Views & Reviews No Holds Barred

Overprescribing antidepressants: where’s the evidence?

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g4218 (Published 30 June 2014) Cite this as: BMJ 2014;348:g4218

Re: Overprescribing antidepressants: A lived experience perspective and response

I want to make a response to Dr McCartney's mention of "Is this true?" in relation to antidepressants leading to falls and fractures and her last sentence with phrases "overshoot the evidence" and "cause harm through the under-recognition and undertreatment of mental illness". I am responding as a person who was prescribed venlafaxine in maximum doses in 2002/3 and who has made a complete recovery from a "severe and enduring mental illness" diagnosis, a label of schizoaffective disorder given in 2002.

I experienced a menopausal psychosis in 2002 aged 50 and the treatment in Fife was hospitalisation, detention and being made to swallow the antipsychotic risperidone which brought me out of the psychosis quickly and also depressed me. The psychiatrist then gave me venlafaxine which did not lift my mood, still flat I had suicidal impulse and took an overdose of the antidepressant, a bottle of pills, and ended up in Ninewells Hospital getting my stomach pumped. After this episode I was put on a maximum dose of venlafaxine. Still flatness of mood so I was prescribed lithium to "augment" the antidepressant. Still no change.

Therefore it was up to me to do something about it and so I did. I got involved in volunteering and got active. This gradually helped to lift my mood so I tapered each of the drugs in turn, latterly getting off the lithium completely in 2004. I went back to paid work, full-time in 2006 and gained another postgrad qualification in 2008.

However in March 2005 I broke my fibula in 3 places when walking down a stair after a job interview in Cupar Library. I didn't trip or fall. It was a mystery as to how this happened. I got a 6 inch metal plate inserted, was in a wheelchair for 6 weeks then learnt to walk again, drive etc. Tests for osteoporosis came back negative.

Then recently I came upon research articles that mentioned venlafaxine in maximum doses in older people can cause bone loss:
http://www.jnrbm.com/content/9/1/3
and finally it made sense to me why I broke my leg when only walking down a stair. I'm now 62 this year and fortunately am fit because, I think, of the swimming and weight training I did in my 40's. Exercises I did daily when working in the community (I'm a community development worker, latterly a lecturer in care subjects at an FE college). I believe that my workouts prior to taking venlafaxine have helped me counteract the effects of the venlafaxine on my system.

In addition I was told in 2003/4 that I had a lifelong mental illness and would require to be on lithium for life. I didn't believe it because I'd recovered from puerperal psychosis on two occasions previously, after breakdowns in 1978 and 1984. I knew I could do the same again despite the psychiatrist telling me of the DSM4 and its many diagnoses. And so I recovered. The schizoaffective disorder label still sits in my medical/psychiatric notes, "in perpetuity", whatever that means. I still have a 6 inch metal plate in my leg and get cramp, pain, arthritis like, but I don't let this keep me back from being physically active.

However if others believe the mental illness labels/diagnoses given to them and have swallowed the pills/antidepressants then theirs might be a different outcome. I see many women in psychiatric settings walking with sticks. The ones who have survived. There are others who are no longer with us. I can name a few. I know of quite a few women in their 40's walking with sticks, on clozapine, diagnoses of SEMI. This tells me that something isn't right with psychiatric drug prescribing. I count myself very fortunate to have avoided the disability of antidepressant and antipsychotic prescribing. My mother wasn't so fortunate, died at 68 after more than 25 years on a depot injection of depixol. Because of what she went through I was prepared not to accept the same outcome without putting up a fight, or resisting.

Competing interests: No competing interests

01 July 2014
Chrys E Muirhead
Unpaid Carer. Writer, activist, campaigner in mental health matters
None
Cupar, Fife, Scotland, KY15 5SE
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