Am I “against” antidepressants and other prescribed psychotropic drugs?

I had not intended to write much just yet directly about prescribed psychotropic drugs, beyond sharing my own (S)SRI story, because it is my intention for this website and blog to serve as a larger exploration of what it means to be well. But various versions of the above question come up a lot in my world, and more have come up in response to the launch of this website and blog. I am often asked if overall I am against the use of these drugs, or sometimes people (understandably) just assume that I am. This is an important discussion to have because as I explore in this space what it means to embody wholeness, to heal, and to be well, I’ll be doing it through the lenses of my own lived experience. And my lived experience includes a long, intimate, and difficult relationship with prescribed psychotropic drugs from the (S)SRI antidepressant class. In many ways this relationship has been the catalyst for everything I am doing now and sharing in this space. Why? Because it is this relationship which caused me to become so ill that I realized I needed to (gradually) take a good hard look at everything about how I was living my life, and find a better way.

But let’s clear something up before I really dive in: I do not actually take a generalizable stand in either direction “for” or “against” the use of prescribed psychotropic drugs, because I don’t feel it is my place to make that judgement for anyone but myself.

Overall, my experience has been that in addition to harming me physically, my continued long term use of these drugs made me just “comfortable” enough to tolerate things that really, desperately, needed to change in order for me to actually be well. In this way my prescribed psychotropic drug use served to help keep me sick, and to sever my connection with myself. Taking these factors into consideration, at this point I am against these drugs for me. However, I have encountered plenty of people over the years who credit the same drugs as having saved their lives, and those experiences are just as real and valid as mine. None of this is either/or, yes/no, good/bad, right/wrong, black/white. It’s just not that simple. We are all different, our journeys all look a little different, and our needs are varied. All of this is perfectly okay. At the end of the day I believe in each of us doing whatever we need to in order to be well. That is the bottom line.

The generalizable stand I do take now and forevermore is one of pro truly informed consent. And I have come to learn that opportunity for truly informed consent is not something most people are given when they start on a prescribed psychotropic drug. Why is that? There are way too many reasons to get into in a single blog post. I could actually write a whole series of posts addressing that topic (and maybe I will if there is an interest). But I think the single biggest reason why there is little-to-no truly informed consent is that the majority of prescribers out there–even psychiatrists–still don’t actually have all the pertinent information themselves. If prescribers don’t know, they can’t tell us either.

For instance, there have actually been no studies in over six decades of research that definitively link low serotonin levels to depression (Brogan, 2016). This includes various imaging studies, blood and urine tests, post-mortem assessments, and animal research (Brogan, 2016). And still, the mainstream narrative is that depression is caused by an imbalance of neurotransmitters in the brain, namely low serotonin levels. (Nevermind the fact that upwards of 80% of our serotonin is actually produced and stored in our gut–not our brain. But I’ll save that for a different post). Large meta-analyses of placebo controlled studies have shown us that while antidepressants work statistically better than placebos, it turns out that the statistical difference between the antidepressant group and the placebo group is not clinically meaningful–ie the difference is too small to be of importance in the life of someone who is depressed (Kirsch, 2010). Yet antidepressant drugs carry with them potentially harmful side effects and withdrawal effects for anyone who takes them. According to a 2019 study published in Addictive Behaviors, over 50% of antidepressant users will experience some kind of withdrawal effects upon cessation of their prescribed drug, and 25% of users will experience withdrawal rated as severe (J. Davies & J. Read, 2019). Withdrawal symptoms can include but are not limited to: affective symptoms (irritability, anxiety or agitation, low mood or depression, tearfulness, dread), sleep disturbance (insomnia, nightmares, excessive dreaming), gastrointestinal symptoms (nausea, vomiting, diarrhea, anorexia), cognitive symptoms (confusion, decreased concentration, amnesia), disequilibrium (dizziness, lightheadedness, vertigo, ataxia, gait instability), general somatic symptoms (flu-like symptoms, lethargy or fatigue, headache, tremor, sweating, weakness, tachycardia), and sensory symptoms (paraesthesia, numbness, shock-like sensations, rushing noises, palinopsia) (M.A. Horwitz & D. Taylor, 2019). Several countries around the world have also observed that the number of their citizens disabled by depression actually increased after the arrival of SSRI drugs onto the scene (Whitaker, 2015), calling into question whether the long term use of these drugs might actually be making the problem worse, not better.

And these are just a few examples… and they are only examples of antidepressant drugs, they don’t take into account all the other classes of prescribed psychotropic drugs… and they are only examples pertaining to the use of these antidepressant drugs for symptoms of depression, as opposed to the myriad of other symptoms antidepressant drugs are so often prescribed in an attempt to address.

Welcome to the rabbit hole, if you are so inclined. This information and so much more is out there if you go looking for it, but you have to know that really digging is necessary. Just a google search won’t unearth any of this. If I hadn’t had the impetus and made the effort to dig and to keep digging, I wouldn’t know any of what I know today. And I am pretty confident that none of the doctors who ever wrote me prescriptions over the years knew any of the above either. If they did they sure never told me. I was never truly afforded the opportunity for that which I advocate for most: informed consent. And if you are someone who takes one or more prescribed psychotropic drugs I’ll encourage you gently to consider the question: were you?

Furthermore, from all the evidence I have seen it appears there were never any long term clinical trials conducted on any of the prescribed psychotropic drugs before they received Food and Drug Administration (FDA) approval and came onto the market. The information that most prescribers have is largely based on these short term studies looking at the use of these psychotropic drugs over a period of weeks, up to a few months at most. As such these studies cannot possibly tell us anything about what happens when people take these substances for years–or decades even–like I did and like so many others do. Based on this, how can anyone who hasn’t spent years in patient forums and countless hours looking at more obscure research be well enough informed to really know what they’re signing up for?

During my tapering and withdrawal process I was bringing my doctor peer-reviewed published papers about harm reduction tapering, withdrawal, and drug injury she had never seen before. She had no idea. And if I had a nickel for every time I heard a similar story from others in my shoes, well… you get the idea. 

So I’ll say it one more time: I am pro truly informed consent, which means having readily available access to accurate data around safety, efficacy, and potential long term outcomes. This includes any evidence that makes the drugs look helpful/useful/like a good idea, and any evidence that makes them look harmful/useless/like a bad idea. It also means access to accurate information about all the various different non-pharmaceutical treatment approaches available, which include a lot more than just talk therapy. I am pro people doing loads of their own research in order to make the most informed decisions they can about whether or not opting to take a prescribed psychotropic drug is the right choice for them. I am pro each individual–given adequate information–doing whatever they feel they need to in order to be well, which looks a little different for everyone and which may or may not include some kind of prescribed psychotropic drug. And of course, as always, I am pro the questioning and the reevaluating of any stories we are attached to that might be facilitating stuckness, disconnection, dis-ease, and disempowerment.

Above all else, I think what matters is that we each take good care and do right by ourselves on the journey.

For more information looking at what we know and what we don’t know about prescribed psychotropic drugs (and psychiatric diagnostic labels), visit: https://www.theinnercompass.org/learn-unlearn

Works Referenced:

“A Mind of Your Own” by Kelly Brogan, MD

“The Emperor’s New Drugs” by Irving Kirsch, Ph.D

“Anatomy of an Epidemic” by Robert Whitaker

“A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based?” James Davies and John Read, Addictive Behaviors Volume 97, pages 111-121.

“Tapering off SSRI Treatment to mitigate withdrawal symptoms” Mark Abie Horowitz and David Taylor, Lancet Psychiatry Volume 6, Issue 6, pages 568-546.