The people who started antidepressants during lockdown

t was in July 2020, shortly after the UK had emerged from the first national lockdown, that Siobhan* realised she was crying almost every day. “I was functioning – work and everything was fine – but as soon as I got home, I couldn’t stop crying. I didn’t know what to do with myself,” she said. The chief executive of a charity, she had been struggling with an estrangement from a close family member. Siobhan was able to access private counselling, but was unwilling to consider antidepressants, fearing she would be perceived as weak and that staff would lose confidence in her should they find out.

When her sister came to visit for the first time since lockdown began, she found that Siobhan had stopped washing. After a positive experience herself with antidepressants, she encouraged Siobhan to contact her GP. Upon waking the next day, Siobhan realised something needed to change and called her doctor to make enquiries about medication for her mental health. She was prescribed citalopram.

Siobhan is far from alone. Antidepressant use in England has been rising in recent years; data from NHS Digital, published in The Lancet, show that 70.9 million prescriptions for antidepressants were given out in 2018 in England, compared with 36 million in 2008. But it seems lockdown has exacerbated this. A recent investigation by the Guardian found that more than six million people in England received antidepressants in the three months to September 2020, the highest figure on record. Calls to mental health helplines have also soared, with Mind’s Infoline taking up to 500 calls per day in October, twice the number it would usually see at that time of year. 

Research by Rethink Mental Illness carried out during the first lockdown showed that 79 per cent of people living with severe mental illness said their mental health was worse because of the pandemic and in the six months since the first lockdown began, more than 2.3 million people visited mental health support website rethink.org for advice and information. Analysis of website traffic revealed an increase of 183 per cent in people seeking advice about anxiety disorders, a 188 per cent increase in people seeking advice on how to support someone experiencing suicidal thoughts, and a 229 per cent increase in the number of people reviewing advice and information about self-harm.

“The Covid-19 pandemic and restrictions people have been living under will have been challenging for everyone, and for many, it will have undoubtedly affected their mental health and wellbeing in some way,” says Dr Gary Howsam, vice-chair for the Royal College of GPs. Dr Howsman tells The Independent that college members have reported an increase in the number of patients presenting with mental health concerns during the pandemic.

Amy, 27, had struggled with poor mental health since her teens, although it wasn’t until 2020 that she realised her existing support mechanisms were no longer working for her. Although she doesn’t believe that the first national lockdown was the catalyst for her to seek help, she admits that, similarly to thousands of others around the country, her life had changed. “I wasn’t working in the office, so I was spending a lot more time at home and was living alone at that point,” she said. “One day, I just woke up alone in my flat and thought, ‘I can’t do this anymore – I need to speak to someone about this’.”

After calling her local GP to make enquiries about antidepressants, Amy says said she was “surprised” at the speed with which she was handed a prescription for citalopram. “The call was no longer than three minutes,” Amy tells me. “It was like a business transaction that the doctor just wanted to get done. I actually got off the phone and felt a little bit scared – what had I just agreed to? You always hear about people finding it so hard to get antidepressants, but it was a weirdly quick process for me,” she says. 

The National Institute for Health and Care Excellence (NICE) publishes health sector guidelines on antidepressants. According to them, antidepressants “should not be used routinely for mild-to-moderate depression, but may be used for people with a history of depression, persistent sub-threshold symptoms, or a concomitant chronic physical health problem”. It adds that people with “moderate or severe depression should be offered a combination of an antidepressant and a high-intensity psychological intervention (such as individual CBT, interpersonal therapy, behavioural activation, or couples therapy).”

Lucy Schonegevel, the deputy campaigns director at the mental health charity Rethink, says there is a “big risk of antidepressants being prescribed with no support”, adding that such medications should be offered alongside therapy, not instead of it. A short-term course of Cognitive Behavioural Therapy (CBT) has long been a “quick fix” for patients presenting with mental health difficulties, but it doesn’t suit everyone and, like all things, the quality of care can be hit and miss.

Amy was reluctant to engage with further NHS talking therapies after a previous CBT experience, which she described as “terrible – it just felt like she [the therapist] was reading from a worksheet.”

Prior to the pandemic, a demand for talking therapies had left many people at the mercy of a postcode lottery, with some patients forced to wait 112 days for treatment through the NHS’s Improving Access to Psychological Therapies (IAPT) programme, despite a supposed six-week maximum wait. Paul Farmer, chief executive of the mental health charity, Mind, warned that delays to patients struggling with anxiety and depression were so low in some parts of England that they could lead to people taking their own life.

“Since they were introduced 10 years ago, IAPT services have dramatically increased the numbers of people getting access to mental health support,” he said. “But services are clearly struggling to cope with demand. No one should have to wait three months between their assessment and starting treatment, and how long you wait shouldn’t depend on where you live.”

This situation is even more acute for BAME people, who are more likely to be given medication than offered talking therapies, according to a Mental Health Foundation report.

In terms of the efficacy of antidepressants, studies have revealed that taking commonly used antidepressants prevented a relapse in an average of 27 per cent of people, compared with 50 per cent who had taken a placebo. In other words, taking an antidepressant over a long period of time successfully prevented a relapse in an average of 27 per cent of people.

