Earlier this year, a study came out suggesting that SSRIs — selective serotonin reuptake inhibitors, the most commonly prescribed form of antidepressants — can cause “emotional blunting.” Those of us on Twitter who take mental health medication knew exactly what would come after. My feed quickly filled up with “hot takes” on how this was further proof that antidepressants ruined your life and stole your personality, how exercise and fresh air were the only real antidepressants you needed, and how Big Pharma was just trying to prescribe us all to death. I’ve read and heard takes like this all my life, and still — despite over a decade of antidepressants transforming my mental health, despite the countless other treatment methods I’ve tried — it’s hard not to feel affected. In the face of hundreds of strangers telling me that medication is my “crutch,” that I would feel better if I just picked up running, I struggle to remember that my personal life experience proves those opinions wrong.
The most recent national survey on antidepressant use in America found that, between 2015 and 2018, 13.8 percent of American adults took some form of antidepressant medication: that’s over 1 in 8 people, and that number only went up during the pandemic. Despite this staggering prevalence, the stigma attached to mental health medication is still alive and well — and dangerous. Every day, the stigma convinces people who have gotten lifesaving help from mental health medication that they would be better off without it, and it doesn’t just come from strangers on Twitter: it comes from family, friends, and even therapists. I expected things to improve in my lifetime, but the all-encompassing wellness and self-care industry that’s spent the past decade swinging into view has ushered in a renaissance of people claiming that antidepressants are just too unnatural to really be good for you, and, given how much these opinions make me doubt myself, I’m concerned for everyone out there in my position.
I suffer from major depressive disorder, and I’ve gone off my antidepressant medication multiple times in the last decade. Not because it wasn’t working, but because I went into periods of intense anxiety that I would never be able to quit it entirely, that my depression wasn’t really cured if stopping my medicine made it come back, or that I was “reliant” on too many things to get me through my day. On one occasion when I went back on my antidepressant, I quit coffee as a kind of peace offering to that inner critic: There. One less substance that I required daily.
When I go off my antidepressants, I’m doing absolutely every that anti-medication people recommend and then some. I resent having to list it all out, but in short, I am exercising, eating whole foods, taking mood-boosting supplements, getting daily sunlight, meditating, going to therapy, journaling, sleeping eight hours, practicing gratitude, and spending time with loved ones. It’s like trying to stop a flood with the palm of my hand. All of those things may be good for one’s mental health, but when it comes to certain forms of mental illness, they are not adequate treatment.
Anti-antidepressant people will argue that medication is a quick fix for problems only “real work” will solve, ignoring the fact that many, many people with mental illness have tried to do that work and found it insufficient. As a self-proclaimed “rogue therapist” recently wrote on Twitter, “SSRIs don’t replace meaningful relationships, nutrition, exercise, sunlight, fulfilling hobbies, valuable work, meditation…SSRI or no SSRI, you have to do the real work yourself.” I recently saw a new mental health provider who echoed the same stance: “Medication is a Band-Aid,” she told me. “Therapy is where the real work happens.”
When I’m faced with language like this, I have to actively remind myself that I’ve done all of that real work — and, for me, it still wasn’t enough to keep my depression at bay. I struggle not to feel like if I’d only worked harder, maybe exercised three times a day instead of two, or meditated for an hour daily, I might have been able to do it. But that kind of thinking gets me nowhere: or, more precisely, it gets me off my meds and spending six hours a day on the self-care necessary for me not to want to kill myself, and even then, it’s often not enough.
Dr. Kyle Elliott, founder and career coach at CaffeinatedKyle.com and a speaker coach with The Stability Network, has experienced similar offhand stigma about his mental health medication, and admits that it gets to him even though he knows he’s a conscientious person who takes good care of his health.
After a panic attack resulted in paramedics being dispatched, one of the responders commented that Elliott was taking an awful lot of medication.
“I thought I was experiencing a heart attack,” Elliott explains of his panic attack. “When asking for my medical history, one of the emergency responders made a comment about the number of medications I was taking. Although I am a proud and confident advocate for myself and my mental health, it still stung to hear this from a medical professional.”
It is often in our most vulnerable moments, when we’re actively seeking help, that patients like Elliott and myself will be hit with this stigma, the sudden suggestion that maybe, instead of all this medication, we ought to try actually doing something about our conditions. But no one I know rolled out of bed one day and thought, hey, I might like to take some brain medicine. While medication may in some instances be too casually prescribed, everyone I personally know who takes mental health medication does so precisely because they’re so invested in taking care of their mental health — like Elliott, who only came to be prescribed medication precisely because he had carefully pursued different avenues of care over the years.
“I meet regularly with my doctor to check in on my anxiety, as well as my overall mental health,” Elliott notes. “I also see a therapist as well as a spiritual director.”
