Coming off Citalopram after five years was not a decision I took lightly.
My doctor and I made the decision together, after long conversations with my friends, family and partner, who all believed I was in a good position to do so. I tapered off them slowly, as you’re advised to. I built in self-care, cut down on drinking, took a week off work, exercised, and ate healthier.
I began taking antidepressants when I was 26, during a year when it felt like my depression was piling on top of me. I had dealt with mental illness for years, but for the first time, it felt like I was drowning. After breaking down at work and calling the employee mental health helpline, I decided to take control. I went on Citalopram and began seeing a therapist regularly.
Antidepressants balanced me out so well that even in times of hopelessness, sadness, or anxiety — particularly during the Covid-19 pandemic — my panic attacks all but went away, and even though I experienced lows, as everyone does in life, they no longer left me feeling suicidal.
As the pandemic eased and I returned to normal life, my doctor agreed it seemed like I no longer needed the medication, and I could think about going off them. I did so with her help, and after a pretty horrendous withdrawal period, I actually felt really good. I felt relieved I didn’t have to remember to take a pill every day and pleased I managed to taper down safely.
Within six months, the depression threatened to drown me again.
Antidepressant use is rising in the UK, with as many as 4 million adults in England being prescribed antidepressants in the past year. It is reported that two million people have been taking them for five years or more in England.
The report didn’t mention the cause of the rise, but the cost-of-living crisis, growing poverty, and going through a traumatic pandemic could be part of the reason Brits are increasingly looking for mental health support.
I had felt an internal stigma against antidepressants before my doctor suggested them; they are the subject of countless jokes on TV and film, tabloids often use the language of addiction around antidepressants, and a small part of me (in an incredibly British way) genuinely believed it was “cheating” to manage my depression with medication, as opposed to pulling myself out of it with a determined enough mindset.
In March, NHS England published a plan to help patients come off antidepressants, as well as help people manage withdrawal symptoms. As part of that plan, it could provide art therapy as a replacement for antidepressant use, or prioritize talking therapy over prescribing drugs.
Therapy is a fantastic resource for those who can access it, however, with waiting lists for NHS therapy growing, the idea it should be prioritized over receiving the more immediate relief that comes with antidepressants doesn’t seem practical. The alternative, private therapy, is largely inaccessible for many in the UK due to cost.
Much of the stigma surrounding long-term antidepressant use comes from their side effects, along with the idea that medication withdrawal is a sign of them being “addictive.” The same harmful assumptions are often leveraged toward those taking painkillers long-term for chronic illnesses.
I don’t love the comparison of mental illness to physical illness, or when people imply mental health isn’t taken as seriously as physical illnesses, because one thing women, people of color, and disabled people can agree on is that their own physical health is often not taken seriously enough. Solely within the discussion of medication, however, I will make the comparison.
Several of my family members have chronic physical illness requiring life-long treatment, with some drugs causing severe side-effects that require additional medication to treat. Those side-effects, while potentially harmful, are rarely seen by doctors as a reason to cease using any medication, nor is life-long use of something like blood pressure medication ever described as “addictive.”
In my experience, depression behaved similarly to a physical illness. It made me exhausted all the time. It made my chest hurt, gave me headaches, diminished my appetite, made me experience shortness of breath. If all of this could be alleviated with medication, so what if long-term usage came with risks?
Since coming back on Citalopram, I feel lighter, more clear-headed. It didn’t erase my depression, but it lifted it enough for other coping mechanisms to have an impact. I realized while I might not need to be on medication for life, if that ended up being the case, I was okay with it.
Experts claim while long-term antidepressant use is appropriate for people like me — whose conditions were severely impacted by coming off them — everyone is different, and communication with doctors is crucial in deciding the right kind of treatment plan.
“Antidepressants are effective at reducing the symptoms of moderate to severe depression, particularly when used in combination with talking therapies,” a spokesperson for the Royal College of Psychiatrists said.
“Long-term use of antidepressants should only be considered for people that have recurrent depression and repeated, severe relapses after stopping antidepressants. For those patients, the beneficial effects of continuous use of antidepressants are more likely to balance the potential risks. However, this should be reviewed regularly, and multiple attempts should be made to stop taking these medications after prolonged periods of established wellbeing.
“We advise all those thinking of stopping their antidepressants to talk to their doctor first, as these medications should not be stopped abruptly.”
Some doctors believe, however, that side effects from antidepressants don’t get more dangerous over time, and that taking medication can be beneficial in the long term.
“These medications have been around for decades,” Dr. Jin Hee Yoon-Hudman, a psychiatrist and medical advisor at Minded, told the publication.
“There’s really no evidence that people have had serious side-effects or adverse effects from being on SSRI medications for too long.”
She added: “There’s a lot of work we need to do in society to help people understand that taking care of mental health is just as important as taking care of physical health.
“If you had asthma or diabetes, you’d take meds the rest of your life, so why is mental health any different?”
Antidepressants will be a contentious issue for as long as mental illness itself continues to be stigmatized, and while I don’t take the risks associated with medication lightly, it’s also true that antidepressants turned my life around. In my experience, both therapy and medication were invaluable resources, but I don’t personally believe I could have gotten the most out of therapy had it not been for Citalopram.
It’s taken me a long time to overcome the internalized shame I had against my depression, but I know I’m in a better place for being on medication, and that it’s personally the right choice long-term.
Whether people manage their mental health with medication or, in other ways, take antidepressants for just a few months or for several years, we all deserve to feel like our health is being taken care of, regardless of stigma.
Emily Chudy is a writer and journalist from London. She has been published in The Independent, Slate, Glamour Magazine, PinkNews and more.
