THE chances are if you’re reading this article you’ll have an opinion about psychiatric medication such as anti-depressants.

If this were an article for the Daily Mail you would probably not only have an opinion about such drugs but also about the people taking them.

Judgemental views on anti-depressants can come from many places. Recently a book, Lost Connections by Johann Hari, gained a lot of publicity in the press and online.

One interview he did attracted plenty of comments. A person wrote: “I will go a step further and say bipolar [disorder] and schizophrenia are fake illnesses too. I’m not saying people are pretending to be ill or are lying. I’m just saying they don’t exist, not like diabetes or cancer … To be a real disease there has to be a biological test or pathology.”

To attract this sort of comment, Hari claimed that by changing the aspect of your life making you unhappy, individually or collectively, you can conquer depression.

The “advice” that anti-depressants are ineffective or that a change in circumstances is the one, true solution to mental-health difficulties can lead to people abandoning their anti-depressants.

If this is done hurriedly and without professional support, the potential physical and mental health implications can be dangerous.

The disparity in the way psychiatric service-users are treated as opposed to those with physical health problems is something neuroscientist Dr Dean Burnett has studied. He argues: “Much of the constant debate around anti-depressants medication does largely boil down to stigma.

“I was on a panel recently with Dr Clare Gerada and Professor Ann John who deal extensively in this area and they said the same thing.

“Nobody bats an eyelid when someone’s on constant medication for diabetes or takes statins or certain vitamins. When it’s anti-depressants or similar, people feel very inclined to judge and condemn.

“They might claim things like how it’s all a big pharma conspiracy created to drive up profits, but statins and vitamin pills are totally fine for some reason.”

Rosie Claverton, a junior psychiatrist and author, says: “I often find people are keen to stop their mental health medication quickly, even if they experience few or no side-effects and are only in the early stages of recovery.

“Some even proudly tell me they ‘never take a pill for anything.’ The association between taking medication and weakness in our society is disturbingly prevalent and can lead to self-hatred that feeds into mental health problems.

“By contrast, the wellness movement means people are obsessed with finding the right food or supplement to improve their health.

“A woman with a first episode of psychosis asked me if there were any vitamins she could take to help with the voices and depression. I had to explain to her there isn’t any good evidence for that, but it was the only ‘treatment’ she found acceptable.”

Depression and anti-depressants seem to be where pill-shamers concentrate most of their time. Burnett says there are copious reasons why this is the case.

“One is that anti-depressants are not 100 per cent effective and reliable, so many people will have had a negative experience with them or found them to be ineffective.

“This will obviously colour people’s perception of them and, given how commonly they’re used, this is something that’ll happen often.

“Another is we don’t know for certain how they work yet. We know they increase levels of neurotransmitters that seem to be depleted in depression but we’re not sure why this ends up being therapeutic or why it can take three or four weeks to ‘kick-in’.

“There are more social factors too. The influence of the pharmaceutical industry in psychiatric diagnosis is something that needs close attention paid to it.

“The mental health diagnostic manual we use in the UK is the ICD-10 — and it came out in 1994! The DSM-V, which is the US version and used by psychologists here was very heavily influenced by the nature of the US healthcare system.

“Diagnostic coding in the US is driven by the amount of money a healthcare intervention costs.”

Claverton stressed: “Sadly, due to Payment by Results this is increasingly happening in NHS England as well.”

So, a further factor is this link to healthcare settings, finance and how readily available treatments might be. It may be the case that doctors overprescribe anti-depressants, Burnett said. “Though, I maintain this is more of an indication of an increasingly stretched and underfunded health system.

“For example, talking therapies may take hours with a trained professional, but a box of cheap pills is a much quicker and easier way of helping someone who is clearly in distress.”

Claverton felt that improving access to psychological therapies has improved this in some areas. “But the focus on CBT to the exclusion of longer, more expensive interventions means that some people aren’t getting the individualised approach they need.

“Taking this all into account,” Burnett said, “I think pill-shaming stigma is largely rooted in the idea mental health problems aren’t as ‘serious’ as more physical ailments.

“Nobody questions a broken leg or bout of pneumonia. However, with mental health it is far more subjective. It occurs within a person’s own head and cannot be easily seen from the outside.

“The behaviours manifested therefore don’t seem to have an obvious cause, so it’s easier to think that a person is putting them on or just being unreasonable or attention-seeking. 

“Plus, the term ‘depressed’ has more everyday expressions too. This means people who don’t suffer from it, feel able to judge, as they think they’ve have had similar experiences to the person who really does have depression.”

Claverton agrees: “I think the lack of biological testing and scans for mental health problems adds to this stigma, including within the medical profession.

“However, we also have a myriad of opinions within the mental health, psychology, and service-user movements. This will shape the mental health services of the future, when my hope is that people will be able to access the support they need.

“This will be without judgement, in the form that answers their difficulties, in a way that’s acceptable to them — which might include timely and targeted use of medication.”

Dr Dean Burnett is a neuroscientist, author and blogger for The Guardian. You can find his work on deanburnett.com. Rosie Claverton is junior psychiatrist, novelist and screenwriter, visit rosieclaverton.com for more from her. Ruth Hunt is a freelance journalist and author of The Single Feather. Her website is theasilentroar.wordpress.com.