A little over a year ago, when I made the decision to go on antidepressants, the social media landscape seemed quite different—largely empathetic to mental health struggles exacerbated by the pandemic. It seems incredible to write that, considering the amount of false information and vitriol spreading about antidepressants online today. But this is the internet, a place where debunking misinformation is like playing whack-a-mole.
Such widespread disinformation is extremely counterproductive to people who are struggling with their mental health, and who may be considering taking psychiatric medication. When you’re experiencing debilitating symptoms—I barely ate, cried every day, and could hardly get out of bed—one of your first instincts will probably be to do a Google search on the subject, or check out what people are saying on social media.
I know that’s what I did. At that time, I found enough information to determine that medication was a good decision for me, although I still had many questions. On Twitter, I found compassion, encountering folks who were experiencing similar symptoms, and brave enough to speak about their own journeys and decisions. Looking back, I consider those tweets to be the extra nudges I needed to talk to my doctor.
Since then, the online landscape has shifted, influenced by alternative medicine gurus, tech billionaires, right-wing pundits, and conspiracy theorists. While good information on antidepressants and psychiatric medications can be found, it can be increasingly hard to separate it from the myths and disinformation.
On social media, individuals are still speaking out and sharing their stories about depression and medication, but they’re being drowned out by powerful Republicans like Fox’s Tucker Carlson and Georgia Rep. Marjorie Taylor Greene, who have gone as far as to blame mass shootings on antidepressants, despite the dearth of evidence that links the medications with such violence.
Jonathan Stea, a clinical psychologist and adjunct assistant professor at the University of Calgary, tells Lifehacker that social media is filled with a ton of misinformation around antidepressants, other psychiatric medications, and mental illness. He is one of many in the medical community seeking to debunk the current anti-psychiatry propaganda, which is part of a movement that goes back decades.
“Anti-psychiatry propaganda is harmful: it stigmatizes people who experience mental illness and it aims to deter treatment seeking,” Stea said. “It does this by using rhetoric and inaccurate claims that essentially deny the existence of mental illness and fear-monger about the dangers of psychiatric medications. This is why it’s so important to help improve mental health literacy among the general public—to protect against such misinformation.”
Lifehacker spoke to Stea and Dr. Jessi Gold, a psychiatrist and assistant psychiatry professor at Washington University School of Medicine in St. Louis, to clear up the myths around antidepressants and underscore the facts about them. We also spoke to Dr. Tyler Black, a psychiatrist and clinical assistant professor of psychiatry at the University of British Columbia, about what questions people who are considering going on antidepressants should ask themselves before they make a decision.
Depression is complex. Believe me, I know. However, people who are going through it already have enough on their plates and shouldn’t have to stress the false myths about their current or future treatment options. We hope this guide can give you some answers, and a degree of comfort. If you still have questions after reading, don’t hesitate to reach out to your doctor.
Fact: There are different types of antidepressants
When speaking about antidepressants, many often fail to mention that there isn’t just one type of medication. In fact, as Black explains, there are many types of antidepressants—and doctors even see different responses within the same types. While the “pantheon” of antidepressants can be classified in different ways, Black said doctors pharmacologically separate them based on their actions at the neurotransmitter level.
For example, in the case of selective serotonin reuptake inhibitors (SSRIs) such as Prozac or Zoloft—some of the most commonly prescribed antidepressants—Black states that they create a negative effect on the SERT receptor on the brain that changes the way the nerve cells process serotonin. Also known as the body’s “feel good” chemical, serotonin is a neurotransmitter that plays a role in regulating mood.
Gold points out that SSRIs work for many people and are often used as a first-line medications because of their tolerability. But, she adds, they don’t work for everyone, which is why psychiatrists also prescribe serotonin and norepinephrine re-uptake inhibitors (SNRIs), tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs), among others.
“We often pick medications for people based on things like beneficial side effects or extra uses,” Gold tells Lifehacker, pointing out that medications like Wellbutrin, officially known as bupropion, can decrease appetite, which is a good option when people have a depression that causes them to overeat.
“Medication in psychiatry, as unfortunate as it is for patients, is often trial and error,” Gold said. “What may work in one person might not in another, and we will work together to find something that does—one that benefits symptoms with the least amount of side effects. It is a frustrating process and I wish it was more exact, honestly, but maybe it will be when we understand more in the future.”
