A few months ago, I got a call from a reporter from the BBC’s Disclosure programme asking me to appear in a documentary about antidepressants. He said it was a short film that would present the subject ‘in a balanced way’, featuring a variety of views. The medicine, taken by eight million Britons, has had its fair share of bad press recently amid concerns about psychiatric side effects.
However, as I have written before, I am a big advocate for the pills.
In November I revealed how, on three occasions, I’ve been prescribed antidepressants for anxiety – the first when I just 15 years old, helping me to overcome the disabling panic I was feeling and get through my GCSE exams.
The reporter told me he had read my article and, in June, visited my office to film an interview. My take was nuanced: as a health journalist, I am well aware of the downsides of antidepressants, namely potential side effects and withdrawal.
I also know there are some experts who say the benefits have been overblown and are, in fact, outweighed by the harms.
STRONGEST BOND: Dylan Stallan with his mother Seonaid
My experiences have been overwhelmingly positive, though. I’d had no problems until my most recent time on the treatment – I was prescribed, and am still on, fluoxetine, also known as Prozac, in September – when I felt completely mad for the first two weeks.
This has since subsided. My anxiety has been controlled and those tricky few weeks were ultimately worth it. I explained that I’d never had a problem coming off them but, when I do, this time I’ll reduce my dose slowly, as per the latest NHS guidelines, to avoid any shocks to the system.
I thought it made for an interesting discussion. Unfortunately, you can’t decide for yourself.
The reporter called last week, a few days before the film, Disclosure: Are My Anti-depressants Worth It?, aired. He told me my interview had been cut due to technical difficulties while filming.
And this may be the case, but I can’t help wonder if it was also, to some extent, because I wasn’t anti-antidepressants enough.
It appeared as though they swapped my teenage experience for another’s: 18-year-old Dylan Stallan, who took his own life in 2015, two months into a course of the antidepressant sertraline.
It was a tragedy – and utterly worthy of the attention it was given. I strongly believe that it’s vital we talk about cases like these and try to learn from them.
But it’s also important to realise they are mercifully rare. So much so, it’s impossible to say whether antidepressants are the cause.
It seems like a missed opportunity that a much more mundane story, like my own, wasn’t also aired.
Admittedly, it wouldn’t have been as compelling.
But perhaps that’s the point: antidepressants are taken by millions of Britons every year to help with sometimes crippling anxiety and depression. For the vast majority of patients, benefits greatly outweigh the risks.
The documentary didn’t feel balanced to me. Although it featured two mildly positive personal stories, it focused heavily on the negatives – that the pills are linked to sexual issues, withdrawal symptoms and declining mental health.
I’m not saying that these things aren’t true. As with any drug, there are a number of people affected by side effects. My worry is that constantly painting antidepressants in a bad light could result in people either refusing or quitting treatments that are often life-saving. And I’m not alone in my concern.
‘The portrayal of antidepressants in recent documentaries is of a drug that’s overprescribed, addictive and can cause suicide,’ says Professor Allan Young, head of academic psychiatry at King’s College London.
‘Not only is this untrue and unhelpful, it is potentially dangerous. Friends have phoned me up and told me they’re planning to stop taking their antidepressants because they’re scared by what they’ve seen on TV or read online. There will perhaps be deaths and suicides as a result. That is a scandal.’
You might ask just how harmful a documentary could possibly be. The answer? Very.
In 2013, Australian broadcaster ABC aired a two-part documentary The Heart Of The Matter on the cholesterol-lowering drugs statins. It suggested that the pills were ‘toxic’ and questioned the benefits.
There was an outcry from the medical community and, eventually, an internal review found that ‘relevant perspective’ about the effectiveness of statins was not properly reflected. The show was pulled from ABC’s website, but the damage had been done.
In the eight months after the episodes aired, there were half a million fewer statin prescriptions than expected across Australia.
Dylan Stallan who killed himself after taking sertraline
Researchers from the University of Sydney who tracked the phenomenon estimated 60,000 people had either quit the drug or reduced their dose, and that there could have been an extra 2,900 heart attacks and strokes as a direct result of the documentary.
This effect has been seen in other drugs that have attracted controversy. And scare stories don’t just stop people taking their pills. Research shows that simply believing a side effect might crop up can increase the likelihood that it will.
When drugs are put through clinical trials, volunteers are given the real medication or a dummy pill known as a placebo.
They do this in order to understand which benefits of a treatment are as a result of some other factor – known as ‘the placebo effect’. Studies show placebos can also cause side effects – despite there being no active ingredients.
In fact, when statins, since we’re talking about them, are studied in clinical trials, roughly the same number of patients experience side effects on the real drugs as they do on placebos.
Because of this, experts believe that at least some of the side effects experienced are caused by something other than the medicine. Dubbed ‘the nocebo effect’, it’s more often seen in treatments that frequently get bad press.
Of course, this doesn’t mean that everyone who has suffered side effects is just imagining it.
But it does show perceptions and prejudices held by patients may have a genuine, physical impact.
