Antidepressants Are Great, Until You Have an Adverse Drug Reaction

Editor’s note: this post is reproduced from the blog Healing Journey, with kind permission of the author Anne Marie O’Beirne.

I’ve suffered from anxiety most of my life. Towards the end of 2004 I started to get severe panic attacks. I was prescribed the antidepressant citalopram and was on it for about three years. Initially it did seem to help. However, I was unaware of potential adverse effects. In the summer of 2008, I went into mania and psychosis (a temporary loss of touch with reality) while on citalopram. There was a spiritual aspect to my experience. I wasn’t violent. I live in a culture that lacks empathy and understanding of such experiences.

I was never told that antidepressants could cause these symptoms, despite the evidence that is out there. There is a Yale study from 2001 which looked at Antidepressant-associated mania and psychosis resulting in psychiatric admissions [1] and found this to be the case for eight per cent of admissions – that is one in 12 people. The conclusion of this study states that, ‘The rate of admissions due to antidepressant-associated adverse behavioural effects remains significant’. Knowing this would have helped immensely, especially with the social stigma.

I ended up admitted to a psychiatric hospital without being involved in that decision. At a time of stress and vulnerability I expected genuine support. Instead I had the police on my doorstep and I was locked into a building for three weeks. Forced hospitalisation was a serious trauma and I continue to suffer post-traumatic stress over a decade later. For example, if I hear a truck reverse right now I would immediately have to go to the window to reassure myself that it’s not an ambulance coming to incarcerate me. So I’m left with hyper vigilance, despite being through counselling and therapy. It has started to ease with time but feels like a survival strategy. I had more insight into what was going on than people realised. The sectioning process, where I was carted off to a psychiatric unit of a hospital without consent, was more distressing than the symptoms I was experiencing. While it wasn’t physical, it felt like an assault that has left deep emotional scars.

I was quickly given the label ‘bipolar 1’, which should not happen when a drug can be causing the symptoms. The revised 4^th edition of the Diagnostic and Statistical Manual (DSM-IV-TR, 2000) states that, ‘A diagnosis of mania or bipolar disorder should not be made when the hypomania or mania first appears while the individual is taking a medication that can cause these symptoms’ [2]. The DSM – now in its 5^th edition – is one of the manuals used by psychiatry to make a diagnosis.

What was forced treatment, and the aftermath, like?

It is hard to put the extreme distress I felt at the time into words but I will try. I felt dis-empowered, helpless, as if everyone had turned against me, constricted, caged, my freedom taken away, agitated, pressure of speech, my every word and action observed and judged, unsafe, distressed, no autonomy, frightened, scared, angry, violated, no one seemed to understand, no empathy, unfairly treated, trapped, like I would be there forever, my dignity taken away, disbelief, stressed, anxious, in fight mode (seeing as flight was not an option), my heart racing and my adrenaline pumping. Apart from when sleeping, I found it hard to get some relief from the deep distress and emotional pain I was in. I felt traumatised, misunderstood. I couldn’t believe it was like this in the year 2008.

An asylum is supposed to be a refuge, a sanctuary, a place of safety. The Acute Psychiatric Unit felt like the opposite. There was no awareness or understanding of what was really going on with me. I had been through a trauma and was in drug withdrawal from citalopram. (Shortly before, I had been asked by a professional in the mental health system to stop citalopram cold turkey). I was exhausted. This was not the place for me. Based on my reading over the last number of years, a Soteria-type crisis house would have been more suitable and healing.

The electric shock instructions on the walls of one of the offices didn’t help, nor the sign ‘ECT Suite’ at the main entrance – although I found out later there was no electric shock suite in the building; it was in separate unit.

My notes before hospitalisation said, ‘Fear of detention based on father’s history’, yet they used a very backward method to bring me to the hospital: ten people at the house including two police officers, two ambulance drivers and two psychiatric nurses. A complete over-reaction to the situation and a waste of valuable resources. I hadn’t harmed myself or others and had no plans to do so.

The psychiatrist that dealt with my admission wrote, ‘Having spoken to her she calmed down’. This was the crux of the problem. No one spoke to me properly and therapeutically. At one stage I wrote in my journal that I was wound up like a coil and that certain people wound me up again when I tried to unwind. I’d lost my job, I had bills to pay but the hospital (while benefitting from my private health insurance) was reluctant to let me out to pay them. It cost my private health insurer €23,000 for the state to have me put away.

The local psychiatric unit was such a cold, uncaring, unsympathetic place to be. Surrounded by strangers, who displayed very little empathy, offering just their trolley of potions and poisons. Some of the nurses were kind, but overall I was very distressed to be there. After three weeks locked away, my escape route was via a transfer to a private hospital in Dublin for another week.

