Proper Gander – SSRIs and side effects

As many as one in seven people in the UK are prescribed antidepressants. While undoubtedly, medication helps lift many out of a debilitatingly low mood, for others, unexpected and unpleasant side effects have outweighed any benefits. Are My Antidepressants Worth It?, an episode of the documentary series Disclosure (BBC iPlayer) looked at the downsides of the medication, especially among young people in Scotland. Presenter Anton Ferrie and his team spoke with over a hundred people prescribed antidepressants about their experiences, along with doctors and researchers. The programme gave exposure to an important issue but predictably only gave hints of the wider context which explains why the problem has arisen.

The most commonly prescribed antidepressants in the UK – sertraline, fluoxetine and citalopram – all fall under the category of SSRIs (Selective Serotonin Reuptake Inhibitors). As the name suggests, SSRIs impact on serotonin, a neurotransmitter involved with regulating mood, with each type working on the brain in a slightly different way. Doctors therefore need to make sure they prescribe the most appropriate type for each patient’s situation, particularly when the patient is a young person who is still developing. The programme includes a sad example of when the wrong decision has been made: Dylan Stallan was switched from fluoxetine to sertraline after he turned 18, and he ended his life two months later. An increased risk of suicide among young people associated with SSRI use is one of the concerns voiced by, among others, Dr David Healy and Prof Bernadka Dubicka in the documentary. As well as the risk of suicidal thoughts, other side effects of antidepressants can include insomnia, sleepiness, dizziness, headaches, fatigue and sexual problems. Thousands of people have reported the latter persisting even after they have stopped taking SSRIs, enough for the complaint to have its own name: Post-SSRI Sexual Dysfunction. PSSD isn’t recognised as a separate condition by the NHS, though, partly because it’s not understood how much its symptoms (which can be as extreme as a numbing of all sexual feeling) are an aftereffect of the medication or are due to depression returning.

For some people taking antidepressants, it’s difficult for them to tell whether what they experience is a side effect or not. Rachel Coburn, the producer of the documentary, talked about being prescribed antidepressants for as long as 12 years, since she was 18. She said that she can sometimes be forgetful and is troubled by not knowing whether this is because of the medication or is just how she is. After taking the pills her whole adult life, she wondered ‘what lies beneath the citalopram’. Radio presenter Katie Thistleton asked herself the same question, and struggled through withdrawal symptoms when trying to come off her medication.

As the focus of the programme was on the general lack of awareness of the side effects of antidepressants, it only touched on other aspects of their use. Dr Ben Davis, a GP, made the point that a brief chat with a rushed doctor isn’t the best basis for a decision about long-term medication, especially for an issue as individual and complicated as mental health. An obvious conclusion from this is that the NHS doesn’t have enough funding to employ more GPs, counsellors and other specialists to meet need. A more fundamental issue is why that need is there, and growing. The numbers of people feeling depressed have been increasing over the decades, particularly among children. A study by the Nuffield Foundation published in 2012 (tinyurl.com/kf2xtxk2) found that the proportion of 15 and 16 year olds reporting that they frequently felt anxious or depressed had doubled since the early 1980s, from one in 30 to two in 30 among boys and one in 10 to two in 10 among girls. By 2021, as many as one in six children in England aged six to 16 years had a probable mental health disorder, according to the NHS (tinyurl.com/mr29j8k9). Partly, this rise is because of more awareness and less stigma around mental health issues than in previous decades, so more people now feel able to access help. In this way, the normalisation of mental health issues has had a positive effect, but looked at from another angle, this increased awareness has come about because societal factors are pushing more people into this state of mind. It’s not surprising that depression is a likely reaction to the privations and alienation which come with life in our society, amplified in recent years by the Covid pandemic and the cost of living crisis.

And so the big pharmaceutical companies have come to our rescue by manufacturing the SSRIs to meet the expanding need. The way our healthcare system functions buys into the clout enjoyed by profit-hungry organisations like GlaxoSmithKline and AstraZeneca. Dr Healy has revealed how drug companies fund research into medicines, creating a bias towards their products which gets disguised by the studies’ academic credentials. The end result is that brands of antidepressants are promoted as the go-to option for busy GPs who realise that a prescription is a more prosaic option than to make a referral to join a lengthy waiting list for counselling. As Katie Thistleton says, antidepressants can be a sticking plaster but they can’t really solve the underlying problem.

MIKE FOSTER

Next article: Book reviews – Smith, Veevers, Yates ➤