'Taking Prozac has changed my life... for the first time in 42 years my mood lifted, I felt normal'
A new study which proves antidepressants really do work has been widely welcomed, but it is no surprise to Suzanne Harrington, who says medication transformed her after decades of being crippled by the 'black dog'
Every so often a great big chunk of definitive medical research appears, offering encouragement to the unsure and reassurance to doubters. The latest such research is a meta-analysis of antidepressants, which has proved conclusively that they work. That they are not auto-suggestive placebos, a conspiracy by 'Big Pharma' to keep tranches of the population zoned out, or chemical sweeties handed out by frazzled general practitioners to make patients go away. No, antidepressants work. All of them.
The research, published in The Lancet, is based on a six-year international study involving 522 trials and 116,477 individuals from Europe, Asia and North America, and was led by Dr Andrea Cipriani, associate professor of psychiatry at Oxford University. The average age of the participants was 44, of whom 87,052 were given antidepressants, and 29,425 a placebo. The result? "In terms of efficacy," says the report, "all antidepressants were more effective than placebo."
Some antidepressants proved more effective than others. Amitriptyline showed the highest efficacy, followed by mirtazapine, venlafaxine, paroxetine, sertraline, fluoxetine, citalopram and reboxetine - 21 types of anti-depressant were tested and these are the top eight.
The reason this is such a big deal is because psychiatric disorders make up 22.8% of global ill health, with depression being the most prevalent and universal, yet only one in six people with depression are being appropriately treated for it in the developed world, and one in 27 in the developing world. That's an awful lot of untreated depression.
The Lancet estimates that in total, depression affects around 350 million people globally, a figure which since 1990 has increased substantially, due to population growth and ageing.
"I think it's important to note how big a worldwide problem clinical depression is," says Stephen McWilliams, a consultant psychiatrist. "The World Health Organization (WHO), in its Global Burden of Disease (GBD) study, has calculated the levels of disability attributable to various diseases. Called 'disability adjusted life years' (DALYs), this is based on how common a disease is, age at onset, how long it lasts, severity of disability, mortality and so forth. In this context, the WHO has found that depression is the third leading cause of disease burden worldwide, after lower respiratory tract infections and diarrhoeal diseases."
This latest research - that the drugs do work - does not come as a surprise to the psychiatric profession. "My own view as a practicing clinician is that antidepressants definitely work and are often lifesaving when it comes to severe depression," says Dr McWilliams. "Remember, untreated severe depression carries a mortality of around 10%. Cipriani et al's recent study in The Lancet, which is highly reputable as a source of research evidence, rings very true in terms of daily practice in psychiatry.
"Of course, non-pharmacological treatments (such a cognitive behavioural therapy, other forms of therapy, carer information sessions, mindfulness and other measures) are very important for recovery, but antidepressants are usually essential where depression is moderate to severe."
Which is why I love Prozac. Eight years after my first prescription, I remain in its debt, and have no plans to stop using it. Why would I, when it has changed my life so profoundly?
Pre-Prozac, I had not understood that there was a difference between endogenous (clinical) depression and reactive (situational) depression - in fact, I had not understood depression at all, thinking it was all about crying and being miserable, usually after something terrible had happened.
Yet I had a nice life with nothing 'wrong' - good physical health, little stress, no external worries beyond the usual first world problems, great friendships and relationships, lovely kids, a comfortable home. Why did I so often feel insanely irritable, and at times unable to get out of bed, overwhelmed by the thought of even the washing up? Why did I feel so numb? Why did I self-medicate with booze? Why did I duvet-dive so much, an avoidant strategy employed since my teens?
Eventually I decided to take action. I quit booze, quit smoking, changed my diet, exercised more, had weekly sessions with a really good psychotherapist, took up yoga four times a week, and got a bicycle. And yes, of course, all of these things made me feel better, because how could they not?
But if I stopped exercising for even one day the numbness and irritability and inability to get out of bed were right behind me, stalking me like a big black dog. An overwhelming feeling of what's-the-point was waiting for me, breathing over my shoulder. It was debilitating, and went on for years.
Until one day when with some people who were discussing in detail the symptoms of depression, it dawned on me - could this be what I had? Listlessness, sleeping too much, craving carbs, irritability, backache, low energy, indecision, a feeling of wading through treacle even with the simplest tasks? Yes to all of them - not all at the same time, but enough to spur me to make an appointment with my GP. She suggested antidepressants.
Here is what I 'knew' about antidepressants. They were a cop-out; they would stop me feeling my feelings; they were addictive; they were dangerous; they only treated the symptoms, rather than the underlying causes; they were for losers. Certainly, I knew people who used them alongside too much alcohol and said they didn't work; people who took them instead of any talking therapies and said they didn't work; people who took them briefly, then stopped and said they didn't work.
Finding the right antidepressant is like finding the right therapist - you may have to try a few before you hit the one that works for you. We are not all neurologically identical. So I tried mirtazapine (made me sleep too much), sertraline (made me awake too much), citalopram (made me want to kill myself despite zero suicidal ideation before I took it), until I found the one that worked - fluoxetine or Prozac.
It took two weeks. Two weeks of no change, then a day of mad intrusive thoughts about violent self-harm (I'd read the label, and knew it was part of the process, so was able to rationalise the thoughts even as my head was urging me to cut myself with broken glass, something I had not done since my teens).
And then, the sun came out. It was quite extraordinary. Nothing whatsoever changed in my external world, only my reactions to it. I no longer felt overwhelmed, or unable to get up, or irritable. Life remained exactly as it always had been, but my mood lifted, numbness replaced with optimism, heaviness replaced by lightness.
Everyone noticed. Yet I did not feel chemically altered or high or out of it in any way, I just felt normal. For the first time in my life, aged 42, I felt normal. The relief was indescribable, reminding me of the end of Elizabeth Wurtzel's 1995 memoir Prozac Nation, when the then-new drug started to work on her. When the depression lifted, and life became illuminated and textured and doable.
Two years ago, having been on antidepressants for six years, I came off them. Not on purpose - I'd had emergency surgery and forgot to take my daily 20mg because I was too busy being in intensive care. Oh well, I thought. Might as well stay off them now, they've done their work. Within two months, the depression was back, this time with added anxiety, which was new and awful.
My doctor suggested I start taking fluoxetine again, which I did, and went almost immediately back to feeling normal. I now fully accept that my normal needs some chemical assistance.
The research published in The Lancet shows that while the lives of many more of us could be improved by using antidepressants, we still don't present for treatment because of our lack of understanding and our reluctance to acknowledge mental health problems.
Left untreated, depression can be a killer. My former husband died of untreated depression. An unopened packet of antidepressants was found by his body. I have often wondered if he had taken them, might he be alive today.