‘Part of maintaining my mental health is through medication – but it took over a decade for it to be prescribed’
Instead of receiving care, Irish people seeking antidepressants often find themselves consulting with GPs who haven’t been adequately trained in offering information or support.
I call them my “crazy pills”, even though they’re what help me feel sane.
Having experienced severe bouts of depression since my teens and a late diagnosis of post-traumatic stress disorder, I’ve long ago abandoned any embarrassment around discussing my mental health. I believe it is vital to break the silence and stigma that can surround mental health so that it’s easier to ask for and receive support, and so people know what help is available.
Part of maintaining my mental health is through medication – though it took over a decade for it to be prescribed to me. Sadly, however, it continues to be a struggle to find GPs who are informed and engaged when it comes to mental health medication. Recent personal experiences and new research shows that the HSE needs to provide GPs with more training so that patients seeking medication to help their mental health feel safer and more supported.
I don’t think it’s a coincidence that my most informed, helpful and engaged doctors when it comes to antidepressants have been American. When I lived in San Francisco in my twenties, I visited the doctor on my college campus and mentioned the usual problems that had been plaguing me since my early teens: bouts of insomnia; constant fatigue and low energy; and low self-esteem and social anxiety. When I told her I had seen a few therapists and doctors over the years, she asked if any of them had suggested antidepressants, and looked utterly bemused when I said no.
“You’ve been dealing with this for over a decade, it’s not been improving with therapy and none of your doctors ever suggested trying medication to help?” I began to cry. I was crying because finally someone was taking me seriously – and I was crying thinking of all the years I spent depressed, when I could have been feeling normal.
For all the rhetoric around American doctors over-prescribing drugs unnecessarily, what is often overlooked is their comfort in discussing medications and their side-effects. My San Francisco doctor prescribed me Lexapro, warning me that side-effects like weight gain and a loss of libido were common, particularly in the first three months, but should settle.
“If they don’t, or you don’t feel like they are working for you, come back to me – after all, if the side-effects are making you unhappy, that’s defeating the purpose, isn’t it!” she said cheerfully. “We can try something else. There can be a bit of trial-and-error to find the right fit for you, but that’s what I’m here for – to find the right medication for you. It can take time, but your mental health is worth it.”
“It can take time to find the right medication, but your mental health is worth it.” Those words changed my entire approach to mental health care.
Those words changed my entire approach to mental health care. When I moved home, I was lucky to find a Dublin-based American GP who was well-informed about anti-depressants and stayed with her for years.
After years of my lovely American GP, dear readers, I grew complacent. I assumed that my doctor’s informed, empathetic check-ins, and my side-effect-free experience was the norm. When I started feeling myself get a bit depressed last year, I wondered if a change in medication would help. I had recently moved house and my American GP was suddenly a 40 minute drive away, so I decided to try a local doctor. I explained my history and asked if a new medication might help.
And so began the worst four months of my adult life. My new doctor, who seemed fairly disengaged throughout our first appointment, prescribed me a medication called Sertraline without explaining any possible side-effects or offering any plan if it didn’t work for me. Within days, I was having shooting muscle pains down my legs which seemed to worsen at night, disrupting my sleep as I tossed and turned in agony.
Muscle pain was listed as an uncommon but possible side-effect, and I dutifully waited out the pain for six weeks, hoping it would eventually dissipate. It didn’t. I tried to book an appointment with my doctor but could only get a phone consultation. My doctor said he would send a prescription for a different medication to my pharmacy, instructing me to start it the next morning. He didn’t even mention the name of the medication, let alone mention any side effects. I checked my phone log. The call lasted two minutes and twenty seven seconds.
The next day, I started Effexor, a drug that is literally life-saving for many people – and is also known for having intense side-effects. The first week on it, I constantly felt nauseous and dizzy, to the point where I didn’t feel safe driving. This finally abated, only to be replaced with a fatigue bordering on narcolepsy.
When I was awake, the brain fog was so severe that I struggled to get any work done or concentrate on anything more demanding than constant re-runs of Desperate Housewives. Still, I persevered. I knew that it could take two months for the initial side-effects to settle, and I was determined to break through to the other side and finally feel some benefits.
Then one day I forgot to take it. The next morning, I got up and went to teach a creative writing class and in the middle of teaching, I started slurring my words. My head was swimming, but I somehow managed to make it through the class. Immediately after leaving however, I had a panic attack and I became completely disoriented, my body shaking and heart pounding. Scared I was going to collapse, I hopped a taxi to St James’ Hospital where I sat in a waiting room for eight hours without being seen before giving up and going home, vowing to just stay off the meds.
Three days later, I was still a wreck. I had full-on body shakes and felt dizzy and disoriented constantly. Desperate, I called my old American GP, who immediately told me that I shouldn’t have been prescribed Effexor without having had a lengthy consultation and having been informed of the side effects, the possibility of severe withdrawal symptoms if I missed even a single dose, and the danger of discontinuation syndrome, which is a severe reaction to coming off the drug suddenly.
“If you had rang me three days ago, I would have put you on a plan to withdraw slowly over two to three months,” she said. “But you’re in it now – you might as well have another horrible few days and be clear of it.”
Antidepressants are not the problem. For many people, antidepressants are a life-changing solution. The problem is the lack of education and care around them, and this lack of care can be dangerous for patients in several ways.
It took another several weeks of flu-like symptoms, constant fatigue and brain fog for me to start to feel normal. As I looked at a mass of unanswered emails and a bank account that was depleted from losing a month and a half of work, I suddenly became furious at the lack of care, attention and basic information from my local GP. But it’s not just that I had a bad GP – it’s that GPs in the UK and Ireland are not receiving adequate training on how to support patients using antidepressants. Antidepressants are not the problem. For many people, antidepressants are a life-changing solution. The problem is the lack of education and care around them, and this lack of care can be dangerous for patients in several ways.
Recent guidelines published in the Royal Pharmaceutical Society’s journal indicates that there is currently inadequate information being provided to patients about the side-effects of antidepressants, with particular attention being paid to the lack of information being offered around withdrawal and GPs’ failures to provide patients for plans to taper off medication slowly and carefully in order to lessen withdrawal effects.
New guidelines published by the UK’s National Institute for Health and Care Excellence also note that withdrawal from antidepressants can be severe and last for months. It states that: “Around half of patients will experience withdrawal effects from antidepressants, with NICE guidelines indicating that withdrawal effects can be severe and can last ‘several months’. For some patients, antidepressant withdrawal effects can last for years and can be debilitating, leading to job loss, relationship breakdown and even (although rarely) suicide.”
The article highlights the vital role that pharmacists and GPs both play in advising each other and patients about best practice and how to avoid harmful discontinuation side effects. However, the HSE in Ireland offers no such guidelines on how to do so, leaving GPs without a roadmap for how best to support patients – and leaving patients to suffer the consequences.
Due to the prevailing stigma around mental health and antidepressants, it can already feel intimidating for people battling mental health issues from seeking help. It is imperative that if they are brave enough to do so, they receive not just a quickly scribbled prescription, but a well-informed, engaged and collaborative mental health plan.
Of course, there are many GPs who go above and beyond for their patients, but it’s clear that there is a need for a systemic and institutional overhaul in how GPs are trained to engage with mental health patients, many of whom use antidepressants. People looking to feel better need to be treated better – which means the medical industry as whole needs to do better.
This article originally appeared in the Autumn 2024 issue of IMAGE.
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