The Truth about Antidepressants
As recent media reports have shown, the use and prescription of antidepressant medication is a topic that generates a lot of interest - from those who feel that they are overused, to today’s reports that they may in fact be under-used. Whilst today’s reports are reassuring for those who may have had worries about taking anti-depressant medications, they may raise further questions. Here are Mind and Soul Foundations responses to some of the most common concerns:
What is an anti-depressant?
The term ‘antidepressant’ covers a range of different drugs, with different mechanisms of action. They all affect the levels of chemicals called neurotransmitters in the brain, but different groups of drug do this in slightly different ways. If you want to read more about the different kinds of anti-depressant medications that are available MIND have a really helpful summary on their website.
Are some more effective than others?
The research reported today seems to imply that some medications may be more effective than others. It is very important that this is properly understood, as some of the most common medications prescribed appear in the list of the less ‘effective’ medications. If a drug you are on is in this list, do not panic! The good news from this study is that all the medications seemed to have a genuine effect. However this study only looked at short term use, so its important we understand the limitations of the results as well.
The impact of an antidepressant medication varies tremendously from person to person and studies like this look at the generalised effect across all people - making it difficult to know what such results mean for any one individual. Drugs also differ in how well they treat particular symptoms - such as the obsessive thinking associated with anxiety, or sleep problems that can be associated with depression. And of course different drugs may be suitable for different people due to a wide range of other factors including age, other health conditions etc.
It is also important to remember that a key feature of antidepressants is how well they are tolerated - that is whether they cause side effects which may mean someone stops taking them. It doesn’t matter how good a drug is if the side effects mean it stays on your bedside table!
When a GP or psychiatrist makes a decision about prescribing a medication they draw all these factors together in making a decision. It is really important that from that moment further decisions about medications are taken together with the patient - doctor and patient working in partnership to make the right decision. This means that as the patient it is really important you do talk to your doctor - be honest about any worries you have, or side effects you may have experienced. Do not be afraid to return and tell them if you feel that a medication isn’t really helping. It may be that a change of drug might help you - or even an adjustment of the dose.
The most important thing to remember is that you should not stop antidepressant medications abruptly without discussing this with your doctor. If today’s reports have raised concerns for you, make sure you have that conversation with your doctor before making any changes.
Can antidepressants be addictive?
Some media reports have stirred up a lot of concern about this topic, featuring alarming case studies and dramatic stories of people who have experienced extreme difficulty in coming off anti-depressants. Some do have a withdrawal syndrome, where you get shakes and sweats (though it can be more unpleasant for some) - meaning that some people think this applies to all antidepressants and worry unnecessarily.
Whenever we talk about addiction we have to remember that true addiction - where your body adjusts to taking a drug and becomes physically dependent on it with craving and drug-seeking - does not occur with antidepressants. However, psychological 'addiction' and the anxiety associated with stopping a drug is much more common. And of course if you have taken a drug for a long time, your body may need a period of time to adjust to stopping that drug - meaning that instead of stopping it suddenly you should gradually taper down the dose.
Many people worry about becoming addicted to a medication given for a mental health problem. The truth is that in fact the vast majority of those who start taking antidepressant medication do successfully stop. However some people do find that they need to take it long term. If this is the case we need to remember that were it a physical health problem being treated - like diabetes or a heart condition - we might have no problem with a long term medication being prescribed. Its important to do this under good supervision from a GP or psychiatrist but it is not by any means wrong.
Having said that, there is good research that particularly for those experiencing mild to moderate depression, medication is best used not on its own but in conjunction with other treatments which help them adjust things like patterns of thinking and lifestyle factors which may adjust their risk for the mental health problem recurring. Strengthening your strategies to manage issues like stress or negative emotion help to reduce the likelihood of your having to continue with antidepressant medication, or have repeated episodes of needing it. But none of these things mean that taking a medication when you need it is a bad thing.
Should I take an anti-depressant?
Many people worry about this question, and it is perhaps the most common reason for people to not take a medication prescribed or suggested for them.
The truth is that anti depressant medication is a very important tool in our treatment of many mental health problems. In some cases it may even be a life saver - where mood has dropped very low and people are experiencing serious symptoms such as suicidal thoughts. Medication can also be a vital step enabling people to benefit from psychological therapies.
Think of it a bit like trying to get a boat across an ocean. Sometimes we sail into storms - and the waves come over the side of the boat so we have to bail water to stay afloat. In addition to this most of us have some leaks in our boat - areas of our personality or history which make us more prone to struggling with certain emotions or situations. These also let water in - so perhaps even on a calm day we have to bail a bit. The combination of these things can mean that we become exhausted, or that even though we are bailing with all our might, we are at risk of sinking. This is where medication can be so valuable - like installing a pump that bails for you for a time. For some this re-sets the balance of vital chemicals in their brain. For others it takes the pressure off until a storm has passed - like bereavement or severe stress. Or it may mean that you - no longer having to focus all your energy on bailing - can focus some time on a therapy like Cognitive Behavioural Therapy - and work on fixing some of the leaks in your boat.
If a doctor is suggesting to you that an anti-depressant medication may be helpful, try not to dismiss it without taking the time to talk it over properly. If you have concerns, be honest about them. And remember, it could be part of your road to getting back on an even keel again.
What about Christians?
Some people have heard unhelpful teaching suggesting that taking an antidepressant is somehow contrary to the bible, or that if they focused on God more, or read their bible more, or were somehow a ‘better’ christian, they would not need this medication. We cannot emphasise enough how untrue this is. Mental health conditions are not linked ot how strong or good your faith is - in fact many great leaders and men and women of faith have struggled with them, both in the Bible and more recent times. Furthermore the development of medications and treatments for mental AND physical health conditions is an amazing thing and there is nothing in the bible that suggests we should step outside of accepting such treatment when we are in genuine need.
If you are worried about where God fits into your treatment for a mental health condition - whether that is medication or other talking therapies, consider asking a trusted friend or member of your church to meet with you regularly to pray - alongside your other treatment. But do not feel that it means you cannot accept secular treatment or medication.
Other treatments are available...
This study strongly suggests that many people with depression will benefit from anti depressant medication of some kind. However it is important that we appreciate that medications are not the only treatment available. Many studies suggest that they are best used alongside other therapies for the best chance of long term recovery or management of a condition.
Other approaches which have an important role in the treatment and management of mental health conditions include talking therapies - especially Cognitive Behaviour Therapy but including things like psychotherapy. Other approaches such mindfulness medication - and even more creative approaches like as exercise therapy have also been shown to be very powerful in lifting mood and helping manage associated problems like stress and anxiety. Some studies have even reported effects as strong as those seen with medications and encourage GPs to prescribe these as well.
So remember - if you are being prescribed medication but you want to do other things to maximise your emotional health and work on your recovery there are many other things you can do as well alongside taking your medication. Medication may not be the only answer - but this study suggests it can be an important part of a wholistic response to mental health conditions like depression.
Try not to neglect the spiritual side of recovery too; bring your fears and concerns to God in prayer. Try to share your journey with other well informed Christians and always remember that you are precious to God and that he loves you deeply.
Kate Middleton, 22/02/2018