This week I turn 43 years old, which means it’s 32 years since I was first put on anti-depressant medication.  

It was the early 90s, I was 11 years old, and a traumatic event had left me depressed and anxious, so our family GP prescribed Prozac, the wonder drug of that moment.

I don’t remember if this was deemed unusual for an 11-year-old but it certainly unsettled my parents and so within six weeks, after little sign of improvement, they (and I) decided to come off it.

Life went on, the trauma buried (rather than resolved) and I was happy again for a while. Fast forward to aged 27 and in-between good times I’d also experienced years of on-off anxiety, depression and issues with addiction.

My GP put me back on antidepressants, a widely used selective serotonin reuptake inhibitor (SSRI) medication called citalopram. I felt a slight mood boost after a couple of weeks and a leveling out of all emotions (joy, anger, sorrow and excitement).

Still I found myself struggling with a sense of emptiness inside. Achievements – in love, career or money – felt temporary and only preceded the longing for more.

My GP suggested I double my dose from 20mg to 40mg but I was wary of the “just take more” approach. Better to be struggling and unmedicated than struggling and on pills, I thought, so without telling my GP, I tapered off instead.  

I tried to ignore and numb (with alcohol mostly) the loneliness and insecurity I felt.

At aged 29, still off medication, I was ready to try therapy, to maybe look deeper into the cause of my struggle. I’d just do it for a few months, I thought, naively, since this was the start of a years-long journey.

It helped enormously but did take time. I learnt about my negative patterns and how they’d developed from early family dynamics. I stopped drinking completely and found a way of being more authentic about my emotions which, when shared, were easier to ride out.

In the latter part of this epic voyage, aged 35, I began a six-year professional training in psychotherapy. During this time, I had some wonderful breakthroughs and some more challenging times. At one point I saw a psychiatrist who suggested I try a different medication. This one was called venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI) medication. Unlike an SSRI (citalopram, fluoxetine, sertraline, to name a few), this type of antidepressant works not just on the serotonin system in the brain (responsible for mood, sleep and sexual desire) but also norepinephrine/noradrenalin, the neurotransmitter responsible for (modulating) the stress response.  

Almost immediately, life’s intensity levelled out and more so than with the previous SSRI medication, citalopram. I was happy, and a bit surprised since the psychiatrist had told me that research indicated all antidepressant medications helped 70 per cent of people but there was not yet any clear reasons why (or which) 30 per cent would not respond positively.

At this point also, many in the medical profession were starting to dispute the notion that depression is due to a chemical deficit of serotonin in the brain. Dr  Camilla Nord, director of The Mental Health Neuroscience Lab at the University of Cambridge MRC Cognition and Brain Sciences Unit and author of  The Balanced Brain: The Science of Mental Health, says: “There is definitely a time for antidepressants, and sometimes long term. Though it’s no longer helpful to talk about a serotonin deficit in the brain, that doesn’t mean we can’t still target the serotonin system [with medication]. By using anti-depressants you aren’t correcting a deficit, you’re adjusting the computations of the brain. These small shifts can, over time, add up to something larger like a change in mood.” 

This was exactly my experience. My psychiatrist had insisted that neither an SNRI or SSRI would yield a positive response for at least two weeks – more likely closer to four. Yet, unlike before, I felt a positive shift by day two, a little bit “high” perhaps but also solid again. I liked myself more, almost immediately, I worried less, had less self-doubt. After four weeks, I was so much more stable. After two months, even more so.  

Was it placebo, that it worked so quickly? Probably not, according to Nord: “Although SNRIs and SSRIs take about 4-6 weeks to produce a positive and consistent shift in mood, some research suggests they can work in other ways within as little as one day.”  

Nord cites the research of Oxford scientist, Catherine Harmer, whose lab found that after one or two doses of antidepressants there was a detectable difference in how people interpreted ambiguous things in the environment, for example faces that could be interpreted as happy or sad.  

“Those with depression will usually have a bias towards the negative emotion and interpretation even when a face is neutral or happy. But if you give people a dose of antidepressants this bias will change [and over time this can change mood].” 

This certainly chimes with my experience and an acquaintance of mine, Ewa’s. Ewa is a 44-year-old acting coach who has suffered with severe mental health problems since childhood, including bipolar disorder. She says: “SNRI medication was the only thing that has really levelled me out [when taken in conjunction with my bipolar medication] whereas before I felt so numb. I can function. I’m my best version. I’ll happily keep taking them.” 

For Clare, a 38-year-old investment manager, it was dosage changes that made the real difference. She had spent years going on and off various antidepressant medications, and tried citalopram for a while when she finally experienced breakthrough after the dose she was on was doubled.

“I’d almost lost hope in these medications if I am honest. But I gave this a go and the shift was amazing. Previously I was so sensitive about everything, now I’m more robust and loving it,” she says. “It’s like a dream. It’s no big deal to take two pills [instead of one] in the morning to have a semblance of a happy life.” 

If it all sounds a little bit like trial and error, then that is probably because it is. This is hardly ideal but does encourage some perseverance if you have stubborn mental health symptoms that don’t respond to psychotherapy (and/or other healing modalities) alone.

“Scientists are starting to understand more about how they [antidepressants] work [however] and this could potentially change the way clinicians use them,” says Nord. “There are two ways this could influence treatment.  One is who  is treated: figuring out the right medications for the right patients. The other is how  someone gets treated: perhaps in future  the  doctors could  pair medication and  therapy  during that time  to enhance the effect of   both treatments and then you’d be carefully titrated off.” 

With hindsight, I can see that before I started taking venlafaaxine and responded so well, I had developed a subtle bias against psychiatric medication. Like some others I’ve met in the psychotherapy profession, and also the psychedelic community, I thought the noblest heroes were those who survived the hellscapes of their mind “au naturelle”. Now I see how medication can aid therapy progress and vice versa, rather than running in opposition or even alongside one another.

Nord agrees: “There’s an unhelpful divide in society between psychological explanations  and treatments and biological explanations  and treatments  for mental health problems.”

“The reality of mental health is that it’s all happening  via  your brain,  even if those changes come through  your social environment. Taking a pill  affects  your mind and changes  your mental processes,  just as psychotherapy affects  your brain chemistry.  All treatments are biological and social in nature.”