The NHS says that people usually need to take antidepressants for one to two weeks before any benefits are felt. A course of treatment usually lasts at least six months, but some people with recurrent depression may be advised to take them indefinitely.

“We must remember that while antidepressants can be very effective for some, they are not the solution for everyone and they should never be used as a first-line treatment for mild depression,” Rachel Boyd from Mind tells The Independent. “It’s important that GPs are prepared and have a full range of treatment options available for patients experiencing depression,” she said.

For Emily, 24, working as a reporter meant she was required to watch the news “all the time”, an activity scientists have found increases anxiety. Alongside what she described as the “overwhelming stress of the pandemic”, she found that many of the usual distractions of day-to-day life fell away. “My friend had died a year previously, and so I think there was a lot of trauma from that, and my sister had been really ill, but I think the pandemic just took all my coping mechanisms away and forced me to be with my feelings,” she says.

Before taking antidepressants, Emily felt as if she was “constantly waiting for something bad to happen. Worrying all the time is exhausting, so I struggled to get out of bed and couldn’t really be bothered to make myself eat properly.”

“I couldn’t remember ever not feeling bad, even though I knew for a fact I hadn’t always felt bad,” she added. “Although I kept upbeat in front of my friends, I struggled to convince myself I’d ever feel normal again.”

Emily was already engaging with a local mental health service when she approached her doctor, who was happy to prescribe her sertraline, although she struggled initially with the side effects.

“Yeah, it’s kind of ironic that I was being prescribed antidepressants for anxiety and depression when some of the side effects were ‘suicidal thoughts’, ‘anxiety’ and ‘depression’,” she laughs. For the first two weeks of taking her new medication, Emily suffered with suicidal thoughts. “For anyone thinking of going on them, you really need a support network,” she says. “If I’d have been isolating on my own at that time when the symptoms were super bad? It’s scary actually. If I didn’t have my boyfriend at that time, I think it would have been very hard.”

The NHS says: “Like all medicines, sertraline can cause side effects in some people, but many people have no side effects or only minor ones.”

“I had to move back to my mum’s permanently because I was so ill I couldn’t look after myself,” Amy says. Her symptoms, which included nausea, headaches, insomnia, dizziness and an upset stomach lasted almost three weeks. “Every morning when I woke up, I felt seasick – that’s the only way I can describe it”. In her struggle, Amy took to social media to find out if anyone else she knew had experienced similar difficulties and described being flooded with messages telling her to “stick with it”, an experience she found reassuring.

Thankfully, not everyone who takes antidepressants can expect to suffer severe side effects. A 2009 study found that 38 per cent of a sample group reported side effects from taking antidepressants, with 25 per cent experiencing side effects that were “very bothersome” or “extremely bothersome”. 

While Emily and Siobhan both received a phone call from their GP two weeks after beginning their medication to check up on their progress, Amy did not. Chairman of the College of Medicine and Integrated Health Dr Michael Dixon emphasised the value of a good GP: “A GP with time and who knows their patients well can probably obviate up to a half of referrals elsewhere using their holistic therapeutic skills,” he tells The Independent. “The discrepancy between an increasing incidence of depression and a reducing GP workforce makes this increasingly less possible and reflects years of neglect of our generalist role.”

Siobhan’s experience with her GP was more positive, however. “She was really good. She emailed me further information about other ways to help my mental health around exercise and food being linked to mood, and some worksheets, which were really helpful. She told me about side effects and rang me two weeks [after starting the pills] to see how I was doing and asked me to call her a month later for a review.”

For Siobhan, the challenges of the pandemic have certainly intensified her experience of mental ill health. “There’s no outlet – no socialising, no offloading with friends, nowhere to occupy and entertain kids and, for the initial lockdown, there were no bubbles or childcare”, she says.

Despite this, Siobhan’s experience of starting antidepressants has been positive. “Within three days, I’d stopped crying,” she said. “It was a physical, tangible thing and the emotions just started to pass.”

She received a text message from her estranged relative this morning that would have devastated her six months ago, but things feel different for Siobhan now. “I picked up the phone to reply, and I just thought, ‘nope’. A few months ago, I’d have been in bits, analysing every word. Today, I just started laughing.”

Overall, Emily described her experience of starting antidepressants as positive.

“At first, I thought ‘it’s just a quick fix’, but it is a fix, you know, and it has helped. Now, I can go to therapy and I’m more receptive to it.”

Amy notes how many people are struggling with poor mental health right now. “The stigma is becoming less and less,” she says. “Lockdown has meant that many people’s mental health has get worse, but it’s also meant that people have sought help. It’s not necessarily a bad thing that six million people sought medication.”

*This name has been changed

If you are experiencing feelings of distress and isolation, or are struggling to cope, The Samaritans offers support; you can speak to someone for free over the phone, in confidence, on 116 123 (UK and ROI), email jo@samaritans.org, or visit the Samaritans website to find details of your nearest branch.