal with large numbers of people and who have a platform through which they can communicate with them”.
Spotting the symptoms in other people and being aware of it as a possibility in others is still something that people could educate themselves on
My impetus for writing this article was to demystify rumours about antidepressants and to encourage people to educate themselves on the topic and look out for your friends and family. There are people all around us who are struggling, people who are embarrassed to tell others that they’re getting help. Cast no judgement, keep an open mind and be kind. For people struggling with mental health issues, if boxing heavyweight champion Tyson Fury can go from a deep depression, contemplating suicide, to a world champion, losing 64 kilograms in the process, the bright days will come back for you too.