The interview
Outrage, it’s my ally. It appeared this morning when listening to an interview with Professor Ian Hickie, Busting the Myths around Depression, produced by New Zealand’s most popular current affairs station, RNZ Saturday. I was keen to learn, but five minutes in I wanted to throw something across the room. His messaging around depression and antidepressants was simplistic and even dangerous. A reflection of rigid and outdated views still held by many in psychiatry. But preferring outrage to anger, I picked up my laptop to write. Writing and expression has been a big part of my recovery from trauma, long-term depression, and antidepressants.
The interview with Hickie (Psychiatrist and Co-Director Health and Policy at the Brain and Mind Centre, University of Sydney) was based around his new book, The Devil You Knew (published Oct, 2023). He emphasised the role of genes in developing depression, and likened the melanoma that runs in his family to families with a history of depression. He advocated treating clinical depression with medication; just as we would for many other illnesses. Highlighting the benefits of taking antidepressants, he made no mention of potential risks. In fact, he championed someone who has made the decision to stay on them for life.
He also downplayed the role of adverse life experiences and circumstances in developing mental illness. In Hickie’s words “we know what’s happening in the brain when someone has depression. But we don’t know what caused it”. He therefore discouraged people from doing an archaeological dig, i.e. rather to find out what works and to move on.
The research
Psychiatry’s interpretation of antidepressant research is that many more people are helped than harmed, and this is their focus. This may well be true. I am in no doubt that antidepressants can work! But pushing them out into the world with rose coloured glasses is misleading.
Research on antidepressants is contradictory and complicated. Some say it clearly shows that they work, and risks are minimal. Others say it shows they don’t and that they come with significant risks. Concerns have also been raised about inflated estimates of efficiency due to flaws in study design, selective publishing, and other biases when it is funded by pharmaceutical companies. It didn’t take me long to find out that Hickie receives funding from the pharmaceutical industry, and I think it is important to point this out.
Hickie’s claim that we know what’s happening in a depressed brain is an exaggeration. A more accurate statement is that we are getting more insight. Studies show there may be a correlation with reduced volume, inflammation, and neurotransmitter imbalances. And while we know antidepressants affect neurotransmitters, there is much we don’t know about how exactly they work or what they do to the brain and body.
While Scientists would likely dismiss platforms such as Reddit and Quora as a source of research, they’re often the only place where stories about antidepressant use are told and heard. Content on these platforms is promoted by algorithms based on community engagement and voting, not on sensationalism as is the case with the likes of Facebook.
In discussion threads many attribute antidepressants to saving their life or staying well. Others provide a more nuanced answer. Some mention how long it took to land on the right drug combination before the real benefits kicked in, or that the benefits outweigh the harm.
There’s also discussion about side effects, that in some cases are so serious that they cause long-term damage, or even irrecoverable harm. And threads about debilitating withdrawal symptoms that Psychiatry often attributes to the person having a relapse. There is also mention of Breakthrough depression that can happen after long-term use.
As well as downplaying the risks associated with antidepressants, Hickie also downplays the role of adverse life experiences in the development of mental illness. This is despite consensus in research about the strong link. For example, studies show that childhood trauma can cause significant neurological impacts which are correlated with long-term depression. How someone who works in the mental health field can minimise the importance of circumstance, such as living with poverty or violence, or having a stressful or unrewarding job, is baffling to me.
My experience with medication
Around four years ago, I experienced a number of major stressors stacked up like toppling dominoes. Desperate to find a way to keep functioning, going to the doctor for medication was the only option I thought I had. I was wary as we discussed various meds and landed on one called Sertraline.
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 brain and insomnia over the years got worse. And the Restless Legs that sometimes turned up when I tried to sleep was now there every night. I also had a brief psychotic episode – something I hadn’t experienced since the post-partum psychosis over 20 years ago. A month or so into taking the antidepressant, I was left incapacitated and unable to work.
I also had adverse reactions to medication during the post-partum psychosis. I have mixed feelings about this as the system and medication that helped me through a very difficult time, also caused me harm. And to be fair, trying to help someone who is presenting with psychosis as I was, is never going to be easy.
While I assume the pills prescribed to me in hospital were sedative and antipsychotic (not antidepressants), I tell this first story to demonstrate psychiatry’s seeming acceptance of side effects (sometimes severe) as part of the course.
In the early stages of being admitted, soon after taking my evening meds, 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 any answers, I went down a path of being increasingly distrustful and agitated. During the remainder of my stay, I cycled through a range of other distressing states, likely caused by a combination of the drugs and my psychosis, before eventually finding more balance.
After three months in hospital, I returned home with a prescription of Aropax (an SSRI 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 when my psychiatrist took me off it and put me on Dopress (a TCA antidepressant) 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. During regular check-ins about my wellbeing and medication dosage, my psychiatrist and support worker made me feel safe, respected and listened to. After about a year when I felt well and strong enough, I was able to slowly taper off the Dopress.
To me this is an example of how psychiatry and medication can work. I’m a believer in the healing power of a trusting and respectful therapeutic relationship. When antidepressants are used, this is ideally alongside lifestyle changes and good support. And with the aim of eventually coming off them.
New beginnings and learnings
Thinking about that moment four years ago when I went to the doctor; whether I could have made a different choice, in all honesty I’m not sure I could have. I’d spent my life trying to overcome the impacts of my childhood. Yet when faced with those stressors I didn’t feel I had the reserves to cope. I believed I had exhausted all my options.
