Hi Jeremy_s,
I listened to a discussion with Dr Horowitz on Dr Louise Newson's podcast a few weeks ago specifically on antidepressant prescribing. It was very good and brought up the issue of medicalising a lot of things that might be treatable in other ways, the history of psychiatry and the DSM and how this led to a big trend in antidepressant prescribing, and the small amount of time GPs have to really assess what is happening with a patient during which the prescribing of an antidepressant is often done as the first port of call, among other topics. I remember he also mentioned how both children and adults dealing with difficult social circumstances (school bullying, financial difficulty, domestic violence etc) are being told they have a chemical imbalance and given antidepressants without the life circumstances being addressed.
While antidepressants are very helpful for some people, they discuss how the issues associated with long term side effects and withdrawal are often not considered. Doctors are often good at quickly prescribing them, but not with handling the consequences experienced by patients trying to come off them. It's a massive issue affecting masses of people. After my own experiences with a couple of antidepressants, including some lasting side effects from one of them that I'm still trying to correct now, I know I'm staying off them now and I'm actually working more directly with the underlying causes rather than treating symptoms. I think for people who do get serious side effects and for whom the medications become less effective over time, there does need to be much more careful consideration about their use and the publication Dr Horowitz has put out about de-prescribing is very important.
The other thing they brought up in the discussion is the way these drugs actually work. Dr Horowitz spoke about how an antidepressant is often presented like an antibiotic, like a neat solution to a biochemical issue, but the chemical balances that are often cited are not actually accurate as to what is happening and are actually based more on presumed ideas that clinical fact. It's been way oversimplified in terms of the messaging. He points out that many of them are not benign and the studies done by the drug companies are often short term, such as for 8 weeks, but people use them for far longer than that and those effects are not being properly looked at. He mentioned that about 1 in 6 people in the UK, Australia and USA are on antidepressants. They discuss the need to look at mental health through a new lens, while advising people not to suddenly come off them as much care needs to be taken for people who do want to come off them.
So I think this is a really important issue and needs to be discussed. Each person is so individual and for some people they may be a great option, but many people do find them increasingly ineffectual with worsening side effects over time. I think that's where we need to have a much more integrated approach to mental health and really try to understand patients in a much more comprehensive way from the outset, rather than prescribing an antidepressant as the first option. I have a really good new GP at the moment and I've just been through a really stressful situation. She advised she wouldn't medicate for it because what I am going through would be extremely difficult for anyone. It's not a mental health issue I have in relation to that issue, it's that the circumstances themselves are highly stressful. I felt that was really good advice and it empowered me more than being given medication for it. She's helped with nervous system calming strategies instead and just great moral support, and that sense of emotional/moral support is actually the thing we humans most need and have often forgotten how to do.
Anyway, those are my thoughts on the topic. Thank you for sharing this topic and I hope things are going well for you on your own journey.
