Wednesday, September 20, 2023

Themes from people’s experience of antidepressants

Many so-called treatment resistant depressed patients do not respond adequately to two antidepressant medications given one after another. The question of the efficacy of antidepressants is still an open issue in the scientific literature because of methodological problems with the clinical trials (see eg. previous post).

Crowe et al (2023) identified four themes from a meta-analysis of qualitative studies examining patients' experiences of antidepressant medication. These were:-

(1) The only option available. This was partly about the sense of ‘needing something’, often quite quickly. People were generally more accepting of taking antidepressants when in acute crisis but were more ambivalent about taking them outside this context. Some felt they had to take antidepressants because of what the doctor said and even felt bullied into taking them. Some said they got relief from their first prescription but over half in one study had a trial of more than one antidepressant before getting any relief. Not everyone took the medication as prescribed, with some deciding themselves when to take it and others choosing not to even take the prescription. Most participants described feeling that there was no other treatment option available and were desperate for relief.

(2) Stigma associated with ‘biochemical deficit’. Participants in 14 studies described how the medical construction of their experience as a biochemical abnormality was stigmatising. Participants may feel different or damaged and reliant on medical expertise. Having been positioned into a passive position with the doctor having control may have shamed some into taking medication. Just using medication itself was linked to the stigma by many. Most participants in this theme described being told they needed antidepressants for their ‘biochemical deficit’. For some the deficit was constructed as something that would require on-going treatment. The doctor may state as fact that the person was biologically flawed even though there was a lack of evidence for such a view. 

(3) Not myself. In weighing up the benefits and risks, participants in 6 studies, if they took medication, described it as helping their functioning, noticing improvement in mood and being given a sense of hope on starting. However, this was often offset by experiences in which they felt the medication was masking the real problem or altering their experiences of themselves and others. This was captured in one study where participants described unbearable side effects, undermining emotional authenticity, masking real problems and reducing the experience of control. Most people commonly experienced a flattening of emotional responses which included feelings of being ‘dulled’, ‘numbed’, ‘flattened’ or completely ‘blocked’, as well as descriptions of feeling ‘blank’ and ‘flat’, affecting their relationships with others and how they saw themselves. Some described how antidepressants made them feel worse than the original depression.

(4) A vicious cycle. Patients in 8 studies identified issues in relation to discontinuing antidepressants. They often described wanting to discontinue antidepressants but had a fear of relapse. Discontinuation was associated with withdrawal symptoms, ranging from mild to severe. Fear of relapse and the experience of withdrawal symptoms meant participants felt compelled to keep taking antidepressants when they no longer wanted to.

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