We remain culturally confused about the place of depression and other mental health difficulties in modern life. According to a report released by NHS Digital at the end of June, 2016 was the fourth year in a row antidepressant prescriptions rose in England. Rates of prescription have doubled in a decade, with 64.7m items dispensed in 2016. Many column inches and much discussion followed asking whether society relies too heavily on antidepressants as a simple fix to complicated problems.
To those who do not experience it depression is something metaphorical, a symptom of some broader social malady. Popular discussion of antidepressant use often has a grim, tutting, morally judgmental edge. In the world of mental health we call it “pill shaming”; the overt act of casting doubt upon the decision or need for others to take medication for mental health reasons.
Couched in the language of concern, criticism of antidepressant use often ignores the suffering of the individual. Some connect the idea of antidepressants with social control, half remembering previous decades’ scandals with tranquillisers prescribed to “keep the peace” to women unhappy with their husbands. Some believe antidepressant prescription medicalises normal human experiences, with tablets as a palliative for dislocation and existential terror. Others see antidepressant use as people reneging on their responsibilities in the world, taking refuge in a chemical safe space. A left-wing vision presents antidepressants as chemical comforts smoothing away anger at neoliberal exploitation.
In the background is the nebulous idea of conspiracy; that “they”—which might be governments, doctors, pharmaceutical companies—want you to believe you need medication as part of their scheme to undermine your autonomy and humanity. Some allow their scepticism about the efficacy of antidepressants to shade into disbelieving depression could be so prevalent: if the drugs don’t work then the suffering cannot be authentic either. Underlying this is the refusal to accept that people can, and do, seek out medication and that medical professionals prescribe it in a world where waiting lists for other forms of treatment are lengthening and other forms of social support are dwindling. An even older cultural idea underpins much of this thinking: that suffering is a test and that there can be no redemption without it, those who face it and flinch are weak.
"It's hard to change the world when you can't get out of bed"The economic, social and cultural landscape influences how likely we are to have problems with our mental health. But the decision to take and to prescribe antidepressants happens in the real world; the world of getting the kids to school, looking for work or doing the dishes. Far from being the “happy pills” of popular imagination, antidepressants are seldom fast acting and without side effects. Talking therapies are brilliant for many, but they can be difficult and upsetting, and are rarely available via the NHS exactly when needed.
Depression can destroy lives. It can be visceral, eating away at the core of who you are, spreading like a mold and settling like a thick blanket. Depression, contemptuous of the demands life places upon us, contrives to make us unreliable, inconsistent, unreachable. It can replace certainty with doubt. It can result in isolating self-loathing and, in the most unfortunate instances, lead to suicide. Those opting to take antidepressants are not trying to reach an altered reality, as such. They’re trying to escape from one where the sun never rises. Medication is often the least worst option.
Inequality, prejudice, violence, poor jobs and poverty all influence depression. But it's hard to change the world when you can't get out of bed.
Antidepressants are far from perfect. No one who takes them thinks they are. But people need help now, today. The idea that them getting it—however imperfectly—is a bad outcome is, bluntly, puritanical. Judgement doesn’t help people with mental health difficulties. Those who cast it would do much better to apply political pressure for better mental health support, if only they could stop tutting.