Brain damaging drugs 

While some tranquilisers can offer relief to a person when used short-term, I was unnecessarily put on several strong and potentially damaging drugs long-term: Zyprexa (olanzapine); Seroquel (quetiapine); lithium; Lamictal (lamotrigine); Rivotril (clonazepam); sleeping pills and others – nine A4 pages of prescriptions! Due to the tranquilising and sedating nature of the drugs, I did not want to face each day and spent a lot of time in bed. I had a very poor quality of life. Doctors were oblivious to the drug’s iatrogenic effects. (Iatrogenic means caused by treatment). I was heavily sedated for three years, until I finally woke up out of a drug-induced haze and started to question things.

Turning Points

Luckily, a few years into my journey and search for the truth, I was fortunate enough to make connections with other psychiatric survivors, as well as some honest and dedicated medical professionals and psychologists – experienced experts who do not have conflicts of interest but who want the best possible outcomes for people in distress. People like Dr Terry Lynch, Prof Ivor Browne and clinical psychologists in the UK – Lucy Johnstone, Anne Cooke and Peter Kinderman. I studied the work of honest psychiatrists like Prof David Healy (who is also a psychopharmacologist), Dr Peter Breggin and Dr Joanna Moncrieff.

One turning point was when I went to see Ivor Browne in February 2012. At that stage I had miraculously managed to come off all the drugs with no support and was down to 25 mg of Seroquel (a low dosage; the maximum is 800 mg). Ivor listened to my human story and gave me a new perspective. In our first session he worked in a methodical way and told me I was not mentally ill, which was quite liberating, like a weight had lifted off my shoulders. Born in 1929, with over 60 years’ experience in this field, Ivor is now a nonagenarian (in his 90s).

My father’s experience

My very sane father unfortunately became a victim of this system in 1973. He was in and out of hospital throughout my childhood. In 1983 his symptoms seemed to disappear, up until his early death in 1993 (age 52). As recently as 2012 I believed that ‘manic depression’ / ‘bipolar’ was genetic as that is what I was conditioned to believe throughout my life. In my first session with Ivor Browne, I said that my father also had ‘manic depression’ and that I remembered his highs and lows. Ivor dropped a bombshell that day that made me rethink the whole experience: he said, ‘Your father was around in the era of medication as well’. Based on my own personal experience, I now realise that the drugs can leave you so sedated that you don’t want to get out of bed, and can also drive a person into a high.

My father was a kind and gentle man, and deserved better than what he was put through. He was put on at least 14 pills a day and given several bouts of electric shock. I now know this was unnecessary and unethical, while not forgetting the devastating impact it had on our family life. It created a lot of stress for my mother and the family in general. Both my parents died young, 10 months apart (my mother was 43). They never got to meet their grandchildren, currently ranging in age from three to 18. I admire how my dad kept going and rarely complained; his favourite saying was, ‘It could be worse’.

What would have helped me through my crisis in 2008?

It’s been a difficult 11 years. My healing journey was impeded by the trauma of a flawed biomedical approach to mental health. The wounds still run deep. My career ended, which created another set of problems. The whole experience has affected my personal relationships and trust in others. Mainstream psychiatry can be very disempowering. After hospitalisation I had lost all confidence in myself.

The following would have made my distress easier to cope with:

• Truth and honesty about the antidepressant drug I was on and its adverse effects;
• An Open Dialogue (OD) approach, which would have involved me in the decision-making process around my care. This was a major event that was about to alter the rest of my life;
• Reassurance that my stay in hospital was temporary – the survival part of my brain was convinced I would be there for a very long time, possibly forever. This left me in a very distressed and agitated state;
• Access to a psychologist and counselling or psychotherapy;
• Honesty about drug withdrawal and akathisia, with advice on how to try to avoid this. (Akathisia is a severe inner restlessness, often caused by withdrawal from prescribed drugs);
• Ethical use of the major tranquilisers at the lowest dosage possible, for as short a time as possible. I needed them for about two weeks initially.

Coming off the drugs

Any change to the drugs a person is on needs to be made slowly under the supervision of an expert. For almost seven years, I have been free of these strong tranquilisers. In the first two years I was prone to relapse as my body re-adjusted to being off prescribed psychoactive drugs. Support from doctors was lacking; they seem to have no problem getting you on their drugs, yet striving to stop them is often frowned upon.

I no longer go into psychosis, which is a major step in my recovery journey. I use WRAP (Wellness Recovery Action Plan) and benefit from self-awareness, rest, yoga, meditation, exercise, nutrition, mindfulness, journaling and talking therapy. Support from others is vital but in short supply. I’m still working on developing good daily habits that enable my healing.

