Antidepressants are not ‘happy pills’

 

I am sick and tired of the way the press portrays depression as unhappiness and antidepressants as ‘happy pills’.

Over and over and over and over and over again they tell us that we’re medicalising our normal emotions and that resorting to tablets simply encourages our own helplessness.

The professional equivalent of cutting and pasting, the same article seems to keep coming back like a bad penny. For problems in other areas of health we’d only trust the experts to comment, but when it comes to mental health it seems like anyone can cast judgement. Every author seems to think they’ve discovered something amazing, when all they’re actually doing is repeatedly insulting a huge group of people with their ignorance.

‘Normal Unhappiness’

Depression is not normal unhappiness, it is not something everyone goes through at some point. Only someone who has not been depressed would say that. It is not a bad day at the office or a row with your partner. Depression feels like someone has reached inside your chest and torn out your soul with a rusty spoon. And is laughing at you about it.

You can’t just choose to instantly recover from depression. It is not a case of willpower or a lifestyle choice. Why would anyone choose to be depressed? Unsurprisingly, ‘snapping out of it’ or ‘pulling yourself together’ have already occurred to people who are depressed, because they aren’t stupid.

I agree, the causes and biological markers of depression are still murky to us. We don’t have a blood test or a scan for it and we realised that the ‘serotonin hypothesis’ was too simplistic decades ago. But this does not make depression any less of an illness, because the symptoms are still there. Just like migraines, we know very little, but we shouldn’t bizarrely stop calling it an illness just because of that.

‘Happy Pills’

Antidepressants are not ‘happy pills’. They do not make you happy. If you’re lucky they take the edge off the searing, crushingly hopelessness and allow you to focus your thoughts in reality just long enough to find a solid foundation for recovery. Taking them is not an admission of defeat or weakness, it is accepting help for a problem which can lead to devastating consequences.

Nor is taking antidepressants an admission that you have a brain disease instead of a complicated illness with psychological and social factors. Antidepressants can be the crutch people use to make it to talking therapy, just like pain killers can be the crutch people use to do physiotherapy. If they help it should be lauded, not chastised on ideological grounds (‘I know you feel better on tablets but I don’t think it’s right for you to be taking them’).

However complex the cause of depression is, we know that antidepressants can help. Even staunch antidepressant-hater Joanna Moncrieff has done a meta-analysis which suggests it, and the largest critical meta-analysis suggests they still work in severe depression.

They don’t work for everyone, but no drug does. In fact, antidepressants work at least as well, if not better, than drugs from the rest of medicine. They have side effects, but every drug does. Some say ‘they only numb you’, as if being numb sounds like a bad thing to someone who feels so gut-wrenchingly low.

The real issues

The real issues are that so many people feel so low that a doctor thinks they might benefit from antidepressants, and that there isn’t enough provision of alternatives in these situations. The first choice treatment for mild to moderate depression, as every reasonable GP knows, is actually talking therapy. But the waiting lists are horrendous and GPs feel they need to do something.

The press desperately need to take a more nuanced view of these genuine issues or they’ll continue to trample over the thousands of people who genuinely need antidepressants to continue living their lives.

For the final time:

Depression is not normal unhappiness and antidepressants are not ‘happy pills’.

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About Alex Langford
I am a psychiatry trainee based in South East London. Before I went into psychiatry, I used to be a general medical doctor, and I also have a BSc in psychology. I'm particularly interested in improving the public face of psychiatry, evidence based medicine, teaching and patient rights. Don't mention cricket unless you've got the next fortnight free to discuss it.

31 Responses to Antidepressants are not ‘happy pills’

  1. This is a great post. I’ve been dealing with the off handed happy pills remarks since I was a teen. After a particularly bad day I snapped at the person uttering the words and said ‘I take anti depressants do I look happy to you’..shut them up quick smart.

