I’m not depressed – and yet I’m hooked on antidepressants

Dr Jane Morris, the chair of the Royal College of Psychiatrists in Scotland, said last month that the country was ‘absolutely in crisis’ due to high demand, long waiting times and low levels of resources, and that this was having an effect on prescriptions.

‘Increasingly GPs don’t have the confidence that people are going to receive psychological treatments or indeed psychiatric assessment without a wait, so they are probably more likely to prescribe [anti-depressants] early on,’ she said.

Though this was squarely about Scotland – where recent figures show more than a million adults are taking antidepressants, almost 25 per cent of the population – it would be unsurprising if the same were true in England, given that mental-health services received a record 4.6 million referrals in 2022 (up 22 per cent since 2019), and in some parts of the country you can be waiting for more than a year for an appointment after being referred. Plus, we’re a quick-fix society.

The National Institute for Health and Care Excellence (NICE) guidelines for treating depression in adults state that it refers to a wide range of mental-health problems, ‘characterised by… a loss of interest and enjoyment in ordinary things’ and low mood, among other symptoms. You don’t have to be suicidal to be depressed, or to obtain antidepressants.

‘By the age of 45, 70 per cent of people will meet the criteria for depression or anxiety,’ says psychiatrist Dr Mark Horowitz. Talk to scientists and the concerning reality is that even the most learned don’t know the full extent of what these drugs do to the brain long-term. ‘As with many medications, you’d be surprised how little we know,’ says Dr Carmine Pariante, professor of biological psychiatry at King’s College London.

Others go further. ‘We are giving people chemicals that are messing about with their brain in some way we don’t understand and that’s surely something we should be concerned about,’ says Dr Joanna Moncrieff, professor of critical and social psychiatry at University College London (UCL). She points to some studies that suggest it is possible that long-term use of antidepressants may reduce natural serotonin levels.

One study, published in The Lancet Psychiatry, found that sertraline is more effective at reducing anxiety than low mood. Researchers from UCL found that nervousness, irritability and other ‘anxiety symptoms’ reduced within six weeks of starting sertraline; it took 12 for modest improvements in depressive symptoms to be seen.

What all the experts I speak to agree on, however, is that depression is often triggered by an event, or set of life circumstances. As Horowitz puts it: ‘Everyone has a breaking point.’ 

For some that will be a very intense trauma – the death of a loved one, for example. For others, it might be the cumulative effects of a harried, pressurised life that cause them to snap. Which perhaps explains why Horowitz views SSRIs as ‘band aids’ for modern life.

So how or when should you stop taking them? And what happens if those modern-life challenges don’t change?

Almost a year after I had started taking sertraline, I was on holiday with my family. One day I forgot to take my pill. And then the next day, too. ‘Maybe I’ll just come off them,’ I thought, and missed another couple of days. Then I started to feel dizzy.

‘Should I just push on through with withdrawing, or should I not let it ruin our holiday?’ I asked my husband. ‘Push on,’ he said. ‘We’re all here to support you.’

On reflection this was a bad idea; not least because this should be done under a doctor’s supervision. Soon the dizziness got worse. I started to get irritated and overly anxious. Not worth it, I thought, and popped a pill.

Back at home, I rang the GP and told her what had happened. ‘Take it slowly,’ was her advice. She suggested that I take one every other day, then every two days, and so on.

I followed her advice. By October, I’d stopped, and felt fine. Christmas came and went. I got through January, always a month I struggled with. Then in February, disaster. Half-term week. On Sunday, I was fine.

On Monday, tired, I had a row with my husband. On Tuesday, the colour gradually leached out of the day. That night, I couldn’t sleep – my head was going round and round, I felt trapped and panicky. By Wednesday, bam, the gloom had descended.

This time around I tried to actually articulate how I felt rather than burying it away. I wrote an email to my husband: ‘It is utterly horrible when this happens,’ I began, ‘and while there are usually contributory or triggering factors, it’s not just a case of snapping out of it.’

Describing what it felt like, I continued that it’s ‘as if the volume has been turned down on everything, or I’m swimming through mud.

‘I feel questioning of myself and my purpose and everything I do and say. I can’t enjoy even small, lovely things like the sun shining – it all feels a bit sepia.’

Then I finally admitted: ‘I have a bath to try and feel better and wonder what would happen if I just went underwater and stayed there – and then wonder how I could even think such a thing and if I’ve actually gone mad. It’s really terrifying because I don’t feel in control of my thoughts, and seem to have lost my usual ability to just motor on.’

The sertraline, I thought. I need to go back on it. I rang the GP again and this time she wrote me the prescription right away. I embraced the comfort the pills brought like an old friend.

The colour came back into the world. I stopped thinking about drowning myself in the bath.

Two years on, I’m still taking them. But in the past month or so, something has changed. A thought has been ringing in my ears: ‘You don’t want to be on them for ever.’

Part of it is the side effects: I’ve gained 10lb since I started taking the drug in 2021, despite doing more exercise – it could be a coincidence but it’s a concern. And what started as a dulling of my libido has turned into a full-on disappearing act. Mostly I feel dead from the waist downwards. Plus sex hurts now, when I do have it.

But above all else, I don’t like the idea of being reliant on a pill for ever. Yet at the same time, I’m concerned that if I try to come off them, everything might fall apart again. So I’m at a crossroads: stay on the drug knowing that it is keeping me on an even keel, despite these concerns? Or try to wean myself off it, slowly and carefully – and hope that life won’t throw me too many curveballs?

Of course there are plenty of other basic things that we’re advised to do to keep on an even keel, in a good place. But as one friend put it, ‘Medicating with exercise and perfect nutrition is a lovely idea, but if you’re busy with a career and a family you can’t spend your days cooking meals from scratch and going to the gym.

‘In the midlife stage there’s quite a glut of factors hitting – raising children, teenagers, caring for older parents, going into menopause… And, if the drugs help through that phase, why question them?’

My sister feels similarly. After six years on antidepressants, she says, ‘I have no regret and at the moment no plans to come off them. It’s like having a broken limb – you need help to fix it.’

But it’s my colleague who is most emphatic. ‘I’ve tried so many times to come off them and it never ends well, so now I know I’ll be on them for life. Whatever the cause this is the only way, until we find some sort of deeper solution.’ For now at least, I’ve decided to stay on them too.

The thought of coming off feels huge. Not overwhelming, now – I’m on sertraline after all – but it could be. And so I stay, stuck with my pile of pills, that mother’s little helper that has been oh so helpful – but which part of me perhaps wishes I had never started relying on at all.