Content Note: in depth discussion of mental illness and medication use, extensive ableism around mental illness and medication use, implied references to suicide, mention of chronic pain, weight loss, self harm, violence towards PoC, and abuse.
My very first distinct memory of depression is from when I was 17 years old, walking into school one morning, feeling awful. Trying to find something to look forward to, I ran through my day in my head. I thought I don’t want to go to first period. I don’t want to go to second. I don’t want to go to break. I don’t want to go to third, fourth or lunch, and so on until I thought, I don’t want to go home. I don’t want to exist.
Looking back, it’s easy to identify that set of feelings as textbook depression symptoms, but it wasn’t until I was 20 that I started receiving treatment for it.
Depression came and went through my young adult life. When a new wave hit me at age 24, I wanted to avoid isolating myself from the people around me as I had done in the past. To hold myself accountable, I got in the habit of writing about how my depression was affecting me on my Facebook page. It was somewhat scary to open up about a topic society encourages you to keep quiet about, but something about writing on the internet allows me to say what I need and not worry as much about how others will react. I wrote about depression on Facebook consistently for several months.
I was somewhat surprised when people I knew started approaching me in person and telling me how much my Facebook posts meant to them. Over and over I heard from people that they too had depression and that they had always hidden it from everyone around them. One man told me that the posts were so meaningful to him because he came from a generation that did not speak a word about mental illness, and it was refreshing to have it out in the open. I had no idea most of these people struggled with mental illness at all.
I came to associate being open about mental illness, provided you have a safe environment in which to do so, with these positive sources of connection. I knew I was benefiting the world around me by talking about it and I became comfortable with the world knowing I had an illness that many people feel shame to admit to.
Staying Quiet About My Medication
In the fall of 2016, a particularly nasty wave of depression hit me. That on top of chronic pain, a job that was detrimental to my health, poverty, and way too many life commitments meant I was I was angry and upset and exhausted all the time.
My therapist and I made a treatment plan, including searching for a new job, and she convinced me to try anti-depressants for the first time. Since job searching can be challenging and discouraging, the weather was getting darker and drearier, and I still had to handle everything that was already on my plate, my therapist worried that my depression would get worse before it got better. She advised that I would benefit from some extra help to get me through this time.
I worked with my doctor to pick a medication, began taking it, and waited. It helped. A lot!
And yet despite my positive experience with the medication and my prior openness about my mental health, I said nothing publicly about starting the medication. When I caught myself hiding it from others, I thought I should make sure to share it on my Facebook like everything else to break the isolation cycle… and then I didn’t. I was scared to openly admit I was on medication for depression.
The truth is, there’s an enormous stigma against taking any medication for mental health, including anti-depressants. I knew I could benefit from connecting to others over the shared experience but the fear of rejection was too powerful. Even now, when I’ve been taking anti-depressants for more than two years, I still tend to not mention that piece of information during public discussions.
The Cultural Stigma Against Anti-Depressants
According to the National Institute of Mental Health, in the year 2016, “An estimated 16.2 million adults in the United States had at least one major depressive episode. This number represented 6.7% of all U.S. adults,” and approximately 44% of that population received a combination of treatment from a mental health professional and medication. Anti-depressants are used to treat a variety of conditions, though primarily depression, and according to the National Center for Health Statistics, 12.75% of the entire U.S. population over age 12 were taking antidepressant medication in the fall of 2017.
They are a standard part of mental healthcare and yet, these little pills are the target of a great deal of cultural scrutiny.
How Stigma Is Enforced
Stigma is a social norm we usually learn from a variety of sources (through socialization). It’s frequently driven home by personal experiences or rejection by important people in our lives, but the media serves an important role in establishing what’s okay and what’s not as well. In the end, we receive the message that anti-depressants are bad for you and you’re bad for taking them from sources all around us, but here are a few potent examples.
From People We Know
When I first started seeking treatment for my chronic pain, my doctor (who I no longer see) first prescribed me anti-depressants; a particular kind that can treat fibromyalgia pain. At the time, I felt as if my pain was dismissed as mental illness. Teary-eyed, I told the story to one of my bodyworkers, who happened to be a strong proponent of healing through supplements and diet changes. She told me I absolutely should not take an anti-depressant and that if I ever exhibited any signs of truly having depression such as not being able to get out of bed in the morning, I should come to her and she’d find a treatment for me.
