October 13, 2002

Mad, bad and dangerous
The executive’s See me campaign is based on commercial pressures not clinical fact, and is best ignored by the afflicted, writes Tim Luckhurst

In April 2000, after months as acting editor of The Scotsman, my employer informed me that the trial period was over. I was appointed editor. Two weeks later, during my first full weekend break of the year, I collapsed at our family home in France. My blood pressure was raised. I had bronchitis. For months I had been too tense to sleep. My family was sick of hearing me lose my temper over trivial irritations. When I was at home all I did was shout and smoke. I should see a doctor.

It seemed sensible, so I flew back to Glasgow and an urgent appointment with my GP. He could not have been kinder. Calmly but firmly he informed me that the physical symptoms were real, but not grave. The core problem was bigger. I was clinically depressed. He ordered me to take a minimum initial break of four weeks, prescribed a course of anti-depressant tablets and suggested I take as much gentle exercise as possible.

It did not cross my mind to challenge the diagnosis. Depression, my doctor said, was an illness. I had it and it was treatable. If I took the course of selective serotonin reuptake inhibitors (SSRIs) I would start to feel better. He gave me a sick note that said I was suffering from hypertension, but not depression. He advised me not to mention it either.

I ignored him. What possible harm could be done by telling my employer the truth? I was entirely candid with The Scotsman. My doctor knew all about the stigma that attaches to any form of mental illness. I was absurdly naive.

Six weeks later, feeling healthier than I had for years, my GP agreed I was fit to return to work. I was raring to go. My boss was having none of it. I was informed that I could not return as editor. His explanation was plain. "It might happen again." I refused the offer to go back to work in a demoted role and we agreed severance terms. The Scotsman was generous, but I was unemployed.

So, having apparently been a victim of the prejudice which says that nobody who has suffered from depression can ever be fully trusted again, I ought to be a vociferous supporter of the Scottish executive’s See Me campaign against the stigmatisation of psychiatric illness. I certainly know that stigma exists.

Dr Peter Byrne, a consultant psychiatrist and member of the Royal College of Psychiatrist’s campaign against stigma, told me: "If you tell your boss you’ve been treated for depression you are worse off than someone who is caught with their hand in the till." Another leading practitioner said: "Employers still regard a history of depression as less desirable than a prison sentence." So, there it is. I am less likely to get a job than Jeffrey Archer or Jonathan Aitken.

Depressing? The thing that makes me angriest is that I do not believe I was ever clinically depressed, nor do doctors who have examined me since. The facts are alarming. Until the introduction of the first wave of tricyclic antidepressant drugs in the 1950s, clinical depression hardly existed. The few treatments available before then were either absurdly expensive or dangerous. That is why the millions of second world war combat veterans who had excellent reasons to feel substantially more melancholy and massively more stressed than I ever did were never invited to believe they were ill.

Drugs democratised the disease. As soon as depression became treatable, its diagnosis rose in frequency. The introduction of tricyclic drugs in 1958 was of epochal significance, but it looks almost trivial compared to the impact SSRIs such as Prozac and Zelmid had when they hit the scene in the 1980s.

Since SSRIs were introduced in Britain there has been a 50% increase in the number of patients deemed to be suffering from clinical depression. As one psychiatrist told me: "We should not convert all human problems into illness. SSRIs make everyone feel good.

"But it is not the job of psychiatry to lend the lustre of science to this kind of folkloric self-medication that is driven forward by commercial interests."

Can that really be true? Is it possible that tens of thousands of Scots are told they have a serious illness they really do not have simply because drug companies have devised products that can make miserable people feel less glum? Consider. SSRIs work on the theory that depression is caused by a shortage of a drug called serotonin in the brain. That might be true, but psychiatrists admit that the drugs work by accident and came about by serendipity.

In other words, no patient who visits a doctor with symptoms that can be associated with clinical depression is ever tested for serotonin deficiency. No accurate test exists.

