12

October


I have taken antidepressants continuously from 1989 and episodically before that, as I have a history of recurrent depressive episodes since my teens. They were finally recognised as part of a bipolar illness in 2001. I think I’ve had 8 different ones in all. I found them helpful. A number of times I made a textbook recovery, starting to improve after a couple of weeks, and my son was the same. Even when they didn’t stop the depression, I found some of the side effects useful, mainly the sedation for insomnia, anxiety and agitation.

I have also taken plenty of other drugs and at present take two mood stabilisers and two antidepressants, a combination prescribed more than a decade ago which has served me well. For most of the time the antidepressant doses have been high, one at nearly twice the recommended maximum (permitted in certain circumstances). It increased my blood pressure significantly.

However, I don’t want to continue on mega drug regimes till the end of my days. Though I would like to stop everything in principle, I acknowledge this isn’t practical as I don’t want to swap stability for instability. So I’ll keep the mood stabilisers – but should I stop my antidepressants?

The case against stopping is simple. If I stop them, I might get ill again. However, I might not. Since early retirement in 2008 I have become progressively healthier and my last serious depression was in 2012. So why jeopardise my recovery? Because I don’t think it will; they don’t act like that.

So how do they act? In fact, do they act? At best, antidepressants are very blunt instruments, because they act on neurotransmitters via the blood stream. Neurotransmitters regulate the millions of highly specialised brain activities, including mood, in a way which could be likened to turning the sound on the television up or down. In other words, antidepressants lack precision and are highly unlikely to be able to do all the things they’ve been credited with.

But isn’t there a lot of research proving they can? Rephrase: apparently proving. Most of it was done by the pharmaceutical industry, which had a major investment in getting positive answers, which they managed to by designing their drug trials in various biased ways. Then there’s the problem of placebos. In drug trials for depression, half the depressed subjects should take the drug and half a placebo (inactive preparation) for comparison. Typically, about a quarter of placebo takers would still improve and under half of the drug takers. So the bottom line seems to be that antidepressants do work but not very well.

Now that I’ve gone through all that, I think antidepressants are probably my comfort blanket but they are unlikely to be keeping me well now and will not take their revenge if I evict them. Over the last two years I have in fact reduced both of them very slowly without any discernible ill effect. I’m about to stop one altogether and I’m down to a half dose with the other.

Should I? Shall I? I have my answer.

Rose
A Moodscope member.

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