The Art of Extricating

Lizzie Clough examines the effects on her partner as he withdrew from 15 years of prescribed antidepressants

text by Lizzie Clough & artwork by Winnie Ng

The human brain is complex.

We know far less about it than science would like us to think; especially when it comes to mental health. In medical terms, what causes schizophrenia is largely unknown, as is the reason for the recent escalation of anxiety-related problems.

The chemical imbalances we hear of so often are, scientifically, little more than guesswork; and psychiatry has always been a dubious industry. Here, medically speaking, the tangible becomes intangible and vice versa, whilst the search for the blurry line between treating physical versus emotional injury makes for dangerous assumptions… as well as horrific mistakes.

The failsafe methods that the medical system relies on in other areas have never worked in the psychiatric sphere; experiments are no longer hidden behind the walls of institutions. The real life horrors of One Flew Over The Cuckoo’s Nest’s ice pick through the eye socket have crept insidiously from out behind bars and infiltrated our homes in the form of antidepressants. The latest wave of these are SSRIs, or Selective Serotonin Reuptake Inhibitors. They were first introduced to patients and the public as Prozac/Flouxetine and have more recently also become known under a number of other aliases.

Zoloft/Sertraline
Paxil/Paroxetine
Lexapro/Escitalopram
Effexor/Venlafaxine
Celexa/Citalopram
Symbyax/Zyprexa/Flouxetine

PRESCRIPTION & USAGE

SSRIs were first prescribed to my partner when he was 16 years old. He subsequently took them for 15 years. I met him halfway through his ordeal. At some point, we made the decision together that it was time for him to stop using these drugs.

SSRIs are a secret epidemic in the Western world. Doctors prescribe these drugs for symptoms as common as nail biting to PMT; and bizarrely, they are sometimes even prescribed for reasons that have nothing to do with mental health, despite being brain altering substances.

Sixteen people I know have been offered an SSRI by their GP, and all but three of those agreed to take them. All of different ages, they were prescribed these drugs for very different reasons. One was a young pregnant woman, two were elderly ladies and another was a friend with MS.

Being prescribed drugs for mental health is not a coffee table conversation. There are certainly many more who are being “treated” with SSRIs amongst my friends and acquaintances that I am not aware of. Many use them long term. One person I spoke with did not even know that they had been taking an antidepressant for all their years of usage. Their had doctor advised them to take it without even explaining what they were. Most of us trust that our doctor knows best, and so we oblige them without question.

Medically, these drugs are considered safe, with only occasional side effects. Furthermore, none are classed as addictive. However, it takes just a casual internet search to see a very different story, and embarking on some proper research into the matter reveals overwhelming evidence that these drugs do the opposite of treat, let alone cure people.

HOW THEY WORK

Serotonin is a chemical believed to be linked to mood. The general consensus is that the higher the levels of serotonin there are in the brain, the happier a person is.

SSRIs are thought to work by preventing the re­uptake of serotonin in the synapses.

To speak plainly, SSRIs are believed to work in a very similar way to MDMA - it’s that surge of extra serotonin that MDMA releases that creates the feeling of euphoria.

It is disturbing that two drugs that alter the same chemical in the brain are marketed so differently. One is legal and when taken daily, will 'cure' mental health problems. The other is criminalised and admonished as being bad for mental health.

The fact of the matter is, both the legal and illegal drugs above are mind altering - that is what they are designed to do.

SSRIs are far from the only case of a drug beginning its life as an antidepressant and ending up as an illegal Class A substance.

AKITHESIA

Of all the side effects and withdrawal symptoms of SSRIS that I have intimately come to know exist, there is one that scares me most deeply. Akithesia is a neurological symptom, and for my partner, it occurred whilst taking the drug and throughout the withdrawal process.

It produces a feeling of inner agitation, restlessness and a physical urge to move your body. It can affect some people very obviously, and for others, it may not be possible to pinpoint these feelings as being a result of taking their prescription.

Physical symptoms have their emotional counterpart, and this agitation is both physical and emotional. It is a kind of short circuiting in the brain that prevents a resolution from the physical and mental conflict.

This agitation can lead to an inexplicable urge to escape from oneself, and not being able to do so causes a rising panic. This can lead to self harm and suicide. It can just as often manifest itself as outward aggression, amongst other dangerous behaviour.

Those who attempt suicide as a result of SSRIs often do so in this state, and cannot really say afterwards the reason for having felt the way they did, or the cause of their actions.

These suicidal feelings stem from the need to escape neurological pain. That’s how bad it feels. Worse still, the patient will then tell their doctor that they have started to experience a desire to self harm, and are contemplating suicide. The doctor will then mistake it for a worsening of symptoms, and will up the dosage as a result.

