This week, the University of Westminster, along with partner Universities both in Australia (Monash & New South Wales) and the UK (Oxford, Nottingham) released detailed research on patient experiences of antidepressants. Published in the journal Social Science & Medicine (1), we analysed the accounts of 107 antidepressant users living in the UK and Australia. Many of these accounts go against the grain of conventional wisdom as discussed below.
Prozac and similar drugs have received mixed reviews since the 1980s. The media, for example, began to wonder early on if Prozac caused violence, and the effectiveness of this and similar medication has come under intense scrutiny in recent times.
Not surprisingly, we found that even before people take their first dose, they are very aware of publicity - often negative - surrounding antidepressants. Our participants seemed to have friends and relatives with strong opinions about antidepressants, including fears of addiction (although antidepressants are not known to be addictive, however, discontinuing some antidepressants can result in unusual symptoms e.g. electric shock sensations). As Victoria* (UK), one of the people that we interviewed in our research, said, "One of my friends was like, 'Oh well we've got to get you off them straight away,' and I sort of went 'Well no because I've only just been on them and I need them for a bit.'"
Fears about antidepressants are important, because people with severe depression - who we know are most likely to benefit from the medication - can end up rejecting a treatment that might be life saving. Like another person we spoke to - Sasha (UK) - who rejected antidepressants outright even though, "...she [the doctor] said 'they're not addictive anyway', but I was still scared."
People are particularly afraid that antidepressants might change their personality, numb them or otherwise make them inauthentic. And inauthenticity is possible. One person said, "[I was a] functional zombie...[it] takes away the bad, but also takes away the good."
But we also uncovered many "counter-stories" to these antidepressant tales of false selves. Thus others argued they that felt authentic - or more like their true selves - on the medication. Layla, (UK) said, for example, "sertraline [is] a bit like Berocca, it's you on a good day."
And while people frequently said their experiences of antidepressants were very ordinary, we found that many others made all kinds of links between their antidepressant use and illicit substances. For example, while doctors will usually tell patients that it can take many weeks for antidepressants to work, some of our interviewees believed they were feeling better - and even high - after only a few hours or days. John (Australia) said, "So I filled the script... I think between 24 and 48 hours I felt so different that I rang the doctor and I said, look do I have to go up to a full dose, because this is amazing."
The problems of this "pseudo-illicitness" were clear to those affected: Things can go wrong. Gary (UK) said "I found it quite scary... I wasn't really ready for taking drugs of that strength," while others reported they later crashed, or had frightening hallucinations on their medication. There were also discussions about antidepressant glamour, and fears of falling into harder medication (or even drug) use. Ivan (Australia) initially thought antidepressants were "...something which Hollywood stars used to take to poison themselves, take antidepressants to move to Xanax... you hear that from popular media."
In a society that is suspicious of depression as a medical condition, psychoactive substances, and antidepressants in particular, it is not surprising that the legitimacy of antidepressants is widely questioned. Being on antidepressants is frequently considered some kind of moral failing, and a barely legitimate practice in many quarters. Antidepressants are stigmatized, and their use can signal to patients (and their friends and family) a kind of moral failing, something shameful, or as one person said, "a dirty little habit".
Given our findings, it is no wonder patients in distress find it so difficult to decode the social messages they receive about antidepressants. Of particular concern, those with severe depression (who are the most likely to benefit from taking the medication) may think twice about using a potentially life saving treatment.
The legitimacy 'crisis' surrounding antidepressants as outlined above powerfully shapes antidepressant use. But the antidepressant "counter-stories" we also uncovered challenge the stigma, shame and perceived moral failings involved in antidepressant use. As one person interviewed said, under the circumstances, it can require "courage to ...take them." Ivan - who was quoted above as initially scared of falling into harder drug use - later defiantly said, "[It's] April, 29th 2010 and I am proudly still on one capsule of Lovan [fluoxetine]. It gives me confidence, it is like a security blanket, and I think it is fine."
We found that patients - no matter how positive about antidepressants - are still compelled to engage at some level with a range of moral concerns about antidepressants. Even if just to challenge unhelpful ways of thinking. We concluded that society's deeply ambivalent attitude towards psychoactive substances - and antidepressants in particular - may be muddying the water. Pragmatism may be a better approach to antidepressants - which are a limited, but at times valuable, means of dealing with depression.
*All names used are pseudonyms
(1) http://www.sciencedirect.com/science/article/pii/S0277953615301568 [Ridge, D., Kokanovic, R., Broom, A., Kirkpatrick, S., Anderson, C., Tanner, C. "My dirty little habit": Patient constructions of antidepressant use and the crisis of legitimacy, Social Science & Medicine(2015), doi: 10.1016/j.socscimed.2015.10.012.]