For years, Lucy Fry struggled with depression but shunned medication, regarding it as an unnecessary substitute for therapy. She reveals what changed her mind – and her life.
When is it good to take antidepressants? Until recently I would have answered hardly ever, preferring to believe that medication, unless used in cases of severe depression, bipolar or schizophrenia, was merely a way of sidestepping legitimate sadnesses, which were better faced and worked through via therapy. I see now how puritanical – not to mention ill-informed – this sounds. But in my defence I had my reasons. Ten years ago, aged 26, I had a breakdown, triggered by confusion over my sexuality and my decision to leave a steady job and go out into the wilderness as a freelance writer. Gradually I realised I was in trouble: panic attacks, hopelessness and hours of tears daily meant that earning became nigh-on impossible.
I went to see a psychiatrist, who put me on an antidepressant medication (Citalopram) and suggested that I start therapy. The idea was that the medication would help to lift my head and heart to a place where I was better able to engage with the therapy and start to challenge my negative core beliefs. Indeed, my weekly sessions with a psychotherapist became part of a long and meaningful unfurling, an ongoing journey towards becoming more self-aware, fulfilled and open. I confided in friends and family that I was in a relationship with a woman and started to carve a career as a journalist. The therapy helped me to understand that the way I thought about myself wasn’t helpful or self-caring, and it gave me space to explore my past: traumatic incidents during childhood that still caused me to doubt myself.
As for the antidepressants, I think they did have a small initial effect: simply by taking them I acknowledged that I was struggling and stopped pretending that I was fine. I don’t think it was supposed to be a long-term thing, but somehow it ended up that way. After just one follow-up session with the psychiatrist I began to get three-month prescriptions from my GP instead. I was afraid to stop taking the medication and yet still the hallmarks of chronic moderate depression hung around: negative self-talk, pessimism and a propensity to drop into sadness, sometimes with frightening speed and intensity.
Eventually, after another terrible self-hating day triggered by an argument with a close friend, my partner begged me to see my GP. He suggested doubling the dose of my medication, but I thought, “Enough”, and decided to follow my instinct, which was that it wasn’t making a jot of difference. I decided to come off the medication completely – and guess what? Once I was off it, everything remained the same. I didn’t feel worse and I didn’t feel better. Now I was convinced that antidepressants didn’t work! And still I walked around with stress on one shoulder and anxiety on the other. Every few months I’d be ambushed by a ferocious sadness and have to withdraw from life for a couple of weeks until the tears dried out. Oh well, I thought, maybe this is just me. I’ve always felt things very deeply. Maybe the lows come with the highs. But at least I’m not on meds. At least whatever I feel is real. Clearly, I had developed a prejudice. I had joined the increasing number of people sceptical about what they believe to be the overuse of antidepressants, those who believe we must dig deeper into the origins of our distress and look at what, both as individuals and a society, we’re getting wrong. This group has many complaints about antidepressant medications.
One is that they’re making the pharmaceutical industry lots of money while silencing (rather than addressing) the anguish felt by millions of people trapped in a world where old-fashioned community is disappearing and we’ve become addicted to technology. This argument resonated with me and I was determined to carry on with life – and therapy – unmedicated. Whenever the subject of antidepressants came up with friends I’d sigh, thinking how sad it was that some people chose to numb themselves when they could be walking unarmoured through their days. I regarded moderate anxiety and depression
less as chemical malfunctions in the brain and more as signs that something in a lifestyle required changing. So in an attempt to cure myself, I read a different self-help book every month, went on personal development courses and meditated daily. I felt sure that if I was courageous and willing, I would be able to go through the darkness, tweak my thinking and emerge into the light a happier, more balanced me.
Yet still the negativity persisted. All that worry and self-criticism was getting worse. Then, late last year, after an intense few months that included the birth of our first child (to whom I am the nonbiological mother), financial pressures and work-related disappointments, I tripped into a sadness of epic proportions. Even the simplest things such as calling a friend back seemed to require too much energy. My self-belief was minimal and I was exhausted – not just as most new parents are, but as though a virus had ravaged my body until walking felt difficult. A virus of sadness, perhaps? In retrospect, the trigger for this depression is fairly obvious. I was physically, mentally and emotionally spent. Perhaps if I’d been able to take a couple of months off and recuperate somewhere hot I’d have bounced back without medical help.
But that wasn’t an option: my family needed me to work, to love, to play, so I acquiesced and visited a new psychiatrist. It was one of the best things I’ve done in years. Firstly, I was completely open with this doctor about my concerns that medication would turn me into a zombie, an idea I’d gathered from books, films and occasional stories told by friends. Secondly, I explained how much I valued therapy and how I felt I’d be a failure in that regard if I succumbed to medication. Well, he asked, what has therapy given you? This was an easy question to answer, I replied: therapy had transformed my day-to-day life in wonderful and interesting ways. I understood my past much better, had unravelled many issues that held me back and felt more able to be myself. Yes, he nodded, and those are wonderful things. But you are still suffering with depression. Don’t you think it’s time to try something new?
