The Guardian journalist Deborah Orr began taking antidepressants this week but only after a year of psychotherapy
Most people know about SSRIs, the antidepressant drugs that stop the brain from re-absorbing too much of the serotonin we produce, to regulate mood, anxiety and happiness. And a lot of people know about these drugs first hand, for the simple reason that they have used them. Last year, according to NHS Digital, no fewer than 64.7m antidepressant prescriptions were given in England alone. In a decade, the number of prescriptions has doubled.
On Tuesday I joined the throng, and popped my first Citalopram. It was quite a thing not least because, like an idiot, I dropped my pill about 90 minutes before curtain up for the Royal Shakespeare Companys production of The Tempest at the Barbican. Thats right. This isnt just mental illness: this is metropolitan-elite mental illness. It was a pretty overwhelming theatrical experience.
The first indication that something was up came as I approached my local tube station. I noticed that I was in a state of extreme dissociation, walking along looking as though I was entirely present in the world yet feeling completely detached from it. I had drifted into total mental autopilot.
Luckily, I was able to recognise my fugue. Its a symptom of my condition, which, as Ive written before, is complex post-traumatic stress disorder. The drug-induced dissociation was more intense than Im used to when its happening naturally. I use the word advisedly. Much of what is thought of as illness is actually an extreme and sensible protective reaction to unbearable interventions from outside the self.
Because Ive been in very good psychotherapy for about a year now, Ive learned to identify times of dissociation, and ground myself. Hitting myself in the centre of the chest works best for me, especially now that Ive stopped wearing the necklace I used to thump into my breastbone. Of course, you look like a bit of a prat, striding about banging your chest, but there you are. The one thing that makes you feel normal is the one thing that alerts others to the fact that something weirds going on.
Ive been resisting dissociation for pretty much every minute Ive been on the drug since then. Being in good company helps most, and being in parks, fields, gardens and nature. You have to keep busy. The leaflet that came with the drug, which I read thoroughly before starting the course, does warn that in the first few days you might find that the symptoms youre trying to escape come back more strongly. Unfortunately, I tend to dissociate in order to avoid having panic attacks. So, as I get better at managing the dissociation, the panic attacks surge. Its like playing symptom whack-a-mole, except that youre whacking bits of your psyche, as well as your chest.
I spent pretty much all of Thursday in one long low-level panic attack keeping busy, telling no one. I didnt want to mention it, because that would make it worse. At one point, in the park with my brother, he insisted, randomly, that I walk up the hill to the bus stop instead of down it, like I wanted to, in the heat. By the time I got to the bus stop, my legs were barely working, and I was in the grip of convulsive shudders.
I go along with things I dont want to do, things that ignore my wants and needs, then hate myself for my compliance. The little examples, such as this one, reawaken my feelings about the huge ones. I was bullied a lot as a child, and my parents were needlessly strict and deludedly all-knowing. Its grown into a major cognitive dissonance. I loathe being bullied or bossed about, yet at the same time it feels so familiar and comfortable that Im complying before I even know it, eager to please people who cant be pleased.
Then I feel full of resentment and anger against the perpetrator of the control so much so that it becomes overwhelming, and my mind and body rebel. I literally shake the feelings out. Its the reason why I recently began to seek NHS psychiatric help, on top of private psychotherapeutic help. A couple of interventions of epic proportions have recently been perpetrated against me. They have left me so poleaxed that Im unable to assert myself enough to walk downhill.
A breakthrough occurred, though. I was able to tell my brother, calmly, what was happening to me and why. He kissed me on the cheek. He never does that.
Why am I writing this down for publication? Practically, its because these powerful drugs arrived with so little guidance about what to expect. An NHS case-worker Id been interviewed by once not a doctor called my GPs practice and arranged for a prescription to be written by a GP Id had nothing to do with. I was told on the phone what the prescription was, and that it was waiting for me to pick up from the local pharmacy. I wasnt consulted about the drug I was being offered at all, although I had said that I wanted to try an antidepressant. Ill meet a different GP and the case-worker in two weeks time.
The process has taken about five weeks, and has been circular. In crisis at the end of May, I asked my GP practice for help and was told to go to A&E instead. I didnt react well, and left upset and furious. Returning a few days later, I said that I would prefer a less dramatic referral to mental health services than A&E, which is how I met the case-worker. Then, back to the GP practice and that remotely dispatched prescription. Which is not to blame the practice. The whole system is itself in crisis mode all the time. Which is particularly bad, obviously, for people with mental health problems.
There is soaring demand for NHS mental health services. Some 80% of bosses of NHS trusts surveyed by the trade organisation, NHS Providers, have expressed worries that they have too little budget to provide timely, high-quality care. Thats so dangerous. I absolutely needed a year of psychotherapy before I started taking this drug. At the start of the therapy, I had become emotionally numb, unable even to weep. I wouldnt have had the insight to understand what this drug was doing to me, let alone control it or explain it to others when I couldnt.
I might never even have got the diagnosis that helps me so much to make sense of my entire life, because that took months. All I can do, apart from look after myself and my kids, is speak out about how complex is the task of managing a mental health condition. Theres so very, very much more to it than popping pills.
- Comments on this article are premoderated