Monday, 2 June 2014

Caught in the crossfire: antidepressants are good, no they are bad

Are antidepressants a good or a bad idea? Based on recent articles from the popular and academic press - these drugs are seriously harmful, or they are as safe as houses. It just depends on who you believe. Confused? You should be.

Now any sensible thinking person will immediately say: “it’s not that simple, it’s not a clear-cut case of good or bad, or either-or.” And of course, you are right.

As I have suggested, recently there seems to have been a spate of articles on antidepressants and other mental health drugs. But repeatedly releasing articles (with minor variations) doesn’t really work for me: I feel storm-battered and, in fact, I simply stop listening. It’s the same when someone loudly raises their voice in discussion – I begin to suspect their argument might be flawed.  I don’t want this to get unnecessarily personal, so for once I won’t include links and citations; suffice to say, in the main, I’m referring to medical doctors and academics writing for or against these drugs.

But as you have also noticed, there is more going on here. It’s not just about whether antidepressants (or other mental health drugs) are good or bad for us. There’s more at stake.

It’s far too easy to get locked into a defensive position, isn’t it? Ideas can become ideals, and before long our personal sense of identity can become bound to an ideological position. Our reasoning becomes unreasonable and soon we can end up quite simply stuck in the mud of cherished beliefs. Sadly, it can feel a safe place to be.

I know about dogma and ideology. I grew up being told what ‘the truth’ was. This ‘truth’ told me who I was and why I existed. This ‘truth’ had ‘answers’ (so I thought) for much of life and stifled out comparative views or discourse. As a young person I formulated an idea about who I was in terms of what I was not; that is, not like one of those who didn’t see life through this narrow and life-constricting lens. Though that’s not how I would then have seen it.

With the passing of time and unforeseen grievous experiences along the way, the pillars of my truth-existence were shaken to their foundations. I slowly began to see that truth is not as fixed or absolute as I had been led to believe.  I recognised that truth is no ‘it’ but rather what emerges when there is openness rather than dogmatism.

And yet, with regards to mental health I see and read the same old arguments going back and forth as they have done for decades. The camps are clearly defined and their advocates seem to know just where they are positioned.

Strange really that I should mention this, for when it comes to antidepressants I too have strong views. When I read critical analyses of drug company misrepresentations of RCTs I know I have been systematically lied to by the drug companies. And something is terribly wrong when harms are being trivialised by so-called key opinion leaders even though the evidence is there and countless people are witness to devastating harms - including the loss of loved ones.

It can be discouraging when opposing parties will not listen – not just to one another, but to their own consciences. How deaf we can be to what could be a co-evolving and emerging sense of truth and rightness – or, to use an old English and now obsolete word, “rightwiseness” where wisdom and truth can merge for the benefit of all.

I respect the frustration of those who believe that their sense of what is true is not being heard. I respect the desire to protect others from unnecessary harms. But doing this in such a way that people don’t stop listening and remain open to dialogue is not always that straightforward.  I so like the concept of ‘discourse’, our English word derived as it is from the Latin discursus “running to and fro”. As I see it, discourse invites us to run to and fro as it were, back and forth, this way and that, as we seek to level out that which is not worthy of truth or justice. But it is not a running away from difficult counter-challenges or hiding behind personal or ad hominem attacks.

Finding the balance between having an opinion and not imposing it upon another isn’t always that easy. And there can be casualties caught in the crossfire of “these drugs are good for you” and “no they are not…”. What about the person who has tried time and again to come off the drugs - but for one reason or another, this has not worked out for them? Are they unintentionally being set up for more discouragement and a greater sense of failure? Perhaps these people could be borne in mind when articles are written.

What about those who genuinely find antidepressants and other mental health drugs helpful? Are their experiences to be denied? Equally, insisting these drugs are virtually harm free, as I have recently read, denies the reality of the experiences of those seriously and permanently harmed by them. Furthermore, talk of reducing or stopping can be most intimidating for the individual who believes the drugs to be a life-line; as perhaps their only hope. It calls for sensitivity. It calls for wisdom.

But considering another person’s feelings and possible reactions does not mean compromising one’s values. I guess it’s not just what is said, but how.

“We each begin probably with a little bias and upon that bias build every circumstance in favour of it.”
- Jane Austen, Persuasion

Mick Bramham is an Existential Psychotherapist based in Dorset, UK.
He has a particular interest in ethical issues and also how our lives are shaped by the society, circumstances and culture in which we live.
Although he has serious concerns about the inappropriate and excessive use of mental health medications, he supports the freedom to choose (to take or not to take these drugs) and the right to be fairly informed of their limits and the risks. He offers support for people who are considering reducing or coming off psychiatric drugs.
He has a long-standing interest in non-clinical (and non-coercive) responses to mental and emotional distress. You can read more about his work and find his contact details here.

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