    Like any illness, medications have their place, they are not a cure all but like you say, they can help someone come to place where they can add more treatments. I don’t understand the hate against psych medications as a general rule, that they are dulling a real person etc. If having medications means that I can get out of bed in the morning, then I am happy to have that ‘realness’ dulled.

  2. Marcus says:

    By the same token these medications shouldn’t be marketed as antidepressants. It’s more truthful to say “these are psychoactive drugs.They’ll make you feel different. Feeling different might make you feel better”.

    ‘Anti-depresssants’ aren’t anti-depressants.

    • They’re no less valid in this regard that many other types of drugs. Analgesics for instance – varied, sometimes even dangerous if used badly, but relieving of pain through a variety of mechanisms which might or might not act directly at the source of the problem. Antidepressants are the same.

      You can argue with depression as a concept, but in the same respect you can argue with concept of pain. And as my article states, the concept of depression is cheapened enough.

      • Cooper Moll says:

        With broken vertebrate, multi-level spinal fusion, pelvic enthesitis and other related issues, the door is continually wide open for depression to take over one’s life (this is the case for most physically chronically debilitated people), it is a natural case for GP to prescribe anti-depressants (anti-mad pills). Such medication is the only way to give the patient time to get their life into a self controlled state. We already live on a mix of med’s for physical pain relief. The anti-mads help one make it through the numerous setbacks and realisations that we cannot do much of the things previously done in life (sport and work as well as family).
        Of course, talking with a therapist is ultimately the best release from depression, but, the therapist is not always available at every moment of need.

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  4. daphne80 says:

    I strongly agree that too many of us are shamed when we accept medication as part of our treatment. Whilst talking therapies are the first port of call, many of us leave asking for help until we are beyond desperate, and I know that the GPs that I’ve seen have prescribed meds in order to help me cope with the waiting list to see someone.
    Those of us who have had anti depressants know that they are not a magic cure and comments inferring that I should be fine when I’m on meds only adds to stigma.
    We still have so far to go when it comes to dealing with our mental health, it is still grossly undervalued, but thankyou for writing this post. I take medication when I need it not to make me “happy”.

  5. My kids named my anti-depressants “happy pills” spontaneously. I’ve gone with it and also use the phrase. I feel it gives them a normality, making them something that can be part of our every day conversation rather than being a technical/medical thing that feels outside of every day experience. I have explained and they can see for themselves, that they don’t result in instant easy happiness – but help me cope and be a bit more “normal” In that sense, it’s been a helpful phrase for us.

  6. My kids spontaneously named my antidepressants “happy pills”. It’s been a helpful phrase for us as a family because it’s helped them get a weapon what’s happening by letting them name it, whereas the more correct terms are more alien and outside their experience. It has enabled us to talk about depression as a day to day thing. I have explained (and they can see for themselves that they don’t lead to “instant happiness” , but help me cope and be more “normal”

    • Thanks, great comment, never considered that the phrase could be helpful if used as a defuser.

  7. Handle, not Weapon, above. Damn you, auto- correct.

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  9. Jean Davison says:

    ‘Happy Pills’ or ‘antidepressants’? Call them what you will. They didn’t make me happy and they increased my depression. But expressing concern about the medicalisation of normal emotions is not the same as shaming those depression sufferers who take antidepressants. Why leap to that conclusion? Isn’t the valid point being made that there is over-prescribing, and sometimes the misdiagnosis of ‘normal sadness’ for a ‘depressive illness’? Yes, this might be put clumsily by many newspaper article writers, not known for nuances (the next newspaper headlines aimed to get people steamed up could just as easily be: ‘Depression Sufferers Are Being Shamed And Blamed!’).

    Maybe the facts are that meds help some people and not others. There is no shame in taking them or in not taking them (though hopefully both through informed decisions). Suffering and despair is very real and can be a devastating gut-wrenching experience whether it’s a normal reaction (as in the normal grief process, to use just one example) or something that goes beyond our perceptions of ‘normal’.