While trouble getting out of bed in the morning is a very common sign of depression, in all my years of fighting this mental illness, it has never been one of my symptoms.
Having my doctor dismiss my need for pain treatment and then my body worker chastise me for considering the only treatment I had available made an already difficult experience much worse. I learned from this experience that my body worker did not understand how depression worked and wasn’t open to listening to me about it. I didn’t feel I could trust either her or my doctor with discussion of my mental health anymore.
That damage of trust transferred to other people in my life as well. I didn’t talk about my medication because I didn’t want to invite more scrutiny of my mental health decisions by publicly declaring my medication status. And no wonder, I had already seen many examples of that scrutiny and that lack of understanding in the world around me before it ever impacted me directly.
From Memes on Social Media
On more than one occasion, I’ve noticed anti-antidepressant memes floating around social media, posted by friends of mine. There are a few listed below.
(I’ve opted to remove names and promotional urls from the memes, because even bad publicity is still publicity. The memes are easily searchable if you want to track down the sources yourself.)
“What if I told you exercise is better than any anti-depressant?”
Me and my disabled body will get right on that whole use-your-body-a-lot thing.
“This is an anti-depressant. This is shit.”
I will make sure to visit the conveniently located forest in the parking lot behind my apartment complex, every day. Lucky my disability doesn’t require a wheelchair to get around! Forests aren’t very ADA compliant.
“For those of you on antidepressants: Exercise induces the same neurobiochemical response as your medication. If you set a goal to get into shape, not only will you overcome your depression, but you will also gain confidence from your appearance.”
Wow, okay, so not only do I need my disabled body to magically become able enough to exercise the amount and frequency that’s sufficient to trigger that neurobiochemical response, but once I do that my depression will be cured and I will also apparently stop feeling bad about how I look (cause everyone with depression has this problem?) because changing your external appearance definitely always fixes internal problems with self-esteem.
“Fluoride is the main ingredient in Prozac for a reason, it makes you apathetic, your problems don’t go away, you just no longer care about them… water fluoridation is mass medication.”
Ah, nothing like some fear mongering pseudo-science undermining the benefits of mental health treatment AND tooth health management at the same time!
“Saying no to pharmaceuticals is an act of feminism. Every time you open that pill bottle, you are saying, “nope, you don’t got this,” to your body, and you are instilling a message of oppression by a system that says feeling anything is dangerous.”
This is just… I...What? And also, what? This one actually came with a great clap back shown below:
Some common themes among these memes are shaming people for using medication to accomplish something they claim you can do easily with exercise or just going outside, implying that you use anti-depressants so that you don’t have to feel anything and the conclusion that if for some reason the suggested alternative methods of treatment don’t work as described, there must be something wrong with you.
Each time I saw a friend share one of these memes, it reinforced my decision to stay quiet about my anti-depressants. I can only imagine the impact it would have on someone who was not already comfortable with being open about their own mental illness or someone who had not yet gotten up the courage to seek treatment for it.
Even From the New York Times
You may have seen this New York Time’s article on the topic of withdrawal symptoms that sometimes accompany the process of tapering off anti-depressants. I could write an entire piece just pointing out all the ways that this piece encourages stigma against anti-depressants, but here are some of the big problems:
The article fails to differentiate between a wide range of anti-depressant medication until about three-quarters of the way through the article, discussing withdrawals and the negative side effects of long-term use under the umbrella term “anti-depressants” as if they all function the same way. It is later revealed in the central data of the article that for several types of anti-depressants, people taking them don’t show any signs of withdrawal symptoms, or they only show withdrawal symptoms if the patient stops use too quickly. The misleading language implies that all anti-depressants are equally likely to cause withdrawal symptoms upon stopping, making them out to be dangerous no matter what, rather than looking at different drugs as having different pros and cons, depending on the person.
