and the stories of harm shared by many
Around 50 years ago, psychiatry began to move away from a biomedical model, which framed mental illness primarily as a biological disorder to be treated with medication and other medical interventions. The current biopsychosocial model acknowledges that mental distress cannot be explained by biology alone, and is also shaped by psychological experiences and social conditions, such as trauma and poverty. Therefore, rather than automatically defaulting to medication, in some cases psychological and social responses may be more appropriate. At least, that’s the official party line. Yet what I’ve experienced, read, and heard makes me question how much of a shift has occurred.
If psychiatry has adopted the biopsychosocial model, why isn’t more time spent on identifying and addressing psychological, social, and environmental causes before medication is offered? Why are prescription rates for antidepressants on the rise?[i] Why are antidepressants still marketed as safe, effective, and non-addictive when these claims are misleading nor backed by science? And why do reports of adverse reactions and other concerns still go mostly unheard, even as more people speak out?
Psychiatry, as well as the pharmaceutical industry, have yet to fully acknowledge the harm that adverse reactions can cause. As was my experience both during my postpartum psychosis over 20 years ago. Then again after taking antidepressants around five years ago.
When I became unwell after birth I needed medication. But the system that saved my life also caused me unnecessary harm. It’s difficult to separate my illness, the medication and the various distressed states I cycled through. But I do know that an adverse reaction to medication early in my stay, intensified the fear and lack of control I felt and lengthened my recovery time.
When first admitted I refused to take anything. I wasn’t anti-medication. I was scared as I had a thing about control as I hadn’t had much in my life. Given it was night-time, and I was putting up my best fight, they must have had to call in the on-duty psychiatrist. I remember his brown leather shoes, as they were the first thing I saw from my position on the floor. After enthusiastically complimenting him on his shoes, and sharing a laugh, I looked up to see a very tall man who then proceeded to inject me in the butt.
On the morning after my injection, which gave me much needed relief, I woke in the secure wing, and they soon transferred me to the main ward. I was allocated a nurse and my son stayed in an adjoining room. I was very lucky to receive this wraparound care.
I then willingly took medication until a few days or so into my stay. A nurse had come into my room with a small paper cup containing a concoction of pills. When I told her I’d already taken my meds, she was adamant I hadn’t. I was more compliant this time but soon after taking them I became catatonic. Frozen with my hands pointing upwards as if ready to catch a ball, I was unable to move or speak for I don’t know how long. My next memory is waking in the morning with a rash covering my feet.
Unable to get answers I became fearful, agitated and mistrusting and medication time became a battle of wills. Some days later, for a few nights I couldn’t sleep as staff taunted me and played loud music through the intercom. Although it was a fine edge, through the whole time when I was unwell, a part of me knew what was real and what wasn’t.
I’m not sure how many times I was asked “Do you hear voices?” Like it’s the holy grail of questions. And while I never lied, I didn’t tell the whole truth. I said I didn’t as I wasn’t hearing them at the time I was asked. Rightly or wrongly, I was wary it may have changed how my illness was perceived including the drugs I was being given.
I’d had audible hallucinations once before, aged around six. They’d come when I was put to bed and lasted for some months. I didn’t hear legible words, rather a deep scary voice whirring around and around like a squeaky wheel until I fell to sleep. I prefer to call them audible terrors, because that’s what they were. Bedtime wasn’t safe with my father in the house. As was the case in hospital, the voices were an expression of being trapped in a very stressful situation.
There’s some truth in the saying “ignorance is bliss”. I didn’t find out about my grandfather’s diagnosis of schizophrenia until around five years ago. If I’d known while hearing voices in hospital, I might have become convinced I was lapsing into something permanent. If the psychiatrists had known to, I wonder if they would have honed in on my family history in line with the simplistic biomedical view that mental illness is hereditable and a case of faulty biology.
After three months in hospital, I returned home with a prescription for an antidepressant as depression after postpartum psychosis is common. On taking it, I became so confused that I couldn’t work out how to turn on the TV or tell the time. Scary stuff, given I had just spent months unsure if I’d ever experience any degree of sanity again.
Next came extreme agitation and days and days of pacing when my psychiatrist took me off it. He replaced it with another one that I eventually did much better on. He never told me that quickly coming off medication (rather than the recommended slow tapering) can cause withdrawal symptoms. The man on the Crisis Team did after I called him numerous times in distress.
I was then put under the care of the maternal mental health team and had regular check-ins about my wellbeing and medication dosage. With good support from the psychiatrist and my case worker, after about a year when I felt well and strong enough, I was able to slowly taper off the medication. Ideally that’s how antidepressants are used; short-term alongside lifestyle changes and, if needed, psychological support.