    • Thanks Jean. I’m sorry you didn’t benefit from tablets, but of course, not everyone will.

      The main problem is that though there may well be a group of people inappropriately given tablets, these people are not alluded to in any story. Instead, the whole cohort of people on tablets are demeaned.

      Each to their own, but such a blanket dismissal derides the valid needs of others.

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  12. Leigh Emery says:

    I must say that I have mixed views on this blog entry. On the one hand, I agree with some of your broader points. I agree that the argument that psychoactive drugs are being overprescribed is one that has been made many times before, and I agree that calling antidepressants “happy pills” misrepresents their effects. I also agree that the real issue is the lack of alternative interventions. And yes, depression is awful. Really awful.

    On the other hand, however, I disagree with your points about depression as an illness. Maybe you’re right that equating depression with ‘normal’ unhappiness does a disservice to the experience of depression. It’s much worse than feeling down in the dumps after a rough day at work. However, that doesn’t necessarily mean that it must be an illness. Why does it need to be pathologised to have some sort of legitimacy?

    Sure, you can’t just “snap out of” depression because emotions don’t work that way. You can’t just snap out of grief at the loss of a loved one, for instance. But nevertheless I’d argue that depression is still part of the spectrum of human emotions, albeit at the most extreme, horrible end of the spectrum. If we call depression an illness, then we risk creating the illusion that depression is primarily a biological condition, and the social and psychological issues become overlooked. Maybe mental health professionals and people with lived experience of mental health problems are more aware of the nuances of depression, but to the lay person this might not be so clear.

    We also need to be careful that we don’t lose sight of the real concerns here. In amongst sloppy language and “cutting and pasting”, articles in the media frequently make valid points too. We should certainly be concerned that antidepressant prescribing is on the rise and we should be concerned that, even in a post-IAPT era, talking therapies are still woefully lacking.

    I don’t mean to say that people shouldn’t take antidepressants. Despite mixed research evidence, some people find them helpful (sometimes they can be the difference between life and death) and that’s a really important point.

    • Thanks for the comment. Good points.

      I won’t reply at too much length because the last thing I want to do is turn this back into the diagnosis debate. It’s about the unsettling practice of belittling seriously horrible emotions, not about the more complex underlying conceptualisations of them.

      However, to reply, I do need to address the issue of conceptualising depression as illness.

      I think that this is the “right” thing to do, as if such a thing were possible, because in my view the domains of physical and emotional are simply inseparable. We cannot cleave off emotions and say that the extremes of their dsyfunction is not illness, when they are a product of the body like any other. This makes especially poor sense if the cause of the dysfunction is overtly ‘organic’ (i.e. drug induced, post-head injury, so on). At the end of the day, everything is organic and there is no obvious place to draw the line.

      But this does not have to mean that we treat things as brain diseases with only biological cures. Our conceptualisation of illness as involving emotions only works if we conceptualise treatment as holistic too. I agree with you that there is still work to do to bring this to fruition, involving both funding and ideology.

      • Leigh Emery says:

        You’re right – this could quickly turn into a diagnosis debate and this has been covered before (in fact I think you and I have discussed this on Twitter in the past!). I’ll try not to get bogged down in it in this response.

        Completely agree that mind/body dualism is a fallacy – it’s all one and the same thing. My concern is mainly with the choice of a medical lens to describe the extremes of human experience (i.e. talking about it in terms of symptoms, illnesses and treatments). I think it’s too reductionist to do human experience justice and encourages thinking about things as more biological than perhaps they are. I think this is particularly a problem among people who aren’t experts in mental health and so have only the dominant medical model to go on. However, I suspect we’ll never agree on this, so I won’t dwell too much on about it.

        I do agree though that the language used to describe mental health problems must be sensitive to the enormity of the suffering involved. MH problems are not simply “life’s ups and downs” or “feeling a bit miserable”. Sometimes the authors of articles in the media are guilty of sloppy language in this sense.

