In a widely read excerpt from his new book, Lost Connections, controversial author Johann Hari asks, “Is everything you know about depression wrong?”
While some readers appreciated Hari’s emphasis on depression as more than just “a broken brain,” many in the science community —especially neuroscientists and psychiatrists — took issue with his claims, published online on Sunday by The Guardian. For example, Hari writes that the medical community peddles chemical imbalance as the sole cause of depression, and he characterizes antidepressants as doctors’ “one menu option.” But this is oversimplifying matters: The National Institute of Mental Health, for instance, lists several non-antidepressant options — like talk therapy — and is careful to say that there is no “one size fits all” treatment plan. That page also warns that antidepressants can make some people feel worse.
The truth is that just as no two brains are the same, neither are any two diagnoses. According to the NIMH, the most current research says that depression is caused by a combination of genetic, biological, environmental, and psychological factors — all of which should be discussed when deciding on an individual treatment plan. If antidepressants are part of the treatment plan, there’s no shame in that; the stigma that depressed people don’t need medication is a dangerous one that can prevent people from seeking the mental health care they truly need.
Here, we asked nine women about their experiences with antidepressants: why they choose to take them, the pros (more motivation!) and cons (fewer orgasms!) of medication, and the biggest misconceptions about mental health treatment.
“I got lucky: The first antidepressant my doctor prescribed worked incredibly well, and still works for me now. It’s the only one I’ve tried and I’ve never had side effects. I’m aware that this is rare and that a lot of people have to try a few medications before finding the right one. Without antidepressants, I struggle with the motivation and focus for many daily tasks. I’m also subject to depressive and suicidal episodes, often with suicidal ideation. The medication prevents that and makes me more able to live the life I want. Antidepressants simply create a floor so that you have solid footing.”
“I’ve taken antidepressants for a decade, starting when I was super depressed in college — but at that time I wasn’t really supervised [by a doctor]. Only in the past couple of years do I think I started taking the right ones for me. It’s hard to tell which ones work best as so many things (periods, drinking alcohol, etc.) can affect my mood. I wonder what it would be like not to take them at all. I haven’t really tried not being on them in my adult life, but I’m happy now and scared to destabilize myself.
“The meds allow me to get out of bed — to have the same hope others wake up with naturally — while suffering from severe depression.”
“I had been battling depression and anxiety without medication for several years and finally realized it had gotten out of control. I was missing work, having panic attacks, and just generally not functioning well. I’ve always struggled with my weight, and that was a main reason I resisted medication when I was younger — I didn’t want to gain the weight that can come with antidepressants. I even stayed on the wrong medication for way longer than I should have because it was helping keep my weight down.
“Now I feel like I gain weight much more easily, but since I’m able to go about my life (get out of bed, go to work, be motivated, enjoy a quiet social agenda), I’ve made some peace with the trade-off. My sex drive hasn’t totally diminished but it has definitely shifted my approach toward sex in ways I’m still trying to sort out. I consider my depression a chronic ailment and I think, Would I treat any other chronic ailment I was facing? Obviously I would. That helps balance the scales for me.”
“I’ve been taking antidepressants since July, for the first time in my life. I was laid off from my job, had a breakup, and I’d wake up at night unable to cope with my anxiety. I wanted to stay in bed all the time and not speak to anyone, and I had zero appetite.
Since starting an SSRI, my anxiety is significantly better but an ongoing side effect is lowered sex drive and difficulty having an orgasm. I see myself going off of them now that I’m out of a bad relationship/job loss scenario, but I haven’t begun to. The orgasm part sucks — it’s a big factor in wanting to go off of them.”
“I took antidepressants for about ten years, starting at 16; now I’m on them again for postpartum depression. I was resistant to taking them both times but, yes, they really are helpful and I’m especially glad this time around that I’m on them. I want to be the best mom and my best self for my daughter. There are two big misconceptions about taking antidepressants: that you’ll turn into a zombie, and that you’re weak for being on them. I’m guilty of still believing that second one, and it’s my biggest struggle with antidepressants. I have to remind myself that like heart disease, depression and anxiety are diseases as well and need to be treated. I’m not in any rush to get off of my medication, nor do I have plans to be on it permanently. At this point I’m just going with the flow.”
“The first time I took antidepressants, extreme depression had caused me to flunk out of college. I couldn’t hide it anymore, and I started medication and therapy that continued for four years. Recently I started taking them again because I was operating with what I call ‘highly functional depression.’ My husband basically had an intervention to talk about how my depression was affecting those closest to me — meanwhile I thought I was doing okay because I was super successful and kicking ass at work.
“Medication has been extremely helpful for me. Not only has my ‘fog’ lifted, but it’s decreased some digestion issues as well. The weight gain sucks, but in the grand scheme of things, it’s not so bad. The benefits far outweigh the negatives and being older now, I recognize that more. The stigma about antidepressants is decreasing — certainly since I was in college — but it’s still there. That’s why I want to speak out and reduce that stigma.”
“I’ve been in therapy for an anxiety disorder for a couple of years now. My doctor and I discussed the option of adding medication to my routine, on top of the talk therapy and CBT I was doing, and I decided to give it a shot. My medication is helpful in that it ‘takes the edge off’ so that I can better manage my anxiety through other techniques like meditation and exercise. I’m not ‘cured’ and I definitely don’t have some feeling of blissful contentment now that I’m on the right medication. But it is part of my treatment and I do find it helps a little. I think people think that antidepressants ‘melt away’ your troubles and make you feel happy.
“In my experience, that’s not what they do at all. When you’re living with an anxiety disorder, just getting close to ‘normal’ is a big success, and medication can help you not feel like your skeleton is trying to leap through your mouth and escape your body. You’ll still feel that way a lot of the time, but medication can help so you don’t feel like that constantly. My doctor and I have discussed going off my medication since I’ve been making more progress with my CBT skills. My plan is to stay on it for at least another year and then experiment weaning off. It’s comforting to know I can always go back on, or stop, depending on what feels right for me.”
“I’ve been taking antidepressants for about nine months now; I took them for another two years in high school and college. I started them again because I’d been suffering from anxiety and panic attacks, as well as insomnia (which actually got worse when I started antidepressants again, but it’s leveled out). I’m on a low dose, and combined with exercise, it seems to be pretty effective. A big misconception about antidepressants is that you have to take them forever — but for some people like me, they’re more of a maintenance thing. I sort of go through ‘seasons’ of needing them. I’ll wait until life settles down a little bit and try to wean off of them again.”
“I’ve been taking an SSRI for about five months now. Medication has been a godsend for me. I had an incredibly emotional experience, actually weeping as I asked, ‘Is this what normal feels like?’ I carried a lot of stigma about antidepressants because of what I saw represented in art. I digested all these ideas that humans were over-medicating ourselves rather than celebrating our differences — that we were creating these zombies. But I was miserable.
And why did I stay that way for so long? Because I didn’t want to become a so-called ‘zombie’ that some student filmmaker decided to show in a ten-minute short? I’m convinced that the people who tell those stories were never truly helped by medication, and surely it’s not for everyone. But my only regret is that I didn’t cave earlier and let myself feel what ‘good’ is.”
Interviews have been edited for length and clarity.