That was over 20 years ago. I took antidepressants once more, around five years ago during a very stressful time which would have given anyone the wobbles. I’d done a lot of work on myself, but here I was struggling to keep it together and I didn’t think I had the reserves to cope. Even though I was very wary, going to the doctor for medication was the only option I thought I had.
They say it’s normal to experience initial side effects when starting an antidepressant but mine intensified. I became increasingly wired and disassociated. The problems I’d had with an overstimulated and noisy brain got far worse. And the restless legs that sometimes turned up when trying to sleep were now there every night. My sleep was completely out of wack. I also had a brief psychotic episode – something I hadn’t experienced since the postpartum psychosis over 20 years ago. A month or so into taking them, I was left incapacitated and unable to work.
My wellbeing is now better than it’s ever been in my whole adult life. As well as making lifestyle changes, I’ve had good support from a somatic therapist. I’ve put in a lot of work to calm my nervous system, the cause of me seeking medication in the first place. My brain has been the slowest to heal though. I still have to be mindful of how much I do, otherwise it will get overstimulated.
I’ve come to learn that one of the categories of people who are more likely to react badly to antidepressants are those who have lived with chronic stress, trauma and long-term nervous system dysregulation. Given that around 80% of antidepressants prescriptions are written by GPs, this was something my doctor should have known. But she receives the same simplistic messaging we all get about their safety.
When you can’t see side effects as you can with a physical wound and you don’t do a medical test to measure changes to the brain, it’s easy to ignore or minimise them. There’s only a person’s word. And as most people take psychiatric medication because of mental distress, reactions are often written off as part of a person’s condition or part of the course in getting their medication right. There appears to be a casual acceptance of adverse reactions that are treated with the same importance as if your meds have given you a skin rash. We’re left to take in on the chin.
Side effects have become an industry in itself. On a trip to the States, I was gob-smacked by the absurdity of adverts for antidepressants showing happy people who had managed to get their lives back. At the end of these adverts the narrator would quickly read a list of possible adverse reactions, obviously a requirement of advertising standards. This advert would be followed by another, for a medication to treat one of the side effects listed, and showing more smiling people.
Many are turning to online communities, such as Surviving Antidepressants, and Reddit for open discussion and to find support regarding the likes of adverse reactions and breakthrough depression after long-term use. There’s also discussion about severe withdrawal symptoms when trying to come off them, which psychiatrists sometimes write off as the person having a relapse.
When antidepressants came on the scene in the 1960’s they were marketed under the chemical imbalance theory. We were sold the idea that these drugs target specific neurotransmitters such as serotonin to correct imbalances in the brain. Even though this theory has never been supported by evidence, we’re still led to believe that they are precise medications targeting specific neurotransmitters.
Interpretation of antidepressant research has been that many more people are helped than harmed. Sharing stories such as mine is seen to conflict with public interest in case somebody who may have been helped by taking them is put off. Downplaying potential harm in public messaging is patronising, coercive and goes against informed choice.
Even more concerning is the positive bias in antidepressant research in the first place as around 80% of it is funded by pharmaceutical companies. They’ve also paid minimal attention to long-term effects and withdrawal symptoms. And people who may or do react badly, are often screened out from studies in the early stages.
There’s also underreporting of reactions to adverse-event databases. Either they’re not regarded as serious by the prescriber, or people don’t report them as they’ve been scared off and don’t see the point. Nor do they want to pay a fee (likely a large one if it’s a psychiatrist) only to receive advice about changing the dose or the medication.
Despite mainstream messaging about the heritability of mental illness and using medication to help fix a person’s biology, there’s so much we don’t know. It’s baffling to me how some are taking our very limited knowledge of genes to explain the human condition when after decades of research we still haven’t found genes that can reliably predict mental illness. And although antidepressant treatment is presented as scientific, their use involves guesswork and trial and error. So far scientists have been unable to develop a test that can detect depression in the brain. Nor do they fully understand how antidepressants work.
The psychiatry and pharmaceutical industries continue to exaggerate and mold science to support their biomedical worldview. A worldview known to have caused so much harm in the mid 1900’s, the period when my grandfather was hospitalised. While the biopsychosocial model acknowledges psychological, social, and environmental influences on mental health, biological explanations—particularly genetic vulnerability—continue to be overstated.
Psychiatric drugs have their place, particularly when people become very unwell. But there needs to be a more cautious approach to administering medication and a recognition of risks. There also needs to be ongoing investment in independent research alongside more honest and open information to help people make informed choices and to reduce harm. Meaningful progress in mental health care won’t happen until we see systemic change.
[i] Prescription rates for antidepressants are growing. According to a study of more than 30 countries, average consumption rose from 52 to >70 daily doses per 1000 people between 2010 and 2020.