Antidepressants are not cure alls. Duh. They are not perfect. Also duh. They have side effects. The duh-est of the duh.
So why is it that when anyone starts telling another person not to take anti-depressants everyone gets all huffy and says they should fuck off? People are just trying to be helpful and warn them of the evils of anti-depressants, right?
You may be catching some sarcasm here. Good job for picking up on that. Recently, Greta Christina has written a series of great posts about why it’s really and truly obnoxious to tell people that they shouldn’t be taking antidepressants because OMG IT WILL TOTALLY CHANGE YOUR PERSONALITY AND TURN YOU INTO A ZOMBIE.If you have some inexplicable urge to give unsolicited medical advice to random people, then please go read all of her posts right now.
But there is a flip side to the question of antidepressants, which is that they really aren’t perfect and we really should be having a scientifically driven conversation about their benefits and their costs. Many people who have taken antidepressants want to be able to have this conversation, but due to the stigma don’t like to openly discuss their medications, the side effects, and the efficacy. Many doctors who want to support those with mental illness are also hesitant to speak out about potential problems with medications for fear that their words might be misinterpreted as part of the fear-mongering around medicating for mental illness.
So I’m going to throw out some ground rules for what a responsible conversation or critique of antidepressants might look like. None of these are hard and fast, but if we want to have a productive conversation, these might be a good place to start.
Everyone is of course entitled to their opinion, but these are guidelines for a conversation that might actually get us somewhere and provide insight. To that end, I’d suggest that the most useful participants for a conversation about medication would be those who have actually taken medications and have firsthand experience of it, and those who study medication/prescribe medication. Potentially those who have considered medication and chosen other routes, or close family/friends of those who took medication could also provide new insights. This is a discussion that should probably be undertaken by those who are actually affected by it. If you really feel the need to have a debate about it and it doesn’t have any bearing on your life, do the rest of us a favor and have that debate in the privacy of your own home.
The Topic and the Style
Again, none of this is to say that no one else is allowed to comment on antidepressants, but I’m going to be perfectly honest here: as someone who has taken 3 different types of antidepressants in the last year alone, I have heard everything that the lay person might have to tell me. I have experienced most of it firsthand as well. I’ve had enough people give me their Very Important Opinion about my medication.If you do find yourself in this kind of a conversation, assume that most of what you know, the person who has a mental illness already knows. If you are worried they’re not taking study x or opinion y into consideration, phrase it as a reminder rather than REALLY IMPORTANT NEW THOUGHTS.
If you do have some hitherto undiscovered piece of information, please don’t shove it in anyone’s face or use it as evidence that THIS PERSON needs to stop taking meds or THAT PERSON really needs to get on them. Present it generally. As Greta has made clear, a person’s mental health is personal and complex. You don’t know what their situation is, and it’s extremely vain to assume that you know the best course of action for someone else to take. The best you can do is present your information and hope that others use that information to make good choices for themselves and others.
Similarly, there are important things to talk about that rightly belong in critiques of medications. Studies of the efficacy or side effects of medications, personal stories about the experience of being on or getting off medication, and stories from doctors who have witnessed a variety of patients reacting to medications are all extremely important to getting a well rounded picture of what medications actually do. All of these perspectives are important because they provide different types of insight. As an example, when I started on my most recent medication (Effexor), I discussed it with my doctor and read the side effects, then felt comfortable to begin taking it. However after missing my dose one day and experiencing some really terrible side effects I did a little Googling and found personal accounts from MANY others who had taken Effexor and found it to be nearly impossible to get off of (inducing such delightful things as hallucinations, dizziness, light headedness, nausea, lack of appetite, extreme anxiety, sensitivity to light and noise, muscle weakness and exhaustion). If I had spoken to others who took the medication, I might have known that Effexor is essentially satan in pill form (no offense to those for whom Effexor has worked). Critiques are clearly important.
The important thing about these critiques is that they should be based either in science or firsthand experience. “I read one time that a doctor said drugs are evil” does not count. It’s also important to remember that offhand comments about “it changes who you are” or other pseudophilosophical bullshit when you haven’t actually been through the experience of being on medications or living closely with someone who is on them is utterly uninformed and unhelpful. Honest and thoughtful opinions on what makes up your essential self and whether that might be altered by medications in a way unlike anything else you ever experience that are backed up with firsthand accounts and science are something completely different.
The general takeaway here is please, if you’re trying to critique antidepressants, don’t do so by preaching. Do so by pointing out specific things backed up with evidence that could cause problems for those who take antidepressants.
Perhaps most important when we’re criticizing something that has actually saved lives is to remember to be a little bit humble. At this point we don’t have a clear understanding of the brain or how we can affect it. Nearly all of our conclusions are preliminary. The criticisms we do have mostly rest on “we’re not sure but this could turn out to be a big problem”. It’s good to bring up potential problems, but remember that at this point that’s what they are: potential.
We should be skeptical of new medications and new ways of treating mental illness, but our skepticism shouldn’t come at the cost of the health of those who actually are mentally ill. Helping and respecting them should guide our discussions around mental illness and medication.