When the drugs actually work….

This week I had a ‘first’ in my life as a medic. I had a young woman come to see me in my ‘student surgery at the GP’s last week with a first presentation of depression. I’d taken a history, done the questionnaire etc, and suggested some medication (and referred for psychotherapy), checked everything with the GP, who agreed, and we asked her to come back in ten days to see if she improved. Because my allocated psychiatry block was with an intensive home team, and how my other placements have happened to fall, I’ve never actually seen someone with mental health problems improve in a clinical setting. When she came in again on Friday, it was like seeing a completely different person. It really did seem like a miracle. Antidepressants, when you get the right one, for the right person, at the right dose, really are life-changing. She wasn’t crying, she wasn’t thinking about killing herself, she was sleeping and eating better, all round, it was so good to see. Such a difference to how she was before. Incredible. She was also really thankful that we’d managed to sort her symptoms out; I felt like I’d been part of making a difference. It’s a good feeling. Obviously, this person will still have a long way to go before she’s fully back to ‘normal’ – but hopefully she’ll get there a bit sooner than I did!

This made me think about two things:

1) I sometimes let my own experience of antidepressants colour my view of them – seeing a clear case where they actually significantly helped someone, has sort of renewed my faith in them as options that actually can work. I get a bit cross when they’re handed out like sweets as an easy option, but it’s good to remember that there is an evidence base behind them, they do work, and they do make a difference, and it’s not just that other options are more expensive to deliver. If I am going to give hope to my patients, I need to have hope myself that these drugs will work for them, some of them, anyway.

2) I gave up on antidepressants. I clearly wasn’t given the right one for me, and had a horrific six months of putting the dose up, and up, and then stopping it myself as it completely accelerated my dangerous thinking and gave me a tremor that frankly scared me senseless. The second time it was increased, I didn’t eat anything at all for four days and only realised that when I fainted and was asked when I’d last eaten- that’s how out of synch it made me. I wasn’t fortunate enough, like so many are not, to get put on the right one. And when I lost faith in fluoxetine, I lost faith in all of them. I was afraid to try another one in case it also pushed me close to the edge. I was too scared to use something else psychoactive. Sometimes, I wish I had been braver – I was not brave. I was more scared than I’ve ever been. Sometimes, I wonder if this whole episode would have lasted the full year it has, had I been put on citalopram or sertraline from the word ‘go’ – I’ll never know that. I only know that doing it cold, was tough – but I didn’t really have anyone encouraging me to try it another way.

People ask me sometimes how I manage being ‘hard core into science’, and a Christian. I love science; I love being involved in research and finding new things out. My specialist areas are across neurodegeneration, plasticity, and molecular genetics, and I love learning about how our bodies work on the most intricate level. I love that someone worked out what’s going wrong in a disease, and someone else engineered a drug to target that mistake. These things only strengthen my faith; when I see someone improve as I did this week, it’s as though I’m seeing the tools God has given us to start to put right all the stuff that’s wrong, all that’s not ‘good’. God so often gives us the keys we need to set things right. For me, science is a big part of that. Medicines, are a big part of that. I’m not saying they’re the only solution, at all – but it’s been good to remember this week that often they are a big part, of a solution. When science works, it’s pretty cool.

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