HOW DID NHS ENGLAND GET IT SO WRONG?
As an inveterate campaigner for mental health issues – in particular, for mental and physical health to be given parity of esteem, as promised in the NHS Constitution – it is always gratifying to see positive action being taken.
So it was with interest that I read of NHS England’s plan to help patients come off antidepressants, as well as set up a support network to help people manage withdrawal symptoms and find alternative succour. It’s not an unreasonable goal. When as many as 8.4 million adults in England have been prescribed antidepressants in the past year, to question whether it might be better to look at root causes rather than throwing pills at the problem is not just sensible, it’s overdue.
But then I read further. The plan is to help people come off antidepressants ‘and painkillers under an NHS drive to tackle addiction to prescription pills… [It] aims to avoid a US-style opioid crisis [and] recommends that patients be sent to art, music or gardening classes.’ At which point I fell off my painting stool and crushed my ukulele.
Where to start? First, the equation of a reliance on antidepressants with a dependence on opioids is at best boorish, at worst fatuous. The opioid epidemic is one of the worst public health disasters affecting the USA and Canada. As many as 600,000 people have died from opioid overdoses in these countries and the figure is rapidly rising. Opioids reduce pain, boost pleasure and often become highly addictive. This is not how antidepressants work. Indeed, the point is we don’t really know how – or if – they work. This is in itself a legitimate reason for caution and research, but to correlate the two just clouds matters further.
As someone who has used antidepressants, has come off antidepressants both successfully and unsuccessfully in the past, and is currently on antidepressants, I can testify to their uses and limitations. I have never felt a euphoric effect, though I have come to view them as virtual water wings. They keep me afloat and prop me up just enough to go about my business with agency. I certainly know it when I go without for a length of time, though I also know this is my own damn fault and that withdrawal is practicable if I do it sensibly.
I’ve never found myself jonesing for an SSRI fix. Though I certainly have craved therapeutic counsel at times and this isn’t always easy to come by. I fully understand the concern that GPs might be doling out pills indiscriminately and irresponsibly when a considered course of psychotherapy and medication is the more sensible option. But often the reason GPs reach for the prescription pad so readily is because the waiting time for therapeutic appointments is so long when the demands are urgent.