So, what can we tell ourselves and others in the face of continued stigma suggesting that medication is just a lazy way out, or a failure to prescribe to appropriate self-care routines?
Dr. David Feifel, a doctor and professor of psychiatry at UC-San Diego, sees patients affected by this stigma all the time — patients who, like me, will want to get off their medication solely so they won’t be reliant on it. But he notes that, within the medical profession, depression and other mental illnesses are understood as chronic brain disorders, and compares the use of medication to combatting diabetes with insulin.
“Your internal medicine doctor wouldn’t say, ‘well, you really need to get off this insulin, you’re not really treating your diabetes,” says Feifel, who is also the founder of the Kadima Neuropsychiatry Institute, an advanced treatment center for people with treatment-resistant depression and anxiety. He believes that the same logic should be at play when looking at medication for mental illness.
Some people will be on board with antidepressants in the short term, but balk at the idea of someone taking them long-term. There, the stigma dictates that mental health medication is a “crutch” to be used only on a temporary basis, and until real coping skills can be acquired. Short-term use of mental health medication may be appropriate for some people, Feifel explains, but for those who experience a recurrence of symptoms upon stopping, the medical recommendation is to stay on that medicine long-term — just like people with diabetes keep taking insulin.
“If you relapse, which is often the case with depression, then you really should go on them and stay on them for years even if you’re doing better,” Feifel explains, “because you know that you need them…it keeps [your] brain chemistry such that [you] stay out of it, or at least it’s lessened.”
When it comes to finding a treatment plan that works for you, it’s best to consider all the available options — including medication, therapy, and the lifestyle changes recommended by fervent anti-antidepressant folks. But to consider only some of those treatments valid sets patients up for failure. According to Feifel, most doctors consider a combination of therapy and medication to be the best treatment plan for disorders like depression, anxiety, or obsessive-compulsive disorder. But in figuring out what works for you, it’s the outcome that matter most: Not what someone on Instagram or your parent or a life coach has to say about it.
“At the end of the day, it’s the results,” Feifel says — and by results, he means actual, visible results in your brain chemistry.
“We actually know that being in a state of depression is more harmful for the brain than any kind of these treatments. It actually produces changes in the brain if you have chronic anxiety, chronic depression — we see atrophy of brain areas. When they’re on the antidepressants, we don’t see that.”
Feifel further explains how you can literally see this change in brain activity take place. It doesn’t come down to serotonin, as many used to think it did, but scientists are now looking at the brain chemical BDNF, brain-derived neurotrophic factor, as an indicator of how depression works and can be treated.
“In depression, BDNF goes down,” says Feifel. “But when they’re on the antidepressants, BDNF goes back up.”
BDNF is “almost like the brain’s own fertilizer,” per Feifel, and plays an important role in neuroplasticity: “the ability of the brain to change and maintain its health.” When a patient is on medication that brings their BDNF up, things like therapy, exercise, and sunlight are actually able to affect the brain at a much greater scale than they could if BDNF levels were low, and neuroplasticity was compromised. Without medication, some patients might never get to a place where other treatments could take effect at all. And for some patients, stopping medication will always mean that their brains return to a place where other treatments aren’t as effective, no matter how fiercely they might pursue them. It’s not a personal failure to not be able to run your way out of depression — it is simply an inability of certain brains to keep themselves running optimally without chemical intervention.
At the end of the day, the internet will always be full of creative ways for people to feel bad about themselves, whether or not they suffer from mental health disorders. But for those of us who take mental health medication, that sting of comparison can take on a more serious tone and start to convince us that the very thing that helps us most is actually standing in our way. In researching this article, I came across so many strongly-held opinions about all the things I should “just” do if I want to actually feel good, and I felt the same frenzy I’ve felt so many times before take hold of my brain — what if I never really did it right? I wonder. What if I could get it right this time, and feel the boundless joy and overflowing energy these people talk about? What if they’re right?
But they’re not right; they’re advertising. They’re talking about themselves, or talking about two people who they know, and they’re not talking about me. I alone know what these wellness routines would get me. I know that I am never one low-carb diet away from a brand-new body, I am never one skincare routine away from reversing my wrinkles, and I am never one exercise routine away from curing my depression — if I were, surely Michael Phelps would never have struggled with his own.
I remind myself what Feifel said — it’s the results that matter, and nothing else — and I remind myself that I love the results I get from my antidepressant. If that ever changes, my medication can change too, but until then, I won’t change my treatment plan because someone else doesn’t like the idea of it. When studies come out showing new side effects from antidepressants and the world buzzes up about how awful they all are, ask yourself if those side effects are an issue for you. And if they’re not, move on with your day. The rest has nothing to do with you.
Before you go, check out the mental health apps we swear by for a little extra brain TLC:
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