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  14. M.K. Hajdin says:

    I have depression. It’s not “within the spectrum of normal human emotions” to be so tired that it is literally impossible to get out of bed, dress oneself, bathe oneself. Those who believe that theory have never experienced depression, or they would know better.

    I’ve spent most of my life off of antidepressants – because I could not afford them, because many of them didn’t work for me, because I bought into the pill-shaming stigma and felt like I was weak for needing them. Now that I have medication that works for me and whose side effects I can tolerate, if I could have those years back I’d choose to be medicated for all of them. I’m sick of people who have no experience with depression trivializing it and pill-shaming. They need to STFU.

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  17. Thank you for this – you speak a lot of sense!
    I have depression and anxiety, within a rather dubious recent diagnosis of Borderline Personality Disorder.Though I don’t present with all the symptoms by any means, I do suffer from overwhelming emotions I find hard to control and live with and they are extremely distressing. I was referred for Mentalisation Based therapy which I stuck for 9 months but the approach wasn’t helpful for me at all – it made me feel MORE anxious and MORE depressed and gave me no insight or coping strategies. On the other hand my daughter, now aged 30, was diagnosed with BPD several years ago and was given DIalectical Behavioural Therapy, available in her area. That changed her life completely and she is now reasonably stable, able to help herself when she feels overwhelmed, but she does take antidepressants which are extremely beneficial for her.
    I am struggling to find an antidepressant to help me. One issue is that I take Imigram about once a week for frequent migraines and most SSRIs are contra-indicated with this drug. I was precribed Mirtazapine by my psychiatrist which eventually helped, at the highest dose, though it did little for my anxiety or mood swings. At least I wasn’t waking in the morning feeling that awful grey shroud over my world. However, a major side effect is weight gain, and that is a big issue for me as I struggle with it anyway. All my efforts to control my weight were failing and I don;t want to die prematurely of a stroke or heart disease (I’m only 60). So reluctantly I agreed to come off the drug.
    So what now? I’ve tried the older style antidepressants and they didn’t help. My psychiatrist has prescribed escitalopram, but warned me that this could interact with the Imigram which would reduce the efficacy of both. I am going to give it a try once I am clear of the mirtazapine, but I dread side effects (I’m going to France soon so not a great time to be changing meds).
    I feel I’m reaching the end of the road medication wise as well as therapy wise. Psychotherapy is NOT helpful for me and DBT not available in my area unless I’m very sick (ie an in-patient). So I struggle on alone, trying to hide my horrible feelings so other people aren’t affected. I wish there was a self help group I could join locally, but there isn’t. Any thoughts?

    • TO Wisehedgecrone,

      Just noticed something in your reply that made me want to respond to you and I hope you get a notification of it at some point. I had been having not just chronic but severe status migraine attacks, almost 23 days out of a month and took Imitrex (I think this may be the US brand name for Imigram) for years, with less and less of a response. Two things the new neuro told me, one was “Cut out most of the caffeine in your diet 200 mg tops a day or the equivalent of ONE cup of brewed coffee. And take 200 mg twice a day of Vit B-2 or Riboflavin. Well, I had already cut out the caffeine, and it didn’t do much for my headaches. And I have tried everything else, so the B-2 couldn’t hurt, I thought. Five weeks later, and I am virtually headache free. Certainly, when I do feel the prodrome of a migraine, if I take an imitrex it never has turned into a full blown attack since the Vit B addition. Wishing you well, Pam PS I am your age, so there is hope even for us old crones!

  18. Actually 3.5 million people in Britain take anti-depressants, not mere thousands, and the meta-analysis you quoted of all 47 clinical trials, published and unpublished, submitted to the Food and Drug Administration in the US, showed the drugs were effective only in a very small group of the most extremely depressed.

    Not only that but the same study showed the drugs produced a “very small” improvement compared with placebo of two points on the 51-point Hamilton depression scale.

