Friday, 20 December 2013

BMJ article on anti-depressant prescribing 'Don’t keep taking the tablets' and my response

[update: my response did get published on the BMJ website]

A colleague alerted me to a BMJ article  on anti-depressant prescribing 'Don’t keep taking the tablets' by Fiona Godlee, editor, BMJ, and the "rapid response" of Prof Ian Reid, Cornhill Hospital, Aberdeen: 'It’s enough to get you down in the dumps.'.

Fiona Godlee writes "A diagnosis of depression may not be necessary. Instead they recommend a focus on shared decision making, watchful waiting, and support and information that helps patients to help themselves." while Prof Reid challenges the statistics re increased anti-depressant prescribing saying "The problem with raw prescription rates is that they do not tell us how many are receiving them, or why.".

This spurred me on to submit a response from my own experience which has no chance of being published in the BMJ because it's "anecdotal".  However here it is, "published" on my own blog:

"I live in Fife, Scotland, and would like to respond to this article from the perspective of lived experience, personally in recovery from mental illness and psychiatric treatment, and as a carer of many family members who have engaged with psychiatric services for over a 40 period.  I now participate in a number of national mental health groups, working with others to influence positive change.  In 1978 and 1984 I experienced puerperal psychoses, altered mind states, sensitivity to sounds, smells, situations, after the birth of my 2nd and 3rd sons.  Both births had been induced with chemicals and there was insufficient pain relief in the cottage hospital.  The treatment for psychosis, then as now, was hospitalisation and chlorpromazine injections then pills which brought me out of the psychosis quickly while also depressing me.  Within the year after each episode I managed to taper the anti-psychotic, come off it completely and return to my normal, busy life as a mother and community worker.  There were no anti-depressants on offer back then and I came out of the depression gradually and naturally as the trauma of childbirth and psychiatric treatment receded.

After 18 years of good mental health I reached the age of 50 in 2002 and experienced a menopausal psychosis similar to the postnatal episodes, and had to enter a psychiatric ward, under pressure, and was given risperidone.  As usual the anti-psychotic took me out of the psychosis quickly, coming back down to earth with a bump and depression followed.  I'm usually an upbeat person, don't get low moods, am very resilient and like taking risks.  However this time around when in a low mood I was given venlafaxine which depressed me more and I had a suicidal impulse, took an overdose and was rushed into A&E.  I was put on a maximum dose of venlafaxine and remained flat in mood, lacking a sense of humour and unmotivated, whereupon I was prescribed lithium, to “augment” the anti-depressant, and diagnosed with schizoaffective disorder.

I realised that I would have to take charge of my own mental health to recover and in 2003 began volunteering in different settings, gradually increasing my motivation and firstly came off the risperidone then tapered and ceased the venlafaxine, supported by the psychiatrist.  This left the lithium, 800mgs a day, which I decided to reduce by 200mg a month and informed my psychiatrist who said I had a lifelong mental illness and had to remain on the mood stabiliser.  I wasn’t convinced of this and didn’t see myself as mentally ill so I tapered the drug, successfully, no difference in mood, and got back on with my life, eventually working full-time in an FE College and gaining another postgraduate qualification, in lecturing.

The point of my story and personal experiences is to highlight how much harder it was for me to get over the trauma of a psychosis and psychiatric treatment by being prescribed an anti-depressant.  It delayed my recovery while also causing suicidal impulse.  I’ve since read that this can be a side effect of venlafaxine but I wasn’t warned of this at the time of being prescribed it.  It also causes bone loss in maximum prescribed doses and about a year after ceasing venlafaxine, in March 2005, I fractured my fibula in 3 places when walking down stairs.  Fortunately I didn’t test positive for osteoporosis although it has caused arthritis.

I believe that it would make sense to gather qualitative feedback from a range of patients on the effects of anti-depressant prescribing and use.  Independent surveys and action research with no conflicts of interest or personal agenda, involving people with lived experience.  Although Scottish Government has a target to increase psychological therapies and reduce waiting times to 18 weeks, if a person is depressed or mentally distressed then having to wait months to talk things through can only increase the likelihood of them being prescribed an anti-depressant.  As a writer and activist I’m interested in people’s stories, which means that I keep hearing them.  A Glasgow taxi driver told me that he knew five of his colleagues who were on anti-depressants.  At a conference, not mental health, I heard from a woman who had been on venlafaxine for over 10 years, due to pain caused by stress when her husband had a life-threatening condition over a 2 year period.  These are anecdotal accounts yet there has to be a place for the personal narratives alongside the medical science statistics, in my opinion.  To give a fuller picture and make sense of it all."


2 comments:

  1. Thanks to Barbra Davidson for sending me this comment:

    "I was a confident, energetic, outgoing and normally very positive and suffered depression for many years but after a breakdown in 2007 i was prescribed anti depressants and dutifully took them without question in my desperate bid to return to my 'normal' self. Instead i became withdrawn and spent many long periods of time not getting out of bed or getting dressed and getting past the doorstep was a rarity.

    When i went back to my GP and reported my further decline his response was to double the dose! Around mid 2010 I made arrangements to end the grey and painful existence once and for all as i had attempted to do back in the 80s. This feeling of helplessness and desperation was In part brought on by my new diagnosis of Rheumatoid Arthritis, at the age 44, i set up all my medications run the bath and got in. If my male lodger had not been in the house i surely would not be here today. Anyways i self medicated off the anti depressants (without informing my GP) got talking therapy after sharing my preparation to end my life and finally moved from under my grey cloud and back to a desire to live life again.

    My point to sharing this with u is the fact of being described pills so readily, no therapy and the subsequent diagnosis of RA at a relative young age and my suspicion of a connection to both. I am no doctor and come to this conclusion from my own experience, but have since read some research from South America exploring the connection between anti depressants and arthritis."

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  2. I think you are right when you say that taking charge of your life is crucial and it is obvious that no pill will do that for you. My son is currently suffering from depression and I am doing my best to make this clear to him and he is getting better slowly but surely

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