A BBC Panorama episode aired this week that explored the potential link between certain antidepressants and violence. Provocatively titled ‘A Prescription for Murder’, it "revealed the devastating side effects on a tiny minority that can lead to psychosis, violence, and even possibly murder."
The episode focused heavily on one case: James Holmes, who killed 12 and injured 70 more at a midnight showing of The Dark Knight in Aurora, Colorado, in 2012. Holmes had no history of violence, but visited a university psychiatrist about the intrusive thoughts he was having about harming people – a coping strategy for social anxiety he’d had since his teens. She prescribed him sertraline, an SSRI (selective serotonin reuptake inhibitor) – the most commonly prescribed antidepressant – which he took 17 weeks before the event.
While this man was clearly unwell, and his mental health should most certainly be examined, Panorama's ‘investigation’ focused on the controversial view of UK-based psychiatrist David Healy, an advisor to Holmes' defence team (but who was not asked to provide evidence), who declared: “I believe if he hadn’t taken the sertraline, he wouldn’t have murdered anyone.”
This kind of statement is explosive, as proven by the reactive headlines seen in recent days: ‘Antidepressants linked to murders and murderous thoughts’; ‘Murder link to SSRI drugs taken by millions for depression’; ‘Antidepressants linked to 28 murders in three decades, BBC investigation finds’.
But that’s just the thing: ‘A Prescription for Murder’ came to no solid conclusions. In the past 30 years, the UK Medicines Regulator has received 28 reports associating SSRIs with murder, but says that these reports do not prove the drugs cause these events. Doesn’t this seem like a classic case of ‘correlation does not imply causation’? While the Holmes case is clearly complex and divisive, Panorama made no effort to explore the wealth of studies and research on SSRIs. Instead, its title indicates what it set out to ‘find’, via lurid details and scaremongering, with no hard evidence put forward by the medical professionals involved.
The media has always been sensationalist, from its anxiety-inducing rolling coverage of terrorist attacks to its voyeuristic focus on celebrity scandals. Aware of the nature of clickbait and bias, I usually read with a large pinch of salt; but as someone who takes SSRIs, I couldn’t ignore the recent representation of antidepressants.
Of course, with prescriptions of SSRIs having doubled in recent years, we should be investigating and analysing their potential side-effects. However, this coverage has spread a wholly one-sided and frankly irresponsible narrative. When, as a stoic nation of Keep Calm And Carry On-ers, we’re only just beginning to have open conversations around mental health, this is damaging and heightens the massive stigma that already surrounds our emotional wellbeing.
Thankfully, many charities and leading psychiatrists have slammed the episode. “I am horrified that the BBC has chosen to use such stigmatising and unpleasant language in relation to people who use antidepressants,” said John Lawlor, chief executive of Northumberland, Tyne and Wear NHS Foundation Trust. “Substantial steps forward to challenge the stigma of mental ill health have been made, and linking the experience of mental health problems with violent crime only reinforces unhelpful stereotypes.”
Professor Wendy Burn, president of The Royal College of Psychiatrists, also challenged the programme: “We are disappointed with recent coverage about antidepressants. For moderate to severe depression, they are an evidence-based treatment. For many, these drugs have had a beneficial effect on mood and have helped reduce suicidal thoughts or self-harm.” I also spoke to Josie Hannaford, a London-based psychological wellbeing practitioner: “Labelling SSRIs as a ‘prescription for murder’ shows factual inaccuracy and poor understanding of SSRIs in mental health. It disturbs me that mental health issues are predominantly covered in the media with mawkish stories – this could end up scaring mental health sufferers, discouraging them from seeking the appropriate treatment.”
