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.

Who do I make myself happy for - me or others?

This may seem a funny question. Happiness is good, right? So why does it matter who you do it for?

The reason it matters to me is that it affects my motivation to do the things that make me happy. I started having mood swings as a child, and it escalated to clinical depression in my early teens. As I grew up there was no shortage of 'helpful' people in my life telling me things like 'smile', 'just be happy' and (the worst) 'cheer up - it may never happen'. My mother's hairdresser was a particular offender. For his troubles he earned my famous death stare, which soon shut him up.

Then there were the high school 'friends' who made it clear they weren't interested in hearing about or seeing any signs of my depression. Needless to say I soon got pretty good at pasting a smile over my sadness, like so many other people with this terrible disease. It did not make me feel accepted or cared about (or happy!) but lonely and leprous, like the real me was not OK.

Some other 'helpful' people write books and articles advising depressed people to 'think about other people more than yourself'. They may even say depressed people are selfish or self-absorbed. Particularly with people who - like me - have attempted suicide, they may point to the pain caused to other people as a reason to stop being depressed and suicidal. I met one young woman who'd had the terrible experience just after a suicide attempt, when she was feeling very vulnerable, of having a psychiatrist yell at her for causing her family so much anguish. Needless to say, this didn't make her feel any less depressed!

So when depression starts intruding to my normal habitual happiness, I find it helpful to shut down the echoes of those 'helpful' voices from the past. It's not that I don't care about how my depression affects others. I do. It's just that I feel so resentful and resistant in the face of these thoughts - just like I did when I was growing up - that it makes me act against my best interests and not do the things I know will make me feel happy.


What works better is to focus on the main reason I want to feel happy - because it makes me feel good. The fact that it is also nicer for others is great, but it's the icing on the cake. The cake is my own good feelings. I've spent too many minutes and hours of my life feeling painful emotions, enviously watching happy people and wishing I was like them. I treasure every moment of happiness I experience, and the reason I work so hard to achieve and maintain it is because it's so pleasurable. So when I feel down I say to myself 'I don't 'have' to feel happy - I want to feel happy for me, because it feels good'. This may seem weird, that I might resist doing something that feels yummy - like resisting eating chocolate! But if you have experienced depression you can probably relate to what I'm saying. Those 'helpful' comments can make you dig your toes in and refuse to do anything, even though you are the one who suffers most as a result. So focusing on feeling happy for yourself can be a way to get past that resistance. And everyone benefits!

Staying happy when times are tough

Life is never perfect (as a reformed perfectionist, I now know this is true!) But for some of us, it's more imperfect than for others. The following circumstances can be a reason:

• being homeless
  


• being out of work
  


• chronic illness
  


• chronic pain
  


• lack of money (particularly when coupled with lots of bills!)
  


• social isolation
  


• living in a war zone.

You get the picture! Barbara Fredrickson has found the happinss is most likely when people feel three or more positive emotions to every negative emotion. Does this apply to negative events too? Is happiness more likely the more positive circumstances we have in our lives? I'm not sure, but I suspect the answer is 'yes'.

In my own experience, being ill, out of work, having money problems and being socially isolated have made it harder to be happy. (I'm thankful to say I haven't ever had to cope with being homeless, in chronic pain or living in a warzone, but I feel for those who do.) But I've also found that negative circumstances don't make happiness impossible - it's a matter of having to work harder to create and maintain the happiness.

I don't want to be Pollyanna-ish about this. Having problems sucks, and when every second phone call seems to be from the taxman, the bank or someone you owe money to, it can be hard to see the world as a sunny place. I know this from personal experience. But in my view it's worth trying, simply because depression is painful and happiness is a whole lot more fun. Look at it this way - it's bad enough having crappy circumstances without feeling depressed into the bargain.

So here are the things I've found help create and maintain happiness in the tough times:

• having a plan for each day, just a list of tasks that can be realistically done (by you - not superman!) each day. I find it helps give focus and increase motivation
  


• having some goals for life that you're working on, such as finding a job, improving health, or creating something
  


• spending time with people you feel close to - this is a biggie
  


• exercise and getting out in natural light are always great for boosting mood, if you can manage them, especially in places of natural beauty



• writing down the positive things that happen each day and what you achieve e.g. I did the dishes, my friend called. Some people prefer to do this weekly but I find that when times are tough, daily works best to help prevent (or offset) a focus on the negatives. I also do way more than 3 each day - as many as I can think of and have time to write



• planning events that could bring pleasure, whether with others, or alone.

It's all about building up the positives in life so they start to outweigh the negatives, as well as noticing the positives when they happen. There's nothing like a lot of negative circumstances to set off negative, depressing thinking. Finding meaning in life also helps to get me through the tough times, in the form of goals I want to achieve, that give me a reason to get up in the morning.