This is the silent, screaming hell administered directly from the caring hand of the NHS. I find it incredibly hard to believe that an antidepressant with this effect on people could be considered appropriate. Is there anything more ghastly than death as a result of the way the system treats depression? This was the vicious cycle my partner was subjected to. He attempted suicide a number of times, and on return to his GP after each attempt, his dosage was increased - to the point where, as a bonus, he was also sent away with packets of strong sleeping tablets. A perfect home suicide kit.

It is shocking that it has taken nearly thirty years for these risks to be taken a little more seriously. The popularity of prozac in the 80s provoked many controversies; including a number of high profile court cases investigating the part that prozac played in murders and violent crimes. Despite this, it wasn't until 2004 when the FDA (the American Food and Drug Administration) made it a legal requirement to include a black box label on all SSRIs, warning users of the risk of suicide.

And still the number of prescriptions continues to rise.

WITHDRAWAL

Though Akithesia can be singled out as one very serious issue, it is the cumulative build up of physical, mental and neurological symptoms that can leave the user feeling completely debilitated, down and alone. My partner experienced many of these symptoms whilst taking Sertraline.

These included, but are not limited to:

Feelings of detachment
Lethargy and passivity
Loss of appetite
Inability to ejaculate
Attempted suicides
Nausea
Dizziness
Shakiness
and an upset stomach.

During this, we pushed on with our research – with thanks to the internet – and discovered that we were not alone in our experience.
I really believe so much of it all was down to the pills, and that only time would begin to extricate what was his own pain, and what was drug induced chaos.

Afterwards though, came a complete loss of his sense of self. This is medically known as depersonalisation. Feelings of detachment, sexual dysfunction, memory loss, the inability to think clearly and retain information, accompanied by a severe paranoia that sometimes verged on psychosis.

There were times when it would get better, when things would be more normal; and then another wave would come crashing down. After about a year of withdrawing, memories and emotions came flooding back to him. He was overwhelmed with deep feelings of loss, sadness, anger. The realisation also came that fifteen years had passed. Finally, came the need to understand where the pain came from in the first place arose.

Now, nearly three years on, things are much, much better. Yet it’s not over. And perhaps there are some permanent consequences – only time will tell. The desire to self harm has dwindled and a new calmness has begun to settle in. It feels like he has emerged from it with an understanding of what has happened, and with a greater emotional strength.

SO.

All of this begs the question of why anybody would take these drugs?

Depression is a lonely place. If you seek help, this is what is offered as a life line. Sometimes, talking therapies are suggested, but there are huge waiting lists and support is intermittent and unreliable. Instead, you relent to accepting a crutch; and doing something like taking a drug is a constant reminder you are trying to help yourself.

Doctors are supposed to know best. They will also advise SSRIS take a long time to work, so of course you just keep going. It’s already too late by that time. You can feel so strange both on AND off of them, that the cycle is already a vicious one.

It is important to remember that drugs affect every person differently. Not everyone is the same, There will always be some who don't experience the worst.

The kid that dies after taking ecstasy once and the lifelong raver still popping and snorting thirty years later are extremes, but the spectrum is huge, with the variations as yet unquantifiable. It is common sense; yet somehow all involved detach from this when it comes to prescription drugs.

As a culture, we are mostly incapable of looking at the body as a whole. In medical research and treatment, symptoms are examined in isolation. An example in the case of SSRIs is that only 5% of serotonin is found in the brain, with the other 95% found in the gut. Yet a doctor will tell you your digestive issues have nothing to do with your medication OR your depression, and will treat your depression with one drug and your digestive issues with another.

We are not observed as a sum of our parts, a harmonious and brilliant system, but as a series of unrelated pieces. Mr Fleming’s discovery of penicillin was miraculous in its effect on the treatment of disease, but it also cut short all sorts of interesting research going on at the time and sent us hurtling into a one-dimensional drugs dominated age. Three generations in and it feels like a closed-minded and defensive industry with very few new ideas.

Our mental and physical self is all we can ever hope to truly own, and the only thing we cannot escape. Understanding this is vital and simple. It's about engaging, outwardly and inwardly. We are creatures within a hostile environment. The sun's rays keep us alive and simultaneously destroy our cells. We are living and dying at the same time. The black dog will inevitably touch our lives.

Our mental health is the imprint of our collisions with the world, every part of it is important. More important than anything else. It is what is left when you close your eyes at night and what envelopes you as you die. It is not to be given away to a chemical or to your doctor. It should not make profit for greedy drugs companies, or feed inhuman corporate entities. Keep it safe.