And herein lies my anger. For a long time, my perception of antidepressants was shrouded in fear, shame and misunderstanding, in large part thanks to a media that twists the narrative so much that I was afraid to ask for help. When I experienced a serious bout of anxiety and depression last year, daily life was difficult. Thinking of reasons to get out of bed was near impossible (despite my supportive friends and family, wonderful partner and exciting job); I felt like I was trapped behind a foggy glass pane that disconnected me from everyone and everything (which I now know is dissociation); and while I knew I must value my life, I certainly couldn’t feel it. I’ve been on 20mg of citalopram a day for around eight months now, and I can’t remember the last time I felt that darkness.
With 64.7 million SSRIs items being prescribed last year in the UK alone (and the number is rising), I’m not the only one who’s been given a lifeline. 30-year-old Annie Davis, a London-based editor, has been taking SSRIs on and off for 20 years: “Anxiety from a young age led to taking time off school and dropping out of university. I would choose not to take medication if I could, but I can’t right now. This might sound defeatist, but they’ve got me through education, jobs, friendships, and relationships – the difference between being on and off them at times of need is incredible.” She’s currently taking 100mg of sertraline, which is the same form Holmes was prescribed. “Using extreme cases like the Batman killer is unnecessarily sensational. He was a beyond-fucked-up individual, and his is not a situation relevant to mine. You’ll excuse me if I don’t suddenly give up the thing that’s helped me get out of bed every morning.”
“Throughout my life, my dad was very, very ill with degenerative multiple sclerosis. He moved into full-time residential care over an hour’s drive from home when I was 11, and died when I was 17,” Imogen, 24, from London, tells me. “Shortly after he died, I moved to London for university, where I was away from home, my mum and any support network that I had."
Struggling to sleep, eat and leave her halls, Imogen began dipping in and out of depressive periods. “I continued with my wait-it-out approach, which was emotionally exhausting, and made me incapable of maintaining a healthy social life. I was in the midst of writing my dissertation when I felt the depression starting to creep back – I didn’t have the time to wait this one out. After gentle coaxing from my mum, I got the train back home, made an appointment with my GP and was prescribed medication. I saw, and still see, SSRIs as bike stabilisers which allowed me to continue with my day-to-day."
Creative producer Megan, 31, tells a similar story. She began taking SSRIs when her father died last year, increasing her citalopram dosage from 30mg, to 40mg, to 50mg, where she’s “existing quite happily now”. “I don’t intend to be on them for the rest of my life, but I certainly wouldn’t have been in a position to cope with everything that is going on without them,” she tells me.
Despite watching documentaries about mental health to increase her understanding, Imogen draws links between media portrayals and the way we approach our own mental health: “Female mental health is so tied up in stereotypes of the wild, pill-popping, tortured girl from celebrity culture – think about Lindsay Lohan, Amy Winehouse or Amanda Bynes. Those people are treated so negatively in the press and within society, that I couldn’t help internalising the thought that I was maybe going to be stigmatised or isolated for taking SSRIs."
Nadine Jacobs, 22, from Brighton, echoes this sentiment: “I had a really negative impression of them – I thought they would completely alter your mood and turn you into a complete zombie. I always thought it would be preferable to live out my emotions un-muted, including my depressive episodes. My views only changed in the last few months when I met a number of people who manage to live their lives while taking antidepressants."
Having seen a distinct change in her mental health – “I literally wanted to die, and was just about in control of my life that I knew I didn’t want to feel that way anymore” – Nadine began taking 50mg a day of sertraline. Again, the same type of SSRI prescribed to Holmes. “They may not be for everyone but antidepressants are really important, and I’m very grateful I’m able to take them. My experience has been great – I’m able to function. I still get depressive episodes, but they are shorter and more contained, which has made such a huge difference.” What does she make of the recent media coverage? “It’s totally irresponsible. SSRIs can be an absolute miracle worker, especially for young people, and it's terrible to only highlight the negative effects and not the positives. The media, just like GPs, has a responsibility to show the full effects of SSRIs."