Additionally, the article skims past the benefits of anti-depressants to an irresponsible degree. It only says: "The drugs have helped millions of people ease depression and anxiety, and are widely regarded as milestones in psychiatric treatment." Note the use of the phrase “ease depression,” as opposed to pointing out how they save lives, allow people to enjoy the things they love, and increase their ability to function at all. The benefits are so downplayed, it makes it sound like it’s clearly a lose-lose situation to try taking them.
And then there’s this gem: “Long-term users report in interviews a creeping unease that is hard to measure: Daily pill-popping leaves them doubting their own resilience, they say."
Of course! It must be the anti-depressant that’s making them doubt their abilities. It couldn’t be, say, the depression itself of which self-doubt and low self-worth are primary symptoms, or the stigma internalized from the world around them saying that people who use anti-depressants are somehow broken, that was causing those feelings. No, it must be the medication causing the feelings of self-doubt and shame.
Shining a Light on Depression
The things that are the most stigmatized are often the things we don’t understand. If we remain in the dark about a topic and how it works, we’re free to replace facts with whatever our culture tells us or whatever we feel is true. If you have previously been in the dark about anti-depressants, allow me to enlighten you.
How to Treat Depression
I think the potentially most common misconception that I’ve seen about the treatment of depression, is that there is one way to treat it, one set of results, and one set of side effects. This couldn’t possibly be further from the truth.
My therapist gave me a model for the treatment of depression that forever changed the way I thought about it. She explained that there are four primary avenues for treating depression:
Chemistry is the most well-known form of treatment, which includes both exercise and medication. Environment includes addressing problems with things like work, living situation, relationships etc. Treating thought patterns and behaviors can include therapies like Cognitive Behavioral Therapy (CBT), to reduce the frequency of harmful ideas popping into our heads, such as, “I’m worthless,” or “I’ll never succeed” and self-destructive actions like self-harming, or impulsive money spending.
However, it’s not as simple as just picking one of these four options and running with it. Most people need to pursue more than one avenue of treatment in order to see results.
You can’t always make the needed changes to successfully treat your depression in a short period of time. Addressing environmental problems such as making a plan to leave an abusive living situation, working to develop new thought patterns, or reducing self-destructive behaviors can take a long while. But in the meantime, you’re still depressed! Addressing multiple avenues at once allows for both short term and long term treatments to be in play.
Depression is complicated. It manifests as a huge variety of different symptoms. There is no one fix that works for everyone. To approach any form of treatment for depression as a one-size fits all, or one scary pill that makes everyone numb underestimates the complexity of depression, and more importantly, the complexity of people.
Why Anti-Depressants Might Fit Your Life Circumstances Better Than Other Treatments
When my bad wave of depression came on in 2016, my disability prevented me from exercising nearly at all, let alone the kind of consistent cardio that’s needed to trigger the chemicals that rebalance your brain. My pain, my poverty, and my body-destroying job were clearly a negative environmental influence, but my pain wasn’t going anywhere and finding a new job that paid better would take time and effort. I had been going to therapy for 7 years already, so my behavior and thought patterns were well monitored. The only treatment I really had available to me that fit my life and my needs until I could make larger scale life changes, was medication.
The stigma-enforcing-memes don’t take into account the variety of life structures that exist, and the article warning against the possibility of addiction doesn’t acknowledge the kind of benefit the medication could have for a variety of situations that balances out the potential risk.
What Anti-Depressants Feel Like
While there is a subset of people who take anti-depressants who feel numb as a result, lack of feeling is not the intended effect of anti-depressants as the memes imply. Usually, if your emotions are shutting down as a side effect of the medication, it’s the wrong treatment for you. It shouldn’t make you numb or constantly happy. A good doctor/psychiatrist will make changes in response to a patient feeling that way.
For me personally, anti-depressants don’t make me numb, depression makes me numb. Depression doesn’t manifest as an abundance of bad feelings in my brain, it’s an emotional blankness and soul-crushing boredom. When I began taking medication for my depression, I started feeling emotions again. It actually allowed my feelings to flow even more freely than they normally do when my mental health is stable. A feeling that can flow is a feeling that can run its course fully so that you can recover from it, rather than getting stuck feeling it or trying to escape it for weeks on end. Kahlil Gibran famously said, “The deeper that sorrow carves into your being, the more joy you can contain.”
The Role of Ableism
The stigma against anti-depressants is really just a poorly disguised cultural rejection of all mental illness, otherwise known as ableism. It’s the idea that you shouldn’t need treatment, that if you just make one or two simple changes you’ll no longer have that problem, that most people would rather you pretend you don’t have this problem so they don’t have to think about it, and that if these minor changes and pretending everything is fine doesn’t fix it, you are dismissed as too dysfunctional to be even offered compassion.
But wait, there’s more. In addition to the implication that you should be able to rid yourself of mental illness if you would just try hard enough, the repeated insistence in the memes on exercise being the best-- and only-- treatment, assumes a level of physical ability that many people don’t have.
Disability and chronic pain occur concurrently with depression at high rates: According to this study, "Up to 85% of patients with chronic pain are affected by severe depression." And if that physical limitation prevents you from regular cardiovascular exercise, that treatment path is not available to you. The memes reinforce the idea that people who are physically unable to exercise do not exist and that people who are mentally unable to be happy naturally just need to pull themselves together. It’s just ableism all the way around.
The Deadly Harm of Stigma
Memes and articles aren’t stand alone things that exist independently on the internet. They are created by people and they are shared by people. The thing that makes a piece of content successful online is that millions of people believe it to be true and are compelled to share it.
The stigma embodied in the content above is representative of our culture’s opinions about mental illness and using medication to treat it. How do you get treatment for your mental illness when the prevailing social attitudes about it mean there’s a good chance you grew up in a household that didn’t acknowledge the existence of mental illness let alone encourage the pursuit of treatment for it?
That stigma also influences institutional forces, which in turn influences what treatment options people have. Mental health services are difficult to access if health insurance doesn’t cover them or if you can’t get health insurance at all. Paid/excused sick days for work or school are a rare enough privilege as it is, and many authority figures don’t consider poor mental health to be a good enough reason to use a sick day, FMLA, or to seek formal accommodation.
But the reality is that this society-wide stigma is dangerous. Mental illness can be fatal and medication can be life-saving. Shaming mentally ill people into silence discourages them from seeking treatment even if their life is in danger. If they believe that they shouldn’t need help, they may not seek it when they do. Discouraging medication use could unnecessarily limit a person’s treatment options or could persuade someone who’s benefiting from medication to stop taking it. The current mental health system is such that it is hard enough to get the treatment you need without also risking social rejection over it.
Even worse, the stigma against mental illnesses and medication use disproportionately affects women, people read as women, and people of color. There’s a long cultural history of women and femmes being perceived as hysterical (which the “pharmaceuticals are anti-feminist” meme alludes to). Women’s emotions are considered irrational and not something that should be indulged or validated, let alone treated, while black people are killed or imprisoned regularly because their basic symptoms of mental illness are perceived by white people as a physical threat.
If you have ever posted a meme like the ones above, there’s a good chance that some of the mentally ill people in your life silently made the decision to avoid opening up to you about their struggles in the future. It may have even discouraged them from opening up to anyone.
Why We Need to Talk About Medication Stigma
The information available about depression and the medications used to treat it are frequently incomplete and/or inaccurate. It’s easy to fill in those blanks with these beliefs that are so prevalent in our society if you don’t have information to tell you otherwise.
Even I started out with that entirely common bias against anti-depressants. When I was 20, my therapist mentioned that medication was an option to treat my severe depression. In response, I said, “No thanks. I don’t do Happy Pills.” The belief usually doesn’t come from a hateful place, but it can have a hurtful and oppressive effect on already vulnerable people.
That’s why it’s so important to talk about it. If it’s not safe for you to be open about your mental illness or what treatment you’re using to manage it, I don’t recommend you sacrifice yourself for this cause. But the more we can talk about how depression actually manifests and functions and how medication actually helps, the more misconceptions we can correct. The more neurotypical folks are active in volunteering to listen and approach these conversations as an opportunity for learning, the more success we will have in enlightening them.
The truth about anti-depressants is pretty simple and not terribly scary: They are a tool. They work for some people and they don’t work for other people. For some, they are so useful that they help keep them alive and/or give them another chance at life. That seems like more than enough benefit to warrant keeping them as a treatment option and to encourage people to try anti-depressants if it makes sense for them to do so.