Therapy alone is often not enough. I, as a patient, told this to a debate between psychiatrists on mental health treatment, but it mostly fell on deaf earsAfter over a year working in Westminster as this paper’s parliamentary sketchwriter, I thought I had learned a thing or two about bearpits. That was before I agreed to second Prof Allan Young in speaking against the motion that “This House believes that the long-term use of psychiatric medications is causing more harm than good”. It turned out that politicians are almost models of decency compared to psychiatrists fighting their own corner.
I had wondered why I had been invited. I have no scientific knowledge of the subject under discussion; all I had to offer was my own personal experience of living with episodes of depression and acute anxiety for more than 20 years. For me, a combination of medication and therapy has proved effective; not so effective as to prevent recurrences of these mental health problems all together, but effective enough for me to have managed them without having to return as an in-patient at the psychiatric hospital I wound up in 20 years earlier. I could perhaps have done more to look after myself, I suppose. I could have given up my Spurs season ticket. But apart from that …
Having raised concerns about my credentials, I was assured that it was important to have a patient’s voice heard. I thought so, too. So I agreed. But on the way home from the debate last night, I did wonder if the reason I had been asked was because everyone else had turned them down. Things didn’t get off to a great start, when there was a pre-debate vote in the packed theatre at King’s College’s Institute of Psychiatry, Psychology and Neuroscience, which had apparently sold out within hours of the tickets being made available in March. 126 people – a mixture of mental health practitioners, students and members of the public – believed the motion to be correct; 28 abstained, and only 64 were on my side.
The debate was opened by Prof Sami Timimi, who concentrated on the data before taking a quick swipe at me. “I don’t think anecdotal evidence is very helpful,” he said. Thanks for that, prof. I won’t be seeing you next time I’m in crisis. Young made what sounded to me like the reasoned response. Drugs are imperfect in all areas of medicine, but the science is improving and the data clearly shows that more people have benefited than have been harmed. Then came Prof Peter Gøtzsche. Apologies to him if I have misunderstood his argument, but what I took from his argument was that psychiatrists do more harm than good to most of their patients. Worse than that, the use of psychiatric drugs has caused hundreds of thousands of premature deaths every year. Psychotropic drugs were one of the greatest known evils, a construct of big pharma’s insatiable greed to make money.
I’m no great fan of big pharma – all my meds are strictly generic – but this just seemed absurd. Was I missing something? Had psychiatry got us nowhere in the past 100 years, would we be better off leaving all mental health patients untreated apart from a few sessions of cognitive behavioural therapy? Or was he just using hyperbole to suggest that patients are better coming off medication as soon as possible. In which case it was a bit like saying stop taking ibuprofen when your headache goes away. A statement of the obvious.
Then it was my turn. I said what I always say when talking about mental health issues. Most mental health patients may be ill, but they aren’t stupid. Allow them to make their own informed choices. Obviously there will be grey areas, such as patients in crisis who are sectioned and therefore have no choice, but for those of us in a position to make decisions, let us make them. Nobody chooses to go on anti-depressants or other psychotropic drugs as a lifestyle choice. We do so because we are desperate. I had been in therapy for 10 years before my first depressive episode. I remain in therapy still. And I find it beneficial. But sometimes it’s not enough.
Nor have the psychiatrists I have seen been careless in their warning about the possible side effects. Before I was first prescribed fluoxetine I was warned it didn’t work on all patients, that in some cases it made them feel suicidal. But every psychiatrist promised to monitor my progress and change or stop medication if I started feeling worse. They were as good as their word. I wasn’t too bothered about the side effects. At the time I was feeling desperate and I felt I had exhausted all other possibilities. It didn’t seem possible to feel any worse than I already did.
Over the years my psychiatrist, therapist and I have tried to manage my condition as best as possible. We haven’t always agreed, but we’ve come up with a modus vivendi. Initially I would stop taking fluoxetine several months after the depression had lifted. Often I would then be fine for a year, but when the depression returned it felt more acute. So now we have reached a situation whereby I maintain a constant low dose of fluoxetine on a daily basis and increase in times of depressive crisis. It’s not ideal, but it’s the best we can come up with. And the depressive episodes have been more manageable as a result.
After I spoke, the bearpit became a free-for-all, with contributions from the floor. Some were moving, most were ad hominem insults. Just a few were helpful. It was pointed out that four highly respected Cochrane editors had cast significant doubt on Gøtzsche’s methodology and results (Gøtzsche himself had earlier made much of his own status as a Cochrane author). Young handed Gøtzsche their comments. Gøtzsche got extremely cross and threw them on the ground without looking at them. It was that kind of night.
Come the end, there was another vote. There were now 136 people in favour of the motion, 34 abstentions and 66 against. Every side had increased its vote within the audience. Clearly there’s still a lot I don’t understand about statistical analysis. I made my excuses and left, making a mental note to myself to stick with the mental health professionals I know. And to keep taking the meds.
'Before I was first prescribed fluoxetine I was warned it didn’t work on all patients.' Photograph: Joe Raedle/Getty Images