Debate on antidepressants needed

Ita McSwiney outlines some of the concerns surrounding the side-effects of prescribed psychotropic medication

In a personal and human capacity, I would like to add my name to the growing number of people concerned about the side-effects of prescribed psychotropic medication and, in particular, SSRIs, a group of antidepressant medication.

This medication is widely prescribed and its use has almost been normalised in this country in recent years. Data from the General Medical Card Scheme and the Drugs Payment Scheme will attest to the escalating pattern of their use nationally.

I have been working as a nurse in adult mental health services for over 30 years, with the last 12 or more of those as a psychotherapist.

From my experience of my work, I have no doubt that a significant number of people, particularly in the early treatment phase with antidepressants, experience bizarre, and often uncharacteristic thoughts, impulses and images that can be both terrifying and difficult to ignore. Examples disclosed to me in the course of my work that come to mind include:

* A sudden urge to drive across oncoming traffic at speed;

* An impulse to drive their vehicle at speed over unprotected quays, into a wall or over a cliff;

* An urge to physically harm themselves or attack a loved one;

* On one occasion a patient expressed the urge to physically attack me, having spotted a potential weapon near to hand.

While it is difficult to gather scientific data to support this, the website www.ssristories.com makes for chilling reading indeed. Data is organised in such a way that this issue can be viewed from a range of perspectives.

And while the information might be more anecdotal than scientific in the strictest sense, the issue cannot be ignored.

Practically all of those referred to me for psychotherapy within the mental health system are already on medication. This would have been prescribed either by their GP (before they were referred to services) or by their psychiatrist within the service.

The only exceptions to this would be those individuals who declined medication in the first place, those who were treated with medication in the past and want an alternative, and those who wish to be supported as they come off medication they are currently prescribed.

There are many forces at play to maintain the usage of medication as the predominant treatment offered to patients in mental health services.

Among these are:

* The dominance of the medical model of care in mental health services in this country;

* The vested interests of the powerful pharmaceutical industry and its unhealthy co-dependant and exclusive relationship with the profession of psychiatry;

* A cultural expectation that a GP or mental health service provider has a cure or a pill for every pain, and also the resulting dissatisfaction when someone does not get what they want.

The cost of medication is huge, both in human terms and to the exchequer. The latter was brought home to me recently when a friend of mine, new to mental health services herself and not having a Drugs Payment Scheme card, spent €360 on a new prescription over just a three-week period, while awaiting her application for her scheme card to be processed.

I could only imagine the ongoing cost of keeping thousands on medication long-term. And it is almost always long-term. Just because we do not pay the full amount for our prescription does not mean that it is not costing somewhere.

This money would have paid for a lot of therapy and avoided kicking the problem down the road.

However, we cannot blame any one individual or professional group for the design of the current service delivery, where productivity is measured counting throughput, or “bums on seats”.

And with an inadequate psychotherapy service, or even in some locations the absence of any service, it is hard to blame a medic for prescribing something that will take the painful edges off a person’s suffering, albeit for the short-term at least

More highlighting and discussion of this and related issues is urgently needed.

* Ita Mc Swiney is a psychotherapist and supervisor with The Irish Association of Humanistic Psychotherapy