And it’s not just statins. In 2018, researchers from the University of Auckland found a significant increase in side effects reported on antidepressant venlafaxine following publication of articles about its supposed ineffectiveness and links to suicidal thoughts.
‘The more negative effects are talked about, the more patients expect to experience those effects,’ says Dr Sameer Jauhar, consultant psychiatrist and senior clinical lecturer in affective disorders and psychosis at King’s College London. ‘It’s a phenomenon we’re well aware of with many drugs – especially antidepressants. And the recent programmes feature good examples of this type of scaremongering.’
The Disclosure episode was the second BBC documentary that aired recently to explore the harms of antidepressants. In June, Panorama broadcast The Anti-depressant Story, a look into the history and alleged downsides of the most commonly taken of these drugs – selective serotonin reuptake inhibitors, or SSRIs. It was suggested drug companies behind the pills had tried to cover up withdrawal symptoms.
One expert featured said that due to a lack of long-term safety data, people like me, who take antidepressants for years at a time, are participating in a ‘huge, unregulated experiment’.
One could argue these are fair comments. If true, people have a right to know. But other experts I’ve spoken to since have told me their contributions, which outlined the benefits and explained evidence that contradicted the negative points of view, were cut from the final show, too. ‘I was interviewed for an hour, but they didn’t use any of it,’ says Prof Young.
One expert describes how antidepressants can be ‘life-saving’, but Prof Jauhar says this was easily overshadowed by the negative views. So what vital information was left out?
In Disclosure, one young man named Connor says he’s suffered sexual problems – genital numbness and a lack of interest in sex – which has lasted a year after he stopped taking the SSRI sertraline. Two experts explain that up to eight in ten people on SSRIs have sexual problems – and some will suffer for decades after they stop taking the pills, a phenomenon called post-SSRI sexual dysfunction.
‘The portrayal of antidepressants in recent documentaries is of a drug that’s overprescribed, addictive and can cause suicide,’ says Professor Allan Young (pictured), head of academic psychiatry at King’s College London. ‘Not only is this untrue and unhelpful, it is potentially dangerous’
It is stated this is not a diagnosis recognised by the NHS, but what isn’t mentioned is the reason: there is very limited scientific evidence to show the incidence is as high as it is claimed.
‘The scientific literature is not clear about the incidence of sexual problems because a lot of people suffer these symptoms as a result of the depression,’ says Dr Jauhar.
A 2015 review involving more than 3,000 patients found those who suffer depression have a 70 per cent increased risk of developing sexual dysfunction.
One high-quality analysis involving 12,300 men published earlier this year found sexual symptoms continued after coming off SSRIs in just one in 216 patients. While the show did feature one patient who said the sexual effects are worth the benefits, I feel these studies could also have been mentioned in to provide balance.
Experts in the film also comment that one in 50 under-25 year olds will experience suicidal thoughts when taking antidepressants. However, according to an Oxford University study published this month, the incidence is actually one in 217. And, for the majority, these symptoms vanish after a couple of months.
Crucially, the programme doesn’t mention that antidepressants prevent suicides, as shown by University College London researchers in a study from 2013.
They followed 5,000 young people with a high-risk history of mental illness for 14 years and found that 75 per cent of those who committed suicide had not taken antidepressants in the year before their death.
Panorama and Disclosure feature patients with dizziness, headaches and declining mental health once they stopped the drug.
Panorama features experts who claim there is little long-term safety data for antidepressants.
But the programme omits decades of observational data – which follow thousands of patients taking antidepressants over many years – that majoritively show the benefits outweigh the risks.
It also does not clarify that the duration and severity of symptoms differs depending on how quickly you stop taking the drugs.
For instance, one 2015 review found withdrawal symptoms occurred in around 40 per cent of patients – but all of these participants stopped abruptly.
And since 2021, the updated guidance by the National Institute For Health and Care Excellence urges doctors to help patients come off their antidepressants gradually.
‘I very rarely see cases where this can’t in fact be managed by tapering patients off slowly,’ adds Prof Young.
Panorama also claims the public were misled about how SSRIs work. We see old US TV adverts for Prozac that claim the drugs correct a ‘chemical imbalance’ in the brain, which the programme suggests isn’t true.
The narrator cites a paper published last summer, by Professor Joanna Moncrieff at University College London, which found insufficient evidence to prove the role that the chemical serotonin has in depression.
It is true that the scientific community is unsure exactly how the drugs work. But the programme fails to mention several brain-imaging studies that show serotonin is implicated in depression.
These were collated in a rebuttal to Prof Moncrieff’s study a year after Panorama was broadcasted, written by nearly 40 of the UK’s top psychiatry experts.
‘If the drugs work, there must be a chemical effect and there is plenty of proof that serotonin modulates mood,’ says Prof Young.
‘It wouldn’t have taken much to find this evidence and it is a great shame that it wasn’t included.’
A BBC spokesman said: ‘Great care was taken to ensure that a balanced view of the issues being covered was presented. The programmes also make it very clear that any decision to stop or alter a dose should always be taken in close consultation with your doctor.
‘All BBC journalism is rigorously researched and conducted to the highest editorial standards.’