Panorama isn’t the only outlet to peddle negativity around mental health in recent weeks. Guardian columnist Deborah Orr has written openly about her complex post-traumatic stress disorder before, and published a piece on 8th July entitled ‘I took my first antidepressant this week. The effects were frightening’. The language she uses throughout undermines both the gravity of the situations most people prescribed SSRIs find themselves facing, and how life-saving the medication can be for most. “On Tuesday I joined the throng, and popped my first citalopram. It was quite a thing – not least because, like an idiot, I dropped my pill about 90 minutes before curtain up for the Royal Shakespeare Company’s production of The Tempest at the Barbican. That’s right. This isn’t just mental illness: this is metropolitan-elite mental illness. It was a pretty overwhelming theatrical experience."
Orr weirdly describes taking the medication as if she were dropping a bomb of MDMA in the queue for a sweaty club, before going into the side-effects she experiences (they affect everyone differently) and the circular process that resulted in her being given SSRIs in the first place. This constant referral is not surprising to people suffering with bad mental health. Our lives are one big waiting list, from late-running doctors' appointments to year-long CBT referrals. Under Tory austerity, the NHS is crumbling, and shoddy mental health services are just one of the many consequences.
Orr explains that she had a year of psychotherapy before “taking this drug”: “I wouldn’t have had the insight to understand what this drug was doing to me, let alone control it or explain it to others when I couldn’t. I might never even have got the diagnosis that helps me so much to make sense of my entire life, because that took months. All I can do, apart from look after myself and my kids, is speak out about how complex is the task of managing a mental health condition,” she writes. "There’s so very, very much more to it than popping pills.”
While it’s fantastic that psychotherapy worked for Orr, implying that “popping pills” should be a last resort, only taken after talking therapies, is dangerous. I tried CBT (cognitive behavioural therapy) alongside taking SSRIs and found it traumatising, while Nadine attended counselling for a few months last year and found it wasn’t for her.
Tilly, a creative producer from Plymouth who has been taking SSRIs on and off for 14 years, also tried talking therapies, but “with long NHS waiting lists and the cost of private care, it hasn’t proved an accessible long-term solution”. While it is undoubtedly beneficial for many people – and often recommended before taking medication – it is also an unreachable solution for some. Orr can write about her personal journey with mental health to her heart’s content but, along with Panorama, it is wildly negligent to present just one droplet in an ocean of experiences.
Of course, like most medication, SSRIs have their side-effects. Each type of antidepressant impacts different people differently, and it is in no way one-pill-fits-all. “In all treatments – from cancer to heart disease – medicines which do good can also do harm. This applies in psychiatry,” Professor Burn explains. “Current evidence from large-scale studies continues to show that for antidepressants, the benefits outweigh the risks – which is why it is important to highlight that the experience raised by the author in the recent Guardian article is extremely rare.”
So what are some of the side-effects? Orr discusses dissociation, a feeling of severance from the world, while GPs warn that anxiety and suicidal thoughts often get worse in the initial weeks before getting better. Tilly spoke of “weight fluctuation, severe bruxism (I have to wear a mouthguard at night) and nausea”, while Megan has “crazy intense dreams, and I sweat more”. “The first couple of weeks were pretty rough,” Nadine tells me. “I had bad headaches, almost no energy and worst of all – which people don’t talk about enough – is it affected my sex drive. I’m a firm believer in masturbation as self-care, but it was really difficult to orgasm in the first few weeks. That’s all settled down now, though.”
As with any medication, we should be talking openly about these side-effects – but we can only do so when we’re free to talk openly about mental health in its entirety. The recent irresponsible and narrow-viewed media coverage will mislead people with no complex understanding of both mental health and SSRIs to draw correlations between those taking them and, at best, zombies, at worst, cold-blooded murderers. Potentially deterring people from accepting life-saving treatment, we can’t afford to let a narrative that further stigmatises SSRIs dominate the debate.
If you’re worried about your mental health, you should speak to your doctor, find out what works best for you, and talk through any issues with said treatment. But don’t let horror stories and alarming headlines decide what’s best for you – your mental health is far too precious for that.