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Priya’s pills

28/07/2017

antidepressantsPriya Khaira-Hanks loves her pills. She wants you to love them too. Or at least look kindly upon her chemical romance.

Perhaps Priya is uncomfortable with the bad press her drug of choice has been getting lately, so she’s written a column for the Guardian to offer her own point of view. She calls herself a pusher, though she makes no money from it. When vulnerable young people talk to her about their emotional distress she’s quick to “sing the praises of selective serotonin reuptake inhibitors (SSRIs)”, though she concedes they’ve increased her risk of developing diabetes and can have other side-effects. Strangely she’s confident she has suffered no such effects in the five years she’s been taking them, though I’m not sure how she’s setting a baseline for comparison.

I’m not about to deny Ms Khaira-Hanks has benefited from SSRIs. I’m not her. I don’t know her. I wouldn’t know. Just because research shows antidepressants offer no clinically significant benefit over placebos for the vast majority of users it doesn’t mean they don’t work for her. Not that the placebo effect on mood disorders is anything to sneeze at either. It’s far more powerful than pills, counselling or CBT. And maybe Priya’s been lucky enough to avoid the life changing side-effects of antidepressants, such as the sexual problems that afflict most SSRI users and don’t always subside when the drugs are discontinued. She’s been on them since she was 16 so she may not even notice.

Priya shows considerable insight in equating her self-medication with her peers’ use of alcohol, caffeine and tobacco. She’s fantasised the glass of water she uses to wash down her pills is vodka. You’ve got to wonder whether the Guardian would have given a column to someone who advocates gin and cigarettes as coping mechanisms though. When it first emerged that SSRIs increase suicidality among under 25s the Guardian’s Sarah Boseley was at the forefront of reporting the evidence. But the research and subsequent black-box warnings failed to change prescribing practices and Priya is only one of the many thousands of young people who were still given the pills despite the danger. There’s nothing in her column to indicate she even knows about it. Perhaps because publications like the Guardian have failed to give prominence to subsequent studies confirming increased suicidality on SSRIs affects all ages, preferring anecdotal articles by antidepressant enthusiasts such as Stephen Fry, John Crace and Priya Khaira-Hanks.

Priya is also confident the pharmaceutical quality medication she gets from Boots is safer than scoring pills at a rave. That’s probably true. But prescription medications kill far more people than street drugs. According to Professor Peter Gøtzsche of the Nordic Cochrane Collaboration they’re now Britain’s third leading cause of death, mostly because so many people take them. Buying drugs from a pharmacist doesn’t make them safe or effective.

Where Priya’s insight fails her is in understanding what happened when she quit her pills cold turkey. “My mood swung to the worst it had ever been and I struggled with fits of anger (something that I’d never encountered, even in the bout of severe depression when I was 16 that resulted in me being put on citalopram in the first place)”. Someone who has tried to give up nicotine or opioids could have told her what was happening, as could anyone who had looked up SSRI withdrawal symptoms. But to her it was apparent she was suffering serious mental illness. She was soon “back on the pills and feeling much better”, thankful they offered her the means to “stay sane in a stressful world”.

Physical dependence is just one pitfall of coping with life through drugs. There are more insidious dangers to medicating your blues away.

Despite using heroin heavily for an extended period I found it relatively easy to quit. OK, it took a few tries and I eventually had to move to a new area and turn my back on most of my friends, but after a few weeks drying out the cravings became steadily less frequent and more manageable. Over thirty years later I still sometimes dream of hitting up and wake up feeling nostalgic for my junkie daze, but I’ve never been in serious danger of relapsing.

Many I knew found it much harder to give up smack. My girlfriend for instance. She started using heroin at about the same age Priya started on antidepressants and had been using it for just as long. She was able get through much of her adolescent angst without needing to develop the coping strategies the rest of us come to rely on. She already had something that worked quickly and without fail. A bit more effective than SSRIs I’d wager.

She could deal with physical withdrawal at least as well as I could. She’d had plenty of practice. But whenever life turned around and bit her she ran straight back to the needle. It was all she knew. When I walked away from heroin I walked away from her too. She was much harder to get over than the drug. About five years later I learned her medicine had finally killed her. She was 28.

I hope Priya hasn’t fallen into the same trap. I hope her pills haven’t cheated her of the life experiences that turn adolescents into adults. I hope she won’t be on chemical crutches forever. That she won’t always need to rely on “a pill that helps me keep my life on track”.

Maybe if she tries a carefully planned and managed withdrawal she will eventually discover she isn’t depressed at all. That, like so many of us, she went through some difficult teenage years but now the situation has changed and she’s developed a bit more resilience and personal power. That she’s not sick, just human.

Perhaps someday Priya will stop blaming herself and thinking she needs drugs to “seize control of [her] own unruly brain and feel in charge of [her] own actions”. Maybe she’ll stop trying to fix what isn’t broken and instead work towards bringing a bit of sanity to an insane world.

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