[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."