    This is NOT what I consider an effective drug and not what anyone who is depressed wants to be told about a drug with some outrageous side effects, when they want something that will actually help them feel and function better. 2 points on the depression scale is disgustingly little, and not worth taking such dangerous and side-effect-ridden pills for, esp when said pills carry the side effects of INCREASING suicidal feelings.

    Forgive me, but I agree serious depression might be considered an unwanted emotional condition, and too many garden variety sad people call themselves “depressed” for my taste, but just because you call something an illness doesn’t mean that drugs the pharmaceutical companies have labelled anti-depressant actually function that way. Ditto by the way for those atrocities called antipsychotic medications, which are and always were behavioral modification drugs, subduing patients into manageability but were NEVER anti-schiziophrenic and still are not. Calling something by a different name does not change its nature.

  19. To Pamela Spiro Wagner:
    I already limit my caffeine intake – we almost always drink decaff coffee and I don’t drink much tea. I never drink cola. Interested about the B2, but what I am wondering is if this is a well-recognised remedy by your doctor, why isn’t it better known and publicised? I take a multivitamin tablet daily, so I assume I get sufficient B2 from that and in my diet, but who knows, maybe it’s not being absorbed properly. I’m willing to try (almost!) anything!

    • Here is an abstract of research found at PubMed. My neurologist was the one who suggested it, but i did check it out before i took it. I think the problem is, as always, that pharmaceutical companies cannot patent riboflavin nor make money from it, so they have no wish to make this apparently effective preventive strategy well-publicized. Definitely, the amount found in a once a day tablet is nowhere near enough for migraine prevention. I take 400mg per day. And i still drink coffee once in a while. But i limit it to 200mg a day. I figure since i have narcolepsy and must take some ritalin to stay awake, there was something silly about restricting ALLcaffeine in my case, as it is at times more effective in promoting wakefulness than the more toxic ritalin…but i am still very careful. One good thing about B vitamins is that you can not overdose as they are water soluble and you tend to simply pee them away daily…good luck! I hope you find some relief. I did not think it would work for me, and went ahead to make an appointment with another neurologist for a second opinion. But after two months and a really significant reduction in headache frequency, i am convinced that riboflavin is effective!

      Eur J Neurol. 2004 Jul;11(7):475-7.
      High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care centre.
      Boehnke C1, Reuter U, Flach U, Schuh-Hofer S, Einhäupl KM, Arnold G.
      Author information

      Abstract
      The aim of this study was to investigate the efficacy of riboflavin for the prevention of migraine. An open label study was performed in a specialized outpatient clinic. Patients received 400 mg riboflavin capsules per day. Headache frequency, duration, intensity and the use of abortive drugs were recorded at baseline and 3 and 6 months after treatment. Headache frequency was significantly reduced from 4 days/month at baseline to 2 days/month after 3 and 6 months (P < 0.05). The use of abortive drugs decreased from 7 units/month to 4.5 units/month after 3 and 6 months of treatment (P < 0.05). In contrast, headache hours and headache intensity did not change significantly. We could demonstrate a significant reduction of headache frequency following riboflavin treatment. In addition, the number of abortive anti-migraine tablets was reduced. In line with previous studies our findings show that riboflavin is a safe and well-tolerated alternative in migraine prophylaxis.
      PMID: 15257686 [PubMed - indexed for MEDLINE]

  20. I have been on anti-depressants for nearly five months, and they have transformed my life. I feel that, in this period, the real “me” – the person I was created to be – has emerged in a sustained way for the first time in my 56 years: someone who is positive, energetic, full of vigour and purpose, considerably less stressed, calmer and more peaceful (and no longer depressed!). I have regained a belief that I can lose weight, joined Weight Watchers and have lost a good amount of weight so far and am determined to get to my goal. I have increased my exercise programme and have reached an intermediate pilates level and am looking to get to the advanced level later this year. There are days when I feel quite radiant. For this reason, I call them my “happy pills” :), and I hope the good effects last forever!! :) I feel deep sympathy for people who have not been able to overcome depression, and hope that, at some time in the future, you will be able to do so.

