Monday, 27 December 2010

The catch 22 of antidepressants

Over the last few months I have been thinking a bit more about the path to recovery from depression and the catch 22 of taking antidepressants. For post natal depression and recurrent depression the research shows that a combination of medication, cognitive behavioural therapy, excercise and good nutrition can help people to recover and maintain good mental health. But the problem with research is that despite it being very convincing, resources are limited and medication remains the cheapest and seemingly easiest option.

I have had a lot of counseling over the years, including CBT, but I still had a severe depressive episode. At the time I was too ill to do any of the self help techniques I had learned and forget diet and excercise when you are recovering from a cesarean and breast feeding round the clock. So for me medication was the miracle I needed to keep me in the land of the living. Over the months the sense if joy and hope I experienced was something that had been missing from my life for the past decade, as I struggled with what I now recognise was chronic low level depression. It was like I was seeing what life was like for other people for the first time and I finally saw what all the fuss is about. It is decidedly scary that I lived for so long being so unhappy and thought that was an acceptable way to live and that it was my fault. So medication has really been a miracle for me.

But there is a down side to having such a positive experience with medication. It means you are easy to treat and it has given me the false idea if I just pop my pills each day, I don't need to think about my mental health or take any greater responsibility for my recovery. Also at the time of deciding to accept medication it really wasn't the time to discuss side effects, long term issues or how to wean myself off them. So 18 months on I am realising that "mother's little helpers" are not a quick fix and that I am still unwell. Well people don't need medication every day to function. And I do.

I recently changed medication. The drug I was on is Paroxetine. It is the best SSRI to use while breastfeeding as it is not transferred into breastmilk in any large amount. However it is also the most difficult of the SSRIs to discontinue and has awful side effects when you withdraw. I tried cutting down my dose and within three days definitely was struggling. That really scared me. Suddenly I felt trapped rather than freed by this medication and I also felt a bit angry that I hadn't know more about it. It wouldn't have changed my decision to use it but I may not have been so naive and "pollyanna" about it. Thankfully it is possible to make a direct switch from Paroxetine onto Citalopram. Citalopram is not as safe for breastfeeding but Paroxetine has a risk of causing birth defects. There are no plans afoot for number two but I wanted to change so that if and when we decide to have another we didn't have to have doctors involved and there would be no pressure on me to change medication in order to conceive.

Thankfully in New Zealand these drugs are subsidised by the government drug agency Pharmac and so the cost has been nearly zero for me. However, in changing medication and struggling a little with anxiety and accepting I still have depression, I have been comtemplating what I can do to help myself. The next step for me is to see a psychotherapist who specialises in PND. However, there is no funding or services for me because my daughter is over one year. While she was under one I could have gone to a support group and had more counselling. But I thought I was doing so well, and I was. So I was discharged. I have only praise for the Maternal Mental Health team who cared for me. They are operating with limited resources and have to prioritise. But I am a statistic waiting to happen. I know that if I don't do something either I will never have any more children for fear of PND, or I will just end up back in the same position. Or possibly take drugs for the rest of my life when they was a possibility I didn't need to.

Now therapy is expensive. $100-200 an hour usually and most people can't afford that. So for those who suit antidepressants it is hard to afford to do the best for yourself so that you can eventually manage life and depression better. It seems a strange logic to give people drugs but not help them make the long term changes to their lives to promote long term health.

It shows that though there is more recognition that health does not just mean the body but includes the mind and that holistic treatment is the most effective, the money just isn't there to turn knowledge into practice.


  1. By and large, the "health" system in NZ (and I think this especially so in mental health) is more about illness than it is about health. If there is a pill that can prescribed that can "control" a condition, that's easy to do, easy to count, easy to describe. Helping people to achieve real well being is, I think, beyond what our health system really aims to achieve. It seems that if you want more than the absence of disease (or "control") it's up to individuals/groups involved to make it happen and find funding. All just IMHO, but there you have it.

  2. I have a feeling you may have read the latest North and South, if you did, I encourage you to write a letter to the editor. If you didn't I can bring a copy tomorrow. I thought of you a lot as I was reading it. My thoughts were along lines of 'well that's ok in theory but I can't imagine someone being able to roll out of bed let alone exercise and 'control their sleep' when they are depressed. You are brave and wise, Marion. Brave and wise.