I was too tired and desperate to argue. I agreed to try some pills and he prescribed what he felt to be the right medication for me (an SNRI – serotonin–norepinephrine reuptake inhibitor – prescribed for alleviating depression, anxiety and panic). He also reassured me that this time I’d be closely monitored, unlike ten years earlier. After a dodgy couple of weeks where side effects included headaches, nausea and a fuzzy, detached feeling, the drugs started to kick in. During this time I returned for a checkup. Soon after I felt an upward shift in mood, but it was around six weeks (and another checkup) later that I noticed how reduced my anxiety was – probably just 20 per cent of what it had been for years. I was concentrating better and felt more able to step back and argue with the critical voice inside my head (which was also quieter).
It was revelatory. I didn’t realise how much stress I’d been living with until it was reduced. Most of my worries about side effects were unfounded: I didn’t balloon in size and I was far from a stupefied zombie. Quite simply, I began to feel more resilient – but not at the expense of my emotional range, merely the highest highs and the lowest lows. What on earth was happening? Could this really be down to medication? Then, after I’d been taking the drugs for a month, a groundbreaking study by Oxford University confirming that antidepressant medication works was released. What’s more, some were found to be tolerated better than others, while others are more effective. And guess what? The pills I’m currently taking were proven to be more effective than those I was on after my first breakdown.
I was intrigued to know what it was about antidepressants that helped produce such astonishing results. ‘Our current understanding is that new brain cells are produced in everyday life, particularly abundantly when the brain develops in childhood,’ explains psychiatrist Carmine Pariante from King’s College London and the Royal College of Psychiatrists (rcpsych.ac.uk). ‘But even as an adult you continue to produce new brain cells and connections between them, which allows you to consolidate memories and learn new things about life. Antidepressants increase the creation of new brain cells, which allows a person to begin to judge life differently and perhaps change the negative way they’re looking at it. ‘From a pathological point of view, antidepressants do the same thing as psychotherapy,’ he continues. ‘The final outcome for the brain is essentially the same – that’s why the combination of the two is the strongest tool we have, and why they are best prescribed together. Antidepressants make the work of psychotherapy more effective but they’re both about learning.’
This was quite hard for me to hear. I still believed (and do to this day) that most mental-health issues are either symptoms of underlying trauma or come about because of a nasty, critical inner voice acquired during childhood. I’m also still committed to the idea that with therapy and lifestyle changes, such trauma can be worked through, and that tackling depression with medication alone is to deny oneself the chance at life-enhancing personal growth. Yet having experienced first-hand what an enormous difference the correct medication can make, I now realise where I went wrong in the past. To disregard antidepressants merely because they reduce the severity of depression symptoms (or purify our emotional life) is stupid, even masochistic. Also, to reject antidepressant medication because you wish to understand what’s caused the depression in the first place is like refusing painkillers when you’re suffering from a migraine. If you take medication, it doesn’t mean you must give up on trying to find the cause of your migraines and reduce their frequency.
The therapy I had over the years did a huge amount to help me reframe my views, but it wasn’t the only solution and, when things got especially stressful, I needed an extra boost. It feels such a relief to struggle less. What’s more, I feel no shame about being on medication, nor any pride that I struggled without it for years – just a little regretful that I struggled for so long.
Is it time to get help?
Three signs you may need to take medication…
- Is there an obvious recent cause behind your feelings? If you’re going through something traumatic such as unemployment, divorce or grief then it’s more than
natural to feel sadness, anxiety or even to struggle with work or socialising. ‘We wouldn’t prescribe antidepressants immediately, but rather hope the patient can get social support and use the experience, however upsetting, as a kind of personal healing,’ says psychiatrist Carmine Pariante. ‘But if that person is still crying every day six months later and can’t get out of bed or has been off work for one to two months, it’s time to think about medication.’
- Are you wondering why you bother with life? If you’re feeling suicidal or as if life might not be worth living, it’s time to take action. ‘One question we always ask – even if someone seems to be doing OK – is, “Have you ever considered that life isn’t worth living any more?”’ says Pariante. ‘Even with a doctor people can go to great efforts to appear as if they’re coping, but when we ask that specific question we often get the truth.’
- Are you waking early? ‘Sometimes people with depression sleep all the time, but the most classic sign is waking up very early, say 3am or 4am, and not being able to get back to sleep,’ says Pariante. ‘People who are clinically depressed have an already elevated level of stress hormones, so their levels peak too soon when the stress hormones naturally begin rising very early in the morning.’