(Trigger warning: Mention of suicide, depression. If you feel suicidal or know someone in distress, please reach out to them with kindness and call these numbers of local emergency services, helplines, and mental health NGOs.)
The World Health Organization (WHO) considers depression to be the leading cause of disability worldwide, and an estimated 5 percent of adults suffer from depression.
The COVID-19 pandemic has also ushered in a number of triggers. Those who never experienced depression are facing it for the first time. Others who were already suffering are reaching new breaking points.
Around 280 million people worldwide have depression, and this is just the tip of the iceberg. It's this common.
Talk therapy, maybe. But people are suspicious of taking medication to help manage it.
What keeps us from taking medication?
Rumours that they are addictive, notoriously alter your brain's chemistry, that bad side effects are inevitable, sap sexual desire forever, turn you into a numb zombie – fuel the fear, reluctance and false narratives we tell about medication and mental illnesses.
What’s Stopping People From Taking Antidepressants?
Anoushka has been diagnosed with generalised anxiety disorder and social anxiety, but says she is apprehensive about taking medication.
"For one, I feared dependency and side effects. Secondly, medicines don't cure anxiety, they only help manage it. I wanted to give therapy and other non-medical ways of managing my anxiety before I resort to medicine," she says.
"It also didn't help that the psychiatrist prescribed the medicines after just one half an hour phone call with me," she adds.
Shreya experiences suicidal tendencies during PMS (Premenstrual syndrome), but says she never really wanted to take allopathic anxiety medicines even though she felt like "the worst weight was upon her."
"I’ve heard they mess with your brain. I've had friends who take them. They’ve helped them, but also screwed them up in some way," she says.
Shreya, who has borderline anxiety, takes Ayurvedic medicine since she considers them to be a much healthier option. Therapy has also helped manage her anxiety as opposed to taking medication.
Myths Surrounding Your Antidepressants
But the reality of antidepressants is far more complex than most seem to think.
The myths at the patient level, society level, doctor level and family level can act as huge barriers for treatment.
There is misconception that every psychiatric illness is depression, says Dr Ashish Kumar Mittal, Consultant Psychiatrist at Columbia Asia Hospital.
"It may be schizophrenia, psychosis, BPD, social anxiety, OCD, etc. Many psychiatric illnesses require long-term treatment. So, people think depression needs long-term treatment," Dr Mittal says.
People think depression treatment is lifelong, it's not.
At the society level, there could be stigma which stops people from seeking treatment.
Doctors' perception about psychiatric illnesses also plays a vital role.
"Doctors who are not psychiatrists are not aware about psychiatric illnesses. They may create fear in the patients and sometimes, misdiagnose patients, don’t treat them the right way which leads to bad outcomes which in turn leads to fear," Dr Mittal says.
A regular physician might start with a higher dosage, while medication should be started with low dosage. This might result in side effects and in turn aversion among patients.
In some cases, there could be lack of family support. You could be stuck in a negative loop of emotions that you can't brush aside, but a family member might tell you to "think positively" or "to be strong" or "see the bright side of things."
"My mum, dad have also been vary of medication and told me to avoid it...Somehow the idea of it really threw me off," Shreya says.
Although well-intentioned, a person cannot simply decide to stop feeling depressed. "It’s like asking a diabetic patient to think positive to cure diabetes. This creates barrier in treatment too," says Dr Mittal.
Not Your Average Pill
While some people felt that they should be able to deal with depression without medical help, others used them as the last resort or weighed their perceived benefits against fears of side effects.
Kartik was diagnosed with anxiety three years ago, but has largely tried to manage it with therapy.
About a month ago, he had a latent anxiety episode, and went to the hospital where he was prescribed some anti-anxiety medicines.
"I don’t take them regularly," he says since he experiences drowsiness.
It's true that these antidepressants have side effects, but these are manageable and reversible in most cases, Dr Mittal says.
SSRIs are the most common antidepressants and also seem to have the mildest side effects.
Most common side effects in the initial days of the treatment include nausea, vomiting, acidity, dizziness, which subside after 3-4 days, Dr Mittal says.
"Some people also develop sexual side effects like prolonged ejaculation, lack of orgasm, lack of sexual desire. Others may develop weight gain."
But these vary from person to person and it's not a given that everyone experiences these side effects.
"They are reversible. You need to modify the dose or change the treatment," Dr Mittal adds.
Pallavi takes two antidepressants, one anti-anxiety medication/ sleeping pill and one SOS medication for panic attacks.
She experienced some side effects, but says they were nothing she could not handle or nothing worse than her actual mental health condition.
There are some studies regarding the risk of suicides, but it is only during the initial days of treatment, usually among those with severe depression, Dr Mittal says.
So, Are Antidepressants Really Useful?
"Yes, medication has definitely helped me. I think of it as supplementary to therapy," Pallavi says.
"The whole point of medication is to take off the edge so that I can work on my issues in therapy. Medication is not a cure-all. It’s something that’s supposed to go side by side with therapy," she says.
"The same way when you break your leg, they give the pain medication to take the edge off. But you need go to physical therapy to have a functioning walk again. It’s the same with mental health."
Pallavi is right. Mental health is no different from physical health. You could definitely go to therapy, change your lifestyle and try a multitude of things. But again, you can't manage your diabetes with some change in your diet or exercise safely to not trigger your asthma. You may need some medical intervention that will help you in the long run.
The intervention depends on the extent of depression. "Psychotherapy or counselling is enough for mild depression. For moderate to severe cases, you need to give medicines," Dr Mittal says.
There's also no such thing as one size fits all when it comes to antidepressants. If one is ineffective, another type can be tried. It's mostly trial and error until you find your type.
Also, remember that there is no timeline for your treatment.
"While I would love for sometime in the future for me to not be taking these medications anymore, if it’s a process that takes a long, long time, then I'm okay with it...because at the end of the day, ever since I started medication, even my worse days are better than my best days when I didn’t have medication, Pallavi says.
If you have any symptoms of depression, what's important is that you speak up and seek help if required.
"If you're reluctant to go to the doctor, make some positive lifestyle changes yourselves," Dr Mittal says.
But if nothing works, there's no harm in seeing a doctor. Chances are, they've heard it before.