Do antidepressants make depression worse?

I just read a book that made me wonder about the adverse effects of antidepressant meds even more than I usually do. I've had my own terrible experiences with them, but I thought that once I was off tricyclics and on St John's Wort my problems with harmful (and in my case, life threatening) med side effects were over. But apparently that might not be the case.

The book that got me wondering is Anatomy of an Epidemic by Robert Whitaker (the link above will take you to his website if you want to find out more about it. The madinamerica link takes you to his blog and a whole lot of other interesting stuff). The book is about the impact psychiatric drugs have on a whole range of mental illlnesses, including depression. The author (whose smiling face appears to the right - this is the look a best selling author wears!) investigates how much these drugs actually help and harm the people who take them in the long term. His conclusions make disturbing reading, but I didn't expect them to apply to my life. It appears I might be wrong.

As I read about people with schizophrenia developing tardive dyskinesia (uncontrollable twitching), intellectual decline, and the inability to hold down a job, while getting progressively worse than people not taking antipsychotic drugs, I thought 'those poor people'. As I read about people who took tranquillizers becoming addicted, developing depression and ending up worse off than anxious people who didn't take the meds I again thought 'those poor people'. But when I read about how taking antidepressants - tricyclic or SSRI - can result in worse and more frequent symptoms of depression compared to not taking the drugs, I thought 'that's outrageous!' Because that's about me. I took a tricyclic for the best part of 16 years. I've been on St John's Wort, which has some SSRI type properties, for the best part of 14 years. That's 30 years of antidepressant medication all up. Just what has this been doing to me?

What Robert Whitaker said about the long-term effects of antidepressant use truly shocked me, and made me re-evaluate my experiences of depression. He said that prior to the introduction of antidepressants, in the 1950's and 60's, an episode of depression usually cleared up by itself within a year and the majority (around 70%) of people went back to their normal lives. This rang a bell because I remember reading this when I first got seriously depressed, in 1982. The reason I had forgotten it is because my experience for many years was of chronically relapsing depression. I had assumed that this was just the way it went, and this assumption was echoed by what I read. What did I know?

But according to research cited in Anatomy of an Epidemic, people who use antidepressants are likely to relapse more, and have less relief from their symptoms than those who don't use meds (62% decrease in symptoms over 6 months for those off meds vs 33% decrease for those on meds). An international study by the World Health Organisation found that the people who did best after an episode of depression were those who didn't take any meds. The people who did worst were those who did as recommended and kept taking the pills.

All this has made me wonder whether the continual relapses I suffered during the 80's and my 'nightmare years' during the early 90's, when I was almost continously depressed and suicidal for 4 years, were due less to the natural progression of the illness and more to the fact that as soon as I was diagnosed with major depression, I was prescribed tricyclic antidepressants. The irony is that they didn't stop the depression. If anything, they made it harder for me to feel happy - things became a lot greyer and less fun while I took them.

My personal triumph is that I persisted with learning and using cognitive and behavioral techniques, along with other approaches proven to reduce depression, and succeeded in becoming happy despite any ill effects the meds might have had. But what I'm wondering now is...if I had never taken antidepressants would have I avoided a lot of that misery? Would the full impact of CBT unimpeded by meds have led to a consistent happiness? If so, that's a terrible thing. That means all those years of misery were unnecessary and avoidable, and that I was robbed of a huge part of my life. I'm only glad I got off tricyclics and onto St John's Wort. But now I'm wondering...is even that safe? I'm pondering the wisdom of taking a drug holiday and seeing what happens. But I've learnt my lesson - if I do I will cut down my meds very slowly and carefully because I know if I stop too quickly, disaster could be waiting - but more on that in a future post.