When it comes to the initial anxiety I experienced, I now know it’s linked to breathing rate, and the oxygen and carbon dioxide levels in my blood. Understanding the cause of panic through talking therapy, along with healthy lifestyle choices, helps. While I’d still be willing to take a minor tranquiliser (e.g. Xanax) very short term in a crisis, I now know I won’t find the answer in a bottle of pills; I’ve been down that road before, for six years in total. The drugs have damaged me but I try to focus on the concept of neuroplasticity.

Access to my records under Freedom of Information

In 2012 I requested my hospital notes as I wanted to check some details. After receiving my hospital records I found it hard to trust anyone. I don’t really recommend requesting your notes unless you have good support around you, as reading them can be a traumatic experience. One thing that struck me about stuff that was written about me was the many factual errors.

When I got the transfer to the private hospital, I had a lot more freedom, and could go in the garden or even to Heuston train station to buy a paper. But the medical notes painted me as an academic failure, even though I have numerous qualifications up to Masters Level. It shows that even factual details can be incorrect in a person’s notes, conveying inaccurate information about a vulnerable person going through a crisis. I look forward to burning these fictional notes someday soon, as part of the healing process.

Conclusion

Being in the system and the consequences of that – the stigma, discrimination, lack of understanding of others, and the effects of the drugs – were the most traumatic parts of the whole experience. In our society the general public have been indoctrinated into the biomedical model, affecting how those who have experienced mental health difficulties are perceived. Social stigma can be an impediment for the person and can seriously impact and slow down the recovery process.

What I’ve gone through since August 2008 (health issues, brain damage from the drugs which hits me in subtle ways, tardive dysphoria [3], insomnia, loss of career, disconnection from family, ongoing post-traumatic stress) is actually a catastrophic grief and bereavement. I sometimes need to pause and reflect on that aspect of the experience. To process the grief and accept the pain. For quite a while I have been stuck in a phase of anger. Some of it justified but, on the downside, the anger can keep me stuck. It’s taken over a decade to process and try to integrate the experience.

While some may feel they had positive psychiatric encounters, I remember my experience, and the suffering of other psychiatric survivors, as being caused by a system that has the potential to be very destructive to a person’s emotional wellbeing. I also remember those that died. Any attempt to actively change such a system is met with resistance. I admire myself for hanging in there, and not becoming a statistic. Unbearable feelings do pass, if you can learn to sit with them or reach out for help. My rebellious nature helped me through.

I have seen the system from the inside and it gave me a very different perspective. I can think about forgiveness if I know that others aren’t being potentially hurt or killed. But I find it difficult to forgive the current system knowing that the delusion continues and that prescription rates are going up year on year, resulting in ongoing risks of damage to people, including children and the unborn.

Note: Do not stop or change prescribed psychoactive drugs without consulting your prescriber, due to the dangers of withdrawal. Any changes need to take place under the supervision of an expert. What I write about is my own experience and is not medical advice. We all have our own unique journey. Samaritans are there to listen to people in distress ~ 116 123}

References

[1] Antidepressant-associated Mania and Psychosis resulting in Psychiatric admissions, Yale study (2001) ~ www.ncbi.nlm.nih.gov/pubmed/11235925

[2] Suicidality, violence and mania caused by SSRIs: A review and analysis ~
http://breggin.com/wp-content/uploads/2005/01/31-49.pdf

[3] Tardive Dysphoria: Anti-depressants can turn mild/moderate Depression into a chronic condition ~ http://www.psychologytoday.com/blog/mad-in-america/201106/now-antidepressant-induced-chronic-depression-has-name-tardive-dysphoria

Other links that may be useful

* Psychopharmacologist & Psychiatrist Prof David Healy “Time to abandon evidence based medicine?” At 6 minutes he discusses the hiding of negative data from anti-depressant clinical trials ~
http://www.youtube.com/watch?v=A3YB59EKMKw

* Promoting awareness of the potential dangers of anti-depressants ~
http://antidepaware.co.uk/

* Many People Taking Antidepressants Discover They Cannot Quit ~
https://www.nytimes.com/2018/04/07/health/antidepressants-withdrawal-prozac-cymbalta.html

Resources to help withdraw from prescribed Psychoactive drugs

* Inner Compass initiative ~ https://www.theinnercompass.org/

* Psychiatric Drug Withdrawal A Guide for Prescribers, Therapists, Patients and their Families ~ www.breggin.com/index.php?option=com_content&task=view&id=296

* Guide for stopping anti-depressants (under supervision of medical professional) ~ https://rxisk.org/guide-stopping-antidepressants/

* An independent drug safety website to help you weigh the benefits of any medication against its potential dangers. www.rxisk.org

* Council for Evidence Based Psychiatry ~ www.cepuk.org

* Council for Evidence-Based Psychiatry Support Page ~ http://cepuk.org/support/

* Recovery stories ~ http://cepuk.org/recovery-stories/

* Withdrawal Advisers ~ http://cepuk.org/withdrawal-advisers/