I first sought help from a psychologist for debilitating anxiety and insomnia in my early twenties. But after two sessions that included long moments of silence and deep burning shame I never returned. Looking back, I realise the psychologist was lacking in relationship-building skills and perhaps how difficult it can be to verbalise memories of events that caused trauma. I know that now but at the time I internalised it as something wrong with me.
Instead of finding someone else, I worked hard on myself using many methods, such as building confidence and skills, meditation, self-help books and workshops, etc. I also had someone come into my life at a very low point who stood by me and helped me through many challenges.
It wasn’t until I had turned 50, when struggling with the relationship with my mother, that I sought help from a phycologist once again. Very different to my first experience, having someone profession and caring listen and validate how I felt very healing for me. Over the year that we worked together my PTSD symptoms eased and I increasingly felt less weighed down.
However, I was still operating at the level of what you might call high functioning. I’d resigned myself to living with an edginess as I didn’t know how to change it, or even that I could. I realise now that over the years I had mostly focussed on overcoming the psychological impacts of trauma.
There was a whole realm of body healing that I had yet to discover. While the notion that we need to heal our bodies wasn’t new to me, it was something I had intellectualized but not fully embodied or understood. I had done some work; healthy eating, exercise, the odd yoga class, etc. but I hadn’t done enough. As I write this now, it seems so obvious. Living with a dysregulated nervous system which often made me feel tired, rushed, irritable, etc. It also made me feel depressed and anxious.
While there’s nothing like calamity to encourage you to change your course of direction and to learn new things, it shouldn’t have to be that way.
My healing
After the medication left me incapacitated, there I was, sitting in front of a therapist once again, feeling depleted and like I had completely failed. I couldn’t see it at the time, but with good support and my hard work, within two years I would gain a sense of wellbeing beyond what I have ever known. I no longer get restless legs and sleep better than I have since childhood. My mood is lighter. To keep it that way, I still live a quiet life, with plenty of rest and self-care.
I learnt about the science. How unresolved trauma changes our bodies, including our brain. It’s not a weakness or flaw, rather a natural response to events, not unlike an injury. It happens to all nervous systems (brain, spinal cord, and nerves) that have experienced trauma yet haven’t had the right conditions to heal.
I also learnt about self-regulation. People who enjoy lots of social interaction and activity often have a well-developed ability to self-regulate. In other words, calm themselves after stimulation. Trauma survivors often don’t and we need to grow our window of tolerance for emotional arousal. It’s often not that we don’t enjoy social interaction, it’s that we don’t have the energy. We also need to grow our window of tolerance for relaxation. We became hypervigilant for good reason and we’re not suddenly going to feel safe about dropping our means of protection.
It was an OMG moment when I learnt my breathing was shallower and faster than deemed normal. I knew about breathing techniques to use when anxious, but I had to completely relearn how to breathe. I doubt this is covered in the many years of training for medical specialists. Even though it’s so vital for wellbeing. I now incorporate time for focused breathing into my daily routine and pay attention to it throughout the day.
There are many forms of bodywork, and I chose yoga as another daily practice. I came to learn that my body needed lots of yin input (slow and calm). At first this felt arduous as I had always had trouble being still and preferred high energy exercise. I’ve now come to enjoy the sense of rest and vitality that this slow form of movement brings.
I made other lifestyle changes, including paying closer attention to a healthy diet, and moving to live close to nature. Our nervous systems will do best if we have a peaceful environment. Exposure to constant toxic stress, for example from unhealthy relationships or toxic workplaces aren’t conducive to healing. Or for that matter, good for anyone. I also gradually increased my levels of activity, positive social engagement and hours of work.
Mental distress often stems from unsafe and unstable relationships. And for me, like many others, receiving warmth and kindness in therapeutic and other relationships has been vital for my recovery. Good support from specialists who have experience in trauma and body work have been a crucial part of this.
Two books stand out in terms of helping me on my journey to wellness. In Unbroken: The Trauma Response is Never Wrong, MaryCatherine McDonald discusses how we will more likely develop lasting trauma if we have an an unbearable emotional experience(s) that lacks a relational home. In other words having someone you can reach out to at the time (a friend, family member, therapist) to support us as we work through things. She also brings in research on the impact on the body and psychology and on ways to heal.
In his book Cured: Strengthen Your Immune System and Heal Your Life, Jeffrey Rediger discusses his research on people who have recovered after receiving a terminal diagnosis. He sets out guiding principles associated with healing. Amongst other things, his book left me with more hope and determination to stick to my practices, even during periods when I doubted if I was getting better.
Final thoughts
Higgie would likely interpret my family history as proof of the strong link between genes and mental illness as my grandfather spent years in psychiatric hospitals. His views reflect the biomedical model that frames mental illness as a medical problem best treated with medication or other forms of medical intervention. However, this simplistic view minimises the role of life experience.
My recovery journey was never going to be easy or straightforward given my childhood and how deeply it affected me. But it didn’t have to be the way it was; difficult, convoluted and long. My hope is that mainstream views catch up with the science. We now know that a holistic approach, including making lifestyle changes and healing the body, is often the best way to overcome depression and/or heal from trauma. Thankfully, I’ve never fully bought into the biomedical model. If I had of, I wouldn’t have kept working on my recovery, or believed it was even possible.