  21. alex says:

    As a psychiatrist you aren’t naive so why appear so? The press love to create a stink, attacking various groups as immoral, corrupt or scandalous without any regard for the truth. They aren’t interested in truth.
    Yes I know some elements in society want to engage in narcissism by ‘exposing’ the ‘negative character and poor attitude’ of those who take antidepressants, hoping that it shows they have all the opposite qualities and they will receive all the accolades. Well, well done!

  22. Jupiter says:

    I’ve just read this and have been deliberating whether to leave a comment. But I feel I must raise awareness in every way I can. If I can prevent anyone from going through what I am then I will. Anti depressants can really help some but they can wreak havoc in others. I wish a test could be available to show whether an antidepressant would suit a person or not. Eg, a person with particular genes may react badly.

    I was prescribed citalopram 20mg last year for anxiety and my life has been continual torture ever since. This is not an exaggeration. I don’t get any relief at all. I reacted terribly and got akathisia and all sorts. I came off the drug and was urged to go on sertraline and quetiapine. I didn’t want to but was so caught up in the medical team then I felt I had no choice. The new drugs made me even worse and I was begging to be helped off the drugs. I was continually told to take my ‘therapeutic’ dose and was not believed. I was diagnosed with ‘agitated depression’, a condition I never had before I took the pills. It was not agitated depression, it was akathisia. The entire time I was on the drugs, I felt suicidal.

    I took myself gradually off the drugs and hoped to feel better. Now, on top of all I’ve been through (I haven’t told you the half of it), I have severe withdrawal syndrome which is still going on 9 weeks after stopping the drugs and the symptoms are horrific. Brain zaps every few seconds is just one of a host of them. I still have akathisia. I didn’t know you needed to withdraw from the drugs extremely slowly. I came off them over weeks because I was reacting so severely, and hadn’t been on them long.

    Naturally I never want to touch another psych drug again and if I hadn’t, I would have a life now. Now I can’t function. I don’t know if I will recover. I know the psych team will want to push more drugs on me but it’s very clear I can’t tolerate them. My best chance of recovery is to steer clear of all ‘meds’ and hope my chemically induced brain injury heals.

    My story is not unique. So many have suffered as I have and are continuing to suffer. It’s all over the internet. Many have spent years on drug cocktails, none of which helped them. These drugs made them far, far worse. Only in moving away from these drugs do people eventually feel better.

    I hope I haven’t offended anyone with my post (I’ve held back on the details). I know anti depressants do help people and many swear by them. But for some people, they can be devastating. I was told ssris were safe. I was also told that I shouldn’t read the side effects before taking them as, because I was anxious, I would imagine I had them all. So I didn’t educate myself before taking them. More fool me.

    30 years ago, benzos were considered safe too. In time, the truth will out about ssris and snris. Too many people lose lives because of these drugs.

    • Cooper Moll says:

      I have chronic spinal and lower body pain including high level pelvic enthesitis after fractures, followed by fusion and much remedial therapy I now live on pain relief med’s (over 15 years so far). But, every time the Dr. asks me to try something new, I discuss and agree eventually to start with a much lower than recommended dose rate. Sometimes I have found good relief at a much lower level than prescribed e.g. 25% in some cases.
      I am a continuing student (and practicing) Psych. Counsellor and Life Coach. Which I am sure would not be possible if I had always accepted the pharmacologists recommended dose rate for the different drugs.
      I am very interested in BP as I have a number of friends with such issues, it will always be my belief that medications are only as good as the method of usage and the patients nature (after Jupiter’s comment) their genetic makeup.
      Try to stay focused and keep interested in other good things about your life,
      best wishes, Cooper

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