Myth: Antidepressants will change your personality
Some people wonder whether antidepressants will change their personality. I was in this camp. Even while at the point where I knew I would benefit greatly from antidepressants, I feared I would lose part of myself in the process. As it turns out, this fear was overrated, which my psychologist and psychiatrist gently explained to me when I expressed my concerns. Stea agrees, explaining that antidepressants can help address the symptoms of depressive and anxiety disorders. No research has shown that they change a patient’s personality.
“There are different ways to conceptualize and understand personality. In short, by definition, personality traits are stable and enduring. Antidepressant medications can help alleviate the symptoms associated with depressive and anxiety disorders,” Stea tells Lifehacker. “There’s no good scientific evidence that these medications change personality—and even if they did, it would be less than the debilitating impact of the disorders on personality for which they’re prescribed.”
Fact: Antidepressants make it easier to deal with your problems and keep your symptoms in check
After I started my antidepressants, I remember asking my therapist if they would make all my problems and sadness go away. She laughed and said that if that were true, people like her would have been driven out of work long ago. While researching for this article, I came across a simple explanation I really liked: “Antidepressants make it easier for you to deal with your problems.”
I asked Stea what he thought about this explanation, and he said it was a good point. The psychologist added that the goal of antidepressant medications and psychotherapy is not to eradicate unconformable emotions.
“They are one tool in a toolbox to help people manage the debilitating distress and impairment associated with mental disorders and to help people get back to a state of mental health, which involves practicing healthy ways to roll with, and grow from, life’s punches,” Stea explained. “In my clinical experience, these medications can sometimes make a difference in helping to stabilize symptoms in order to help people better engage in psychotherapy.”
Myth: Antidepressants will work immediately and you’ll be taking them for life
There are a whole lot of misinformed ideas out there about how quickly antidepressants start producing an effect, and how long patients will have to take them. When my friend started taking them for her post-partum depression, I applauded her for choosing to help herself, but also warned her that it could take a bit of time for her to start to notice changes. (Disclaimer: I am not a doctor! These are just some nuggets of wisdom I’ve gained amid my mental health journey.)
Gold stated that it takes antidepressants about 6 to 8 weeks to work, although she’s seen some patients notice benefits after 2 to 4 weeks. “This is a very long time to wait for someone who is sad, and we are lucky therapies like ketamine are being developed that work much faster,” the psychiatrist said. “Usually the goal is to maximize a medication and the dose of it before adding more medications or switching them around.”
When it comes to the length of time someone will need to take antidepressants, Gold said it depends on many factors. Practice guidelines from the American Psychiatric Association recommend keeping patients on medication for an average of 6 months after doctors find a good drug at a suitable dose and achieve symptom remission.
Gold said many people can try to come off their medication at this point, although it’s important to do so with the help of a psychiatrist or a primary care doctor, as there are side effects.
“However, this does not work for everyone—particularly people who have had multiple episodes of depression. Some people might also stay on based on the severity of their symptoms (like suicidality or hospitalization) or even family history,” Gold said. “It could be a personal preference of the patient to keep on medication for preventative reasons, as well.”
It depends: Antidepressants have negative effects on your sex life and can cause weight gain
Given the complexity around side effects, we’ve decided to classify this topic as “depends on the person” rather than as a myth or a fact. Side effects, such as low libido and weight gain, are a big reason why some are wary about going on antidepressants.
Gold said that all medications have side effects, but“not all medications have the same side effects in everyone.” Furthermore, she added, not all of the same side effects bother people to the same extent.
“Sexual side effects are definitely one of the causes for people to stop antidepressants, or want to switch antidepressants, but you have to weigh the risk of the sexual side effect, with the benefit of the medication to your depression,” she explained. “Some people will choose to stay on a medication that causes low libido, if they are no longer suicidal, while others feel it compounds their mood and makes everything worse, and want to change it.”
According to Gold, if someone is experiencing sexual side effects, psychiatrists can often switch their medication to an alternative that won’t cause that reaction. Doctors can also add a medication like Wellbutrin, a medication that has the least sexual side effects overall, and which is often chosen for that specific reason.
On the subject of appetite, Gold said the same principle applies. Some people who take antidepressants can experience an increase in appetite, but this does not happen in everyone. “Oftentimes, people who are depressed aren’t interested in food (and anxiety makes people nauseated), and so when people feel better on medication, they eat more. Yet, [medications] can also have a metabolic effect and cause an increase in hunger in some people organically,” she said.
