conclusion:
Huge worry: What if I start hearing voices and believe aliens are trying to abduct me?
Likelihood: Actually pretty low – in 2014, an estimated 0.7 per cent of the UK population were reported to show symptoms of psychosis disorder. [44]
Conclusion: While there is a slim chance that I might have a psychotic illness, there are many people who live full lives while coping with serious mental-health problems, and very few people end up in what I think of as ‘asylums’ anymore. There would be a plan of action and I would have great support in place.
I was sceptical of such a method – I’d been dealing with catastrophic worries for years; it felt too simplistic to merely write down my worries and try and reframe them. But what do you know? It started to work. I’d write these alternative conclusions and quickly forget them. Later on, when inevitably another new and SCARIER worry cropped up, I’d do my normal freak-out and start falling down the rabbit hole of catastrophe. But then something would stop me – I’d remember the worksheet and ask myself if I could see a different outcome, whether maybe I had a choice in how far I chose to take the thought. I still do this in my head from time to time – when I feel my thoughts racing and have to rein them in.
CBT has worked for me, and for many others who have been lucky enough to receive this treatment. But current NHS waiting list times often mean that medication is offered first.[45] In the course of writing this book, so many people I spoke to were still on the waiting list to have a limited number of CBT sessions, and would take medication as they waited for talking therapy. The medication most commonly prescribed for anxiety disorders is selective serotonin reuptake inhibitors (SSRIs), which are thought to increase the levels of the chemical serotonin in your brain. After carrying a message between nerve cells in the brain, serotonin is usually reabsorbed by the cells. SSRIs work by blocking this absorption, meaning more serotonin is available to pass further messages between nearby nerve cells. You might also be offered serotonin–noradrenaline reuptake inhibitors (SNRIs), which increase both chemicals, or benzodiazepines, which have a sedative effect and can’t be used for a long period of time because they’re addictive. Speaking personally, they’re bloody amazing for a short window where you’re finding it hard to get through the day. But be aware that the doctor will probably not give you more than two weeks’ worth, for good reason. Especially if you go in wild-eyed, praising them and loudly insisting you must have more. Not my subtlest move.
Whatever meds you’re prescribed, you’ll start on a low dose, and be monitored by your GP to see whether you need a higher dose, and to check your side effects. Don’t expect relief immediately; usually these drugs don’t become fully effective for 2–4 weeks, which I know can feel interminable, but don’t stop taking them, or give up hope.
As with so much to do with mental illness, taking drugs for mental-health problems still comes with a huge stigma attached. This is in part because some who have not had cause to take them find it hard to understand why other people do. It’s also to do with ignorance, or a lack of education around what the meds actually do. Headlines in some sections of the media don’t help, to put it mildly. A NATION HOOKED ON HAPPY PILLS yelled the Daily Mail at the end of 2017[46] – the implication being that those of us who take antidepressants do so for an easy fix, or for a high that doesn’t actually exist.
So, for clarity: does taking antidepressants mean that you’re crazy? (No.) Do they mean you’re dangerous? (No.) Don’t they make you a robot unable to feel emotions? (Hahaha. NO.) But yet still we feel shame or hesitancy in telling those we love about them. A 2011 study showed that one in three women in the UK will take antidepressants in their lifetime, and yet 18 per cent won’t tell their families and one in ten won’t tell their partner.[47] I hesitated to tell my partner that I took medication, worried he’d think less of me. Ridiculous, really. And he didn’t. At all.
I shouldn’t need to argue why it’s so important not to judge someone for taking medication when they’re struggling. I’d love it if we lived in a world where taking SSRIs was just like taking paracetamol for a headache. But we’re not there yet. I’ve been taking them on and off for years now, but I didn’t tell anyone about them for fear of looking like I was abnormal. I didn’t know anyone that took them and I didn’t want to be any different. Except I did. I knew tons. When I finally told people (gradually, cautiously) so many of my friends and family said that they’d had cause to use them at some point in their lives too. Some for a few months, some for a few years. Some were adamant they’d never come off them. A few people were surprised I was being open about it, and urged me not to disclose it to employers, showing that the stigma is real.
I’ve not come to any fixed conclusion about how long I’ll continue to take them. But I do know that, personally, they dug me out of the pits of despair and took me back to a place where I could think about something other than death and destruction. They didn’t flatten my emotions, rather, they let me feel something other than utter misery. They gave me the chance to start figuring out what would help me be actually happy. Because I’m sorry to disappoint but they don’t make you happy – no matter what fear-mongering headline might scream about mind-altering drugs. They just give you a chance to not be so fucking sad. And they don’t work for everyone, and they can come with some pretty serious side effects. I get night sweats (gross and fun to explain to a new partner), and you might feel nausea; or dizziness; or lose interest in sex, but not always, and you have to decide for yourself how much you can put up with. Either way, don’t be scared off medication by people who freely judge because they’ve never experienced the sadness and worry that others have. Lucky them, but you do you.
If you need further reassurance, a 2018 study (published in the Lancet) which looked at the efficacy of twenty-one antidepressants found that all the drugs tested were more effective than a placebo in adults with major depressive disorder[48] – though sadly the data can’t show which drug would be most likely to work best for any individual. The six-year study was hailed by many experts, who heralded the results as a blow to the lingering stigma that still surrounds medication for anxiety and depression.
For all the talking therapy and medication I was lucky enough to be given, however, I was never able to completely get myself on an even keel. The drugs took me out of doom, the talking reassured me that I could keep my thoughts in check better, but I always felt like both were only getting me so far. It was as if I was always tentatively standing on the top of a hill, while everyone skied past me and beckoned me down (I’ve never skied, it looks completely terrifying). And that’s fine – nothing is a miracle cure and you can’t expect total relief from one remedy. I’m glad I was able to get help from both, and I’m still grateful that they got me to a stage where I could find more things that helped. Things that might help me get to be really happy and not in a place where I was just ‘managing’.
It’s not that managing is a terrible place to be, but it can be stultifying. When you get there, it feels amazing – as though you’ve jumped a massive hurdle. But then you find that there are other hurdles in the distance, and it’s frustrating when you want to tackle them too. That’s another little annoyance that mental-health problems are likely to throw up – however far you’ve got with your recovery or management, there are always other levels to tackle, new fears to confront. The journey is never completely over – no final, happy end to the worries you’ll face. It’s a long and sometimes slow process, but once you’re on board, you realise how much better it is to be taking it than the alternative. That doesn’t mean that you won’t get disheartened, but remember how far you’ve come already. And at the risk of sounding like a motivational coach, your progress is your own. When I realised I could go on the Tube without fainting for the first time in sixteen years, I was prouder than a stage-school parent at a recital. The feeling was indescribable, and I carry that memory with me when I feel like I’m not as brave or as competent as those around me. Small steps.
