Ever wondered how the drug Prozac came to be named? When the American pharmaceutical giant Eli Lilly set about launching a new product called fluoxetine hydrochloride in 1987, it was swiftly concluded that a catchier name would be required for this 'miracle pill'. So the product went to a branding agency to devise a zingier label for the drug that was supposed to put a zing in your step.
The result was Prozac: the 'Pro' supposedly evoking 'Professional', 'Ac' hinting at 'Activity', and the extra 'Z' thrown in for good measure, adding some zap to give those taking the pill a 'sense of power'.(1)
After reading a recent eye-opening New York Times piece (2), I felt compelled to look into the way in which Prozac was actively marketed to millions of Americans as a straightforward life-enhancer. As someone engaged in a long-running battle with depression, what I've learnt about the way antidepressants were packaged up as a cure-all for the human condition has left me disillusioned.
Antidepressants are not another consumer product to be pushed as the latest must-have. They are a highly complex medication. Of course, reducing the stigma surrounding depression so that people feel able to talk about their illness and its treatment is positive; but ultimately those who find themselves anxious or low (i.e. every human being, at one time or another) need to be treated as the fragile individuals that they are. They may need medication; but then again, they may not.
A course of medication, like marriage, is not to be embarked on lightly or for problems we hitherto didn't know we had. Even in the specialist field of neuroscience, despite decades of research, psychiatrists now admit that they do not understand exactly how antidepressants affect brain chemistry (3). Certainly, no-one now accepts simple explanations along the lines of: the drugs 'increase levels of serotonin'.
Nor do they work for everyone. As the Royal College of Psychiatrists puts it: "Antidepressants don't necessarily treat the cause of the depression or take it away completely." (4) Their research has indicated that 50-65% of sufferers affected by depression will see an improvement after 3 months of treatment, compared with 25-30% of sufferers given a placebo. It is difficult to measure success in any precise way.
Then there's the side-effects. Even the Royal College admits that taking them can make you feel sick and more anxious for the first couple of weeks (5). In the longer term, they can cause indigestion, but this improves if you eat. They can also cause diarrhoea, constipation and tiredness, and can interfere with your sexual function.
Meanwhile, the Royal College continues:
"There is some evidence of increased suicidal thoughts (although not actual suicidal acts) and other side-effects in young people taking antidepressants. So, SSRI antidepressants are not licensed for use in people under 18," although specialists may prescribe Fluoxetine for minors in some cases.
You might conclude that I therefore would never take antidepressants. You'd be wrong. At times my depression has been so severe, and its physical symptoms so debilitating, that taking the drugs has been a necessity.
At the height of the two depressive episodes I have experienced I was in agony, in such pain that I was suicidal. It was not that I didn't like my life. I just wanted to stop the pain. The only option doctors can offer for acute clinical depression such as this is medication. So I took it. And I did get better.
Antidepressants are serious drugs for a serious condition. They should not be marketed for life's dips, what Freud called our 'ordinary human unhappiness'. They are for a severe illness. The problem is that GPs only have an average of eight-ten minutes to deal with someone who is struggling (6). No wonder the drugs are being freely prescribed - over 50 million prescriptions for antidepressants were issued in England in 2012 (7) - when therapy and other approaches are time-consuming and harder to come by.
But the past 17 years has taught me that it's not beyond our own powers to help ourselves. For anyone who is suffering mild anxiety, feels sad and wonders if they are depressed (you are not: if you have clinical depression, you know - see above) please try other sanity-saving approaches before you resort to antidepressants. For some, it's a new haircut. For others it's a brisk walk, or half an hour spent pruning in the garden. For me, I have learnt how to keep my Black Dog on a firm leash thanks to the healing power of poetry, amongst other strategies.
It's free, has no side-effects, roots me in the present, stops me worrying about the future or regretting the past, and provides a positive narrative in my head. Some of our greatest poets were victims of melancholy: reading Keats's 'Ode on Melancholy' cheers me up. I feel less alone.
Diet also plays a large role for me: I'm an advocate of B vitamins (good sources include tuna, lentils, eggs, pulses, leafy green vegetables), a deficiency of which can lead to 'deep depression' (8). Learning to practise mindfulness, too, helps to lower stress levels (9) - non-judgementally focusing on what one is experiencing in the moment. I have found the easiest way to incorporate mindfulness into my daily routine is to decide on a 'mindful activity': despite my husband making jokes about Lady Macbeth, mine is hand-washing. Incidentally, humour of course is best of all for piercing the gloom.
My other failsafe is noble deeds, what George Eliot called 'unhistoric acts' of kindness. I always feel better after one of the poetry workshops I run at our local prison. In fact, I'd go so far as to say I feel positively professional, active, and with an extra 'z' in my step.
(1) Interbrand Blog on 'Naming', 14th May 2014
(2) 'Selling Prozac as the Life-enhancing Cure for Mental Woes', The New York Times online, 21st September 2014
(3) The Royal College of Psychiatrists, Treatment and Wellbeing: Antidepressants
(4) The Royal College of Psychiatrists, Treatment and Wellbeing: Antidepressants
(5) The Royal College of Psychiatrists, Treatment and Wellbeing: Antidepressants
(6) NHS online, Your Choices in the NHS: Choosing a GP: GP appointments
(7) 'Is England a nation on antidepressants?', BBC news online, 3rd August 2013
(8) 'Vitamin B12 deficiency can be sneaky, harmful', Harvard Medical School Health Blog, 10th January 2013
(9) 'Being mindful online shown to dramatically reduce stress, anxiety and depression', Mental Health Foundation, 5th February 2014