Medication can also be switched in this case after doctors weigh the risks and the benefits.
Myth: Antidepressants cause suicidal thoughts
Earlier this year, Tesla CEO Elon Musk weighed in on yet another thing he’s not certified to talk about: antidepressants. The tech billionaire said that Wellbutrin should be taken off the market, and that every time it came up in conversation, “someone at the table has a suicide or near-suicide story” involving it. As many psychiatrists, including Black, pointed out at that time, there is no specific evidence to suggest that the Wellbutrin causes suicidal thoughts.
Musk’s comments, while ill-informed, highlight a myth that’s not limited to Wellbutrin. Many believe that antidepressants will cause suicidal thoughts, although experts that spoke to Lifehacker said that it is extremely rare and often age dependent. If patients are experiencing an increase in suicidal thoughts, doctors will stop the medication.
“Lost in Musk’s argument is the nuance, and the rarity of it, and also the fact that you are monitored when starting medication and need to communicate with your doctor about anything you are experiencing,” Gold said. “Also, antidepressants very much treat suicidality, and help most people live in the long run. I have seen far more people have their suicidal thoughts decreased and treated on medication than I have seen them increase.”
Black, a child psychiatrist and coauthor of the Clinical Handbook of Psychotropic Drugs For Children and Adolescents, elaborated on the possible effects of antidepressants in people under 24 years old. According to Black, research has shown that “there is a statistical signal that associates antidepressants under the age of 24 with possible increase in suicidal thinking and behaviors.” Yet, he explained, this is commonly misinterpreted as an effect for people of all ages or a statement that antidepressants cause suicidality, which is not true.
“Whenever I speak to families and youth about starting antidepressants, I tell them about this association, so we should be vigilant for any changes in suicidal thinking especially in the first few weeks of starting medication,” Black said via email. “This is out of an overabundance of caution, and as a suicidologist I can state plainly that this should be a standard of care for all kids entering treatment regardless if medication is being used. I’ve prescribed and de-prescribed antidepressants for many children (thousands), and I know that in most circumstances, suicidal thinking changes are due to circumstances in their life and their overall wellbeing, and NOT whether or not they started a medication.”
Fact: More people are taking antidepressants than you think
Stigma around depression might make some people feel like they’re the only ones that need to turn to medication when their symptoms are severe and long-lasting. However, they are way more common than you think. A survey carried out by the Centers for Disease Control and Prevention found that from 2015 to 2018, 13.2% of adults 18 and over had used an antidepressant in the past 30 days.
In Stea’s view, use of antidepressants is too common, which itself is problematic. “Antidepressant medications are great tools, but at the same time, over-diagnosis and over-prescribing are major problems that detract from their helpfulness and carry their own risks,” he said, adding that it is necessary for prescribers to mitigate these risks by practicing ethically and competently.
Myth: Once you start antidepressants, you’ll get hooked
When some people come off antidepressants, they can experience “withdrawal,” which is medically known as “antidepressant discontinuation syndrome,” or ADS. According to Gold, approximately 20% of people who have taken antidepressants for at least a month will experience ADS if they stop their use too suddenly. Symptoms of ADS include flu-like symptoms such as headache, joint aches and sweating, as well as insomnia, nausea, imbalance, and sensory disturbances.
However, ADS is not the same as withdrawal due to drug abuse and addiction. As Stea pointed out, addiction has distinct characteristics. “Antidepressant medications are not addictive in the sense that they are not associated with features that characterize addiction, such as a sense of loss of control, craving, a strong desire to obtain more of the medication, and immediate reinforcing properties, such as euphoria,” Stea explained.
To further illustrate the difference, Gold referenced an analogy from Dr. Caroline DuPont, vice president of the Institute for Behavior and Health, an organization specialized in addiction treatment. DuPont compares needing antidepressants and addiction to putting on eyeglasses every day.
“I am able to function better in all my life roles with my glasses [and] my use of them is as prescribed,” DuPont told Gold in a 2019 article for SELF, noting that she is dependent on them, but not addicted. “This is very different from an addiction where a person will continue to use at great personal cost and despite many painful consequences to their health and relationships.”
