This article is based on an interview, which is also a podcast. You can listen to it here.
If you’re depressed, does it help to take antidepressants? Dr Mark Horowitz thought it would when he started taking them at med school, whilst training to be a psychiatrist. He became one of the world’s leading experts in antidepressants and how they work. At least he thought he was, until he realised he actually knew nothing useful about them.
He didn’t understand the side-effects he was experiencing and he couldn’t wean himself off them. This is the story of a doctor who gradually realised that everything his scientific training had taught him was not only useless but in fact destructive, when he applied it to his own life. He needed to turn to fellow patients who were taking antidepressants, who had no medical training, to find a way out of the nightmare his life had become.
Mark has a PhD in how antidepressants work in the brain. He started taking antidepressants himself at the age of 21, in his third year of medical school, after he was diagnosed himself with depression.
Mark was experiencing low mood, pessimism and tiredness, and he felt too ashamed to try therapy. He remembers thinking ‘People like me take medication like this.’
The side effects of the antidepressants included dizziness and tiredness, so he tried different ones, but they had side effects too. Eventually, he just decided to accept them.
It’s hard for him to say that the medication made any improvement to his mood, but he felt that they must be doing something, and he was nervous to come off them in case he felt worse.
Being diagnosed with narcolepsy
Over time, his tiredness increased to such an extreme level that he was diagnosed with narcolepsy. He used to fall asleep in his medical lectures. One of his professors called him into his office and asked if he’d been staying up all night partying.
When he started working as a doctor, he had to work part time because of the tiredness. It was very depressing for him and he felt he couldn’t keep up professionally or socially. There was no explanation for where this narcolepsy came from.
It is actually very common for antidepressants to cause fatigue: it happens to 25% of people who take them.
As well as being incredibly tired, he also couldn’t remember the names of patients or their case history from a day or two before, despite having previously had an excellent memory. He had topped the state in his high-school exams, and was also top of his final year in medical school.
The tiredness and poor memory completely changed what he thought he was capable of and made him worried that he had early-onset dementia. He was told that the narcolepsy was responsible for his bad memory.
Mark took medications to treat the narcolepsy and ended up on five different psychoactive drugs at the same time.
He was told he had treatment-resistant depression, which was in itself very depressing for him. He was offered electro-convulsive therapy or lithium.
Believing the drugs do work
At this time, Mark was a practising psychiatrist and was a great advocate of medication. He would sometimes call his friends if they were feeling down and recommend that they take medication themselves. He was very much encouraging his patients to keep taking their pills.
They would tell him that the medication worked. He saw agitated people calm down. He also noticed that when people stopped their medications they got much worse, and this reinforced the idea that the drugs did work.
He was assured by his doctor that the narcolepsy was not being caused by his medication.
Trying to come off the drugs
Despite his doctor’s reassurances, Mark suspected was sure the drugs were having a negative effect on him. However, when he tried to come off them, they made him feel even worse. He felt suicidal and had panic attacks — symptoms that were never part of his original condition.
So he felt trapped. He was really struggling to function while on the drugs, but coming off them was even worse.
The turning point
Inspired by a colleague, he decided to go on a mindfulness retreat in Thailand.
He was very sceptical about the whole thing, coming to it with a deeply rooted scientific perspective and feeling like a bit of a curmudgeon. Being surrounded by people who were into psychedelics, crystals, healers and people talking about energies was not usually his cup of tea.
But it was a transformative experience, particularly the walking meditation. He had tried doing sitting meditation before but kept falling asleep. Walking up and down really worked for him and he stayed there for a few weeks. He had time to ask himself, ‘Why am I on these drugs?’
He realised that he had sometimes had thoughts that were so painful, so shameful and embarrassing, that he feared he couldn’t deal with them. He worried his head might explode. The medication numbed those painful thoughts and feelings.
He remembered being bullied at school for his small stature, knowing all the answers in class and for his Jew-fro big hair. It had gone on for years. He had felt too ashamed to talk about it and so it was easier to say that he was depressed and to take medication.
But Mark realised that his head didn’t explode when he had these painful thoughts during the retreat. He wondered if they weren’t quite as overwhelming as he had feared and that maybe he could experience the thoughts without the medication. So he decided to try again to come off it.
Switching academic journals for peer support
Being a nerdy type and an expert in the field, he read all the papers written about how to come off medication, which said it takes a few weeks or at most a couple of months.
He knew this was too fast because when he’d tried to come off them before it had made him feel suicidal, and he’d never had those symptoms before he took the medication. He found peer support websites like Surviving Antidepressants, which help people come off their medication.
Here were tens of thousands of people who had lost faith in their doctors when they misdiagnosed the horrible symptoms they experienced while coming off the drugs as a relapse, concluding that they should therefore go back on their medication. They had realised that they were, in fact, experiencing withdrawal symptoms and needed to come off the medication much more slowly than they were being advised to. These were patients who’d been experimenting for themselves and were sharing their experiences with each other.
Withdrawal symptoms from antidepressants have been recognised in academic papers for 30 years, but are very rarely communicated to patients.
One in six people in the Western world are on antidepressants, so there were all kinds of people on this website, including doctors like Mark, who were coming to patients to receive rather than give advice.
Mark has a PhD in how antidepressants work. At the time, there were only a handful of people more qualified than him on this subject in the world, and yet he was learning how to come off them from people with no medical training. This bizarre role-reversal was not lost on him.
Finding the escape route
As he slowly reduced the medication, he became less tired, his concentration and memory improved. He regained his love of reading and his interest in the things around him. It was like a second chance at life. He now believes that all the impairments he had been suffering from for years were because of the drugs. He was overjoyed to have found a way out.
This experience completely changed his perspective on psychiatric drugs. It was like a blindfold had dropped from his eyes. He had thought they were safe, but they weren’t. He realised that doctors don’t understand how to get people off psychiatric drugs, and he wrote a paper on it, which was covered in the New York Times.
Drugs sold with lies
According to Mark, pharmaceutical companies have deliberately propagated the myth that depression is caused by a ‘chemical imbalance’ — a lack of serotonin in the brain. They claim that their medication, which is known to increase serotonin levels in the brain in the short term, can correct that imbalance.
However, the research doesn’t support this. There is little evidence for a correlation between low serotonin and depression. Despite that fact, many people with depression are led to believe that it is caused by a chemical imbalance.
A lack of evidence that antidepressants work
Mark discovered that no study had ever shown that antidepressants made a clinically significant difference compared with a placebo. Studies had shown a statistically significant difference, so it was enough to measure, but not enough to make a meaningful difference to people’s experience of depression. Also, most studies are only six weeks long, so they don’t measure the long-term outcomes for patients.
According to Mark, many of the studies that are published in journals are, in effect, little more than press releases from drug companies. The companies run their own studies and if those studies do not produce favourable results, they often do not publish them. The regulators are also closely aligned to the interests of drug companies, as they are funded by them. And there is a revolving door of regulators going to work for drug companies and people from drug companies going to work as regulators.
Mark now believes that a large part of psychiatric research is an edifice set up by drug companies.
How is Mark now?
Three and a half years into the grueling process of coming off five drugs, he’s now come off three of them and has two more to go.
He’s experienced dizziness, tiredness and concentration problems each time he makes a reduction, but overall it’s been an incredibly positive trajectory. He’s become more effective and productive, his interests are returning and he feels like he’s coming back to himself after many years. He wonders who he would have been without his two-decade detour on these drugs.
He now concentrates on research and helping people come off their medication.
In acute situations, he still believes medications may have a role, in the short term. However, they are not going to cure the underlying cause of the depression. They are just a crutch.
What if the drugs do seem to work?
People often tell Mark that they personally know someone who was helped by antidepressants — so surely they do work?
In response, he says that when you go to see your GP about your depression, you’re usually at your worst moment. By the law of averages, things are going to get better in a few weeks, whatever you do. Moods are very changeable.
Also, because you are being seen and listened to by a doctor, receiving a diagnosis and being given a treatment, you are expecting things to improve. This expectation is called the placebo effect and it makes a significant difference to people’s recovery.
You might also have time off work and be making other changes that are nothing to do with the chemical in the pill. If you experience side effects, they can make you think the drug is doing something, and that can increase the strength of the placebo effect.
One study found that 71% of people taking antidepressants felt emotionally numb, and that’s a relief — a reprieve from negative emotions. The downside is that being numbed for months or years has all sorts of unforeseen consequences.
So what can I do if I’m depressed?
It’s important to realise that mental health problems are really normal. One study that followed people from birth to the age of 45 found that 86% of them met the criteria for a mental illness at some point during that time.
The cause is often environmental. Mark says he was taught a lot at medical school about depression that has no apparent cause, but he’s never seen that in the real world.
Psychiatry has a tendency to pathologise and medicate normal human emotions. A particularly shocking example is that, according to the DSM (the US bible of mental health disorders), grief that lasts longer than 14 days is a mental illness and should be medicated with antidepressants.
Mark suggests that medication should be the last resort — something you try after you’ve tried everything else.
He proposes that, rather than asking the question, ‘What’s wrong with you?’, it is much more helpful to ask, ‘What’s happened to you?’ The best solution is to fix the problem that is causing the suffering. There’s no tablet for fixing a stressful job.
The focus on medication is a distraction from the real causes of suffering. It takes the focus away from factors like racism, job insecurity, low income and other social causes.
Mark says that the National Institute for Clinical Excellence (NICE) is a helpful resource, because it is not in the grip of drug companies. It suggests 10 ways of treating depression, including mindfulness, therapy (including cognitive behavioural therapy) and exercise. Taking antidepressants is just one of these 10 options.
He suggests trying to be honest with yourself about what’s causing the unhappiness. Medications are not magic bullets with no consequences. Coming off them can be a long, painful process.
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You can listen to my full interview with Mark as part of my Reimagining the World podcast, on any podcast platform, including Spotify, iTunes, Google Podcasts.
