Overcoming the Stigma: On SSRIs & Mental Health Medication

This essay has been brewing for a while, and it comes from a place of fury.  Not the irrational, blood-curdling fury sparked by a stubbed toe or an infuriating colleague, but the one we’re all used to in some way or another.  It’s the buzz of discomfort in your stomach when hands grab you on the tube, or the sick iron taste of a bitten tongue.  It’s being catcalled by the gates of the school where you work, or the acrid shock of a cancer scare.

For woman artists, it’s being told to be “thin and curvy and sexy and innocent”[1]; it’s the lack of adequate representation for all women on film: BAME women, fat women, trans women.  It’s hearing from industry ‘professionals’ that you will not last two minutes if you’re sensitive, if you’re principled, if you have facial acne.

That kind of fury.

But my fury is not (for now) directed at the everyday sexism we’ve become so accustomed to, nor its toxic effects on men, women, and non-binary people.

I am going to talk about medication shaming.  I am going to talk about how news articles on the 2012 Colorado shooting blame not the murderer but his SSRI prescription.

James Holmes was a fan of violent movies and lived just across the border from the avidly pro-military United States.  He was born a white, middle-class male with all the insidious social conditioning that implies, was bullied at college and had unregulated access to guns.  All these factors are as likely as any to have contributed to his tragedy – but would you really believe it if your local newspaper printed the headline “Superhero Films Made Colorado Shooter Violent?”[2]

For the 5% of people currently prescribed regular antidepressants, taking them is not a choice but a necessity, and it often comes with a bucketful of reluctance, uncertainty, and shame.  But the people who have a choice, the people who have the power to influence a nation (imagine if your kids ended up reading that their hay fever meds, for example, would make them grow into a serial killer[3])— they have chosen to demonise this lifeline for the sake of a cheap shot at trophy-hunting the Big Pharma beast.

As it stands today, there is zero accredited evidence of a link between Selective Serotonin Reuptake Inhibitors (SSRIs) and violent behaviour.  SSRIs are provably effective in reducing brain plaques related to the development of Alzheimer’s[4], are known to have caused a 19% reduction in suicide rates, as well as the side-effect of weight gain. 

Another popular myth is systemic overmedication – headlines proclaim that “Soaring Antidepressant Use Is Dangerous”, while medical statistics are conveniently chopped up to fit the story.  While it is true that “just 20%” of 700 tested adults prescribed antidepressants “tested positive when screened for depression”[5], it is misleading to suggest that this indicates systemic overmedication of the public. SSRIs, used alongside cognitive behavioural therapy, are a highly effective treatment for anxiety, as well as the first-line treatment for obsessive-compulsive disorder. Incidences such as reactive, post-traumatic and post-natal depression were also not factored into the 2009 survey, which was undertaken several weeks after commencing treatment; based on the usual half-life of citalopram, the medication had already taken effect, unsurprisingly reducing or eradicating the subjects’ depressive symptoms.  To claim “more than 70% of patients in the survey presented no medical need for antidepressant treatment”[6] is not simply misleading, but an out-and-out lie.

The suggestion that doctors are “doling out”[7] antidepressants is not only an insult to the medical profession, but also glosses over the fact that such treatments are far from easy to come by. As with all psychiatric medications, SSRIs are highly regulated, meaning sometimes high-risk patients require written applications before being taken seriously, triggering self-esteem issues and dragging up associated trauma in the process.  Put another way, debilitated people – whether by intrusive thoughts, suicidal ideation, or assault-related PTSD – often have to fight for the most statistically effective treatment – in my case for 14 weeks, for others just as many months.

Given that long-term conditions such as OCD are usually diagnosed decades into adulthood, refusing to provide adequate support due to slipshod social stigmas causes collateral problems such as infertility, bulimia, unemployment, and bodily harm — most often in women, with the associated shame of the condition and relative lack of clinical studies meaning many GPs “still don’t recognise that a lot of women […] worry[ing] about vaginal infections actually suffer from OCD.”[8]

Patriarchal social norms also play a major role in perpetuating these stigmata, with the profoundly outdated trope of female hysteria de-incentivising first-line treatments such as medication. In the creative industries, antidepressant medication is both widely taken and institutionally stigmatised; despite there being no evidence of emotional inhibition as a result of SSRI consumption, numerous arts forums and even drama school policies suggest that use of antidepressants “lower […] the ceilings on the [emotional] highs and […] inhibit [the] creative process.”[9] One anonymous correspondent claims that a lecturer at their training institution actively discouraged the consumption of antidepressants despite lacking medical qualifications, suggesting that to “whack someone on antidepressants” is somehow inferior to a holistic, art-therapy based approach.  

The treatment of mental health conditions in the arts is further demonized through the pervasive and factually-unsupported ‘link’ between psychological trauma and artistic output; despite friends of surrealist poet Sylvia Plath claiming “her poems were not always based on her experiences,”[10] biographies of Plath and indeed analyses of her work are dominated by her depression, with the suggestion that her “inevitable” suicide is foreshadowed in her literary achievements. In fact, the young and ambitious Sylvia “was light and fun and feminine,”[11] her productivity at its highest “when she was happy.”[12] The romanticising of Plath not as a literary genius but as a victim of the illness that claimed her in later life undeniably de-incentivises antidepressants as a viable treatment method, suggesting to female artists that their depression is a necessary form of ‘suffering for art’ rather than simply a disease while also contributing to the stigma on antidepressants as a signal of ‘feminine weakness.’  Simply compare the presentation of Virginia Woolf’s depression with Hemingway’s alcoholism. Where Woolf’s works are reduced in one article to “the poetics of depression,”[13] we find a series of whimsical articles such as “Hemingway explains his deep love for alcohol” and even “How to drink like Ernest Hemingway.”[14]

Equally toxic is the resultant implication that women are dominated by their emotions and that female genius can only exist as a product of mental trauma; to present Plath’s works as symptomatic of her single depressive episode is to deny her status as a professional and a master of her craft, dismissing the technical prowess and university education that were to contribute to her success. This is not just a social issue but a feminist one; think about the implications on the presently male-dominated literary canon if Virginia Woolf had access to SSRIs, invented forty-six years after her death by suicide. 

While they do not work for everyone, SSRI antidepressants remain, alongside a guided course of CBT, the first-line treatment for depression, OCD, and anxiety; for many who take them, it resembles a life-saving treatment akin to the necessary injection of insulin by Type 1 diabetics. Put simply, it is time to stop pretending that meditation and bubble baths are a valid substitute for medication, and to accept that medication-shaming is an extremely insidious and dangerous form of ableism. 

[1] Quoted from BBC1 comedy short ‘Leading Lady Parts’

[2] CCHR Florida

[3] Ibid.

[4] In the case of Celexa (Citalopram) according to this study by ACS Chemical Neuroscience

[5] Psychology Today

[6] Ibid.

[7] Ibid.

[8] The Independent (archives), London, November 2018

[9] Broadway World (forum)

[10] Coe, Alexis.  Interview with Eleanor Friedman Klein.  No Man’s Land by The Wing.  Podcast audio.  December 15th, 2018.

[11] Ibid.

[12] Ibid.

[13] Cultura Colectiva, “Virginia Woolf and the Poetics of Depression”

[14] Culture Colectiva, “How to Drink Like Ernest Hemingway.”

Georgia Andrews is a freelance actor, writer and facilitator currently based in East London (via Helsinki, Philadelphia and the Midlands). When not writing, acting or embracing “funemployment”, she can be found tending to her fifteen houseplants or curled up with a book.