Myth: If you follow a certain diet, exercise, or take a supplement, you won’t need antidepressants
My struggles with depression began when I was at university almost a decade ago, so believe me when I say I have experienced countless sincerely well-meaning people in my life tell me that I could stop taking antidepressants if only I followed a healthy diet or exercised more—you know, by getting better “the natural way,” without medication. Social media and the internet are filled with similar advice, although not all of it comes from a good place.
Stea told Lifehacker that in this area, wellness influencers and alternative medicine practitioners often “step on the toes” of mental health professionals to market pseudoscientific treatments and spread misinformation about the nature of mental illness and its treatment, despite being unqualified to comment on these very serious topics.
In clinical practice, treatment teams do address lifestyle changes as a part of evidence-based care, Stea explained. However, he added, sometimes diet and exercise “are insufficient on their own to address the complexity and gravity of mental health concerns.” He emphasized that no one should stop their medications without consulting their treatment team.
On the psychiatry side, Gold pointed out that there is no one thing people can do that will help them stop taking antidepressants. It’s not that simple, in part because depression is caused by biology, psychology, and social components in people. In addition, she said, “it is a spectrum of severity.”
“It is helpful to exercise, to eat well, and to find coping skills, but tell someone who can’t get out of bed, wants to sleep all day, and is hopeless, to go running, and you will have no luck,” Gold said. “It is important to approach treatment holistically and understand that in many people therapy plus medication is more beneficial than either alone and that many people need medication to even allow them to get to therapy or get to yoga, and it helps them function in their lives.”
Myth: Antidepressants don’t work because a recent study said so
Recently, a study on selective serotonin reuptake inhibitors (SSRIs)—a type of antidepressants—gained steam online for concluding there was “no clear evidence” that low serotonin levels cause depression. This is nothing new, as the “serotonin theory” hasn’t been considered an official explanation for decades within the psychiatric community, Black explained. However, some media outlets that picked up the news claimed that this was an indication that SSRIs aren’t grounded in science and that, as a result, these antidepressants don’t work.
This is not true, and even the study’s lead author— Joanna Moncrieff, a professor of psychiatry at University College London—said so. Speaking to Rolling Stone, Moncrieff explained that the study was an analysis of one of the mechanisms by which scientists believe SSRIs work.
“We don’t need to know how something works to know that it works,” Black told Lifehacker in an email, pointing out that Tylenol is a good example of this. “The evidence that antidepressants work against depression, anxiety, and a number of other issues is extremely solid.”
Additionally, it should be noted that Moncrieff doesn’t exactly have a reputation for impartiality. She has spent years questioning SSRIs as well as the classification of depression as a mental illness, Rolling Stone reported. At one point, Moncrieff said there could be evidence to support the conspiracy theory that drug companies are purposing hiding information about the side effects of SSRIs.
Black said this incident concerned him because it’s a situation in which people misrepresented science to distort what is known about treatments for psychiatric conditions.
“Many people will be drawn in by the misinformation that the latest study ‘proved that antidepressants don’t work,’ when in fact the study did not show that,” he said. “We have overwhelming evidence that they do work, and the entire paper is an effort by biased professionals who have a history of only portraying medications in a negative light.”
What to remember if you’re considering going on antidepressants
The idea of going on antidepressants can stir up a lot of emotions, and can even feel overwhelming. If you’re considering taking that step, the last thing you need is to encounter misinformation about antidepressants on social media and the wider internet.
Black stressed that when people start thinking about taking antidepressants, they should feel comforted in knowing that these medications work. Other things said to relieve depression, such as exercise, yoga, homeopathy, acupuncture, naturopathic and herbal medicine, traditional Chinese medicine, and eating healthier, among others, are not backed by sufficient evidence that meets clinical criteria. Still, another great option is to start seeing a credentialed psychotherapist, he said, as many forms of therapy have shown benefits equivalent to starting a medication.
For those interested in the “gold standard” approach, Black suggested combining therapy with medication. Doctors are quite convinced that people who adopt this approach have the best outcomes in depression, he said.
“Ultimately, one of the biggest questions someone has to ask themselves is ‘what is the trajectory my symptoms are on, and if this trajectory continues will I face consequences in my life enjoyment, productivity, or safety?’” Black emphasized. “If the trajectory is poor, talking to a qualified psychotherapist or physician about starting evidence-based treatments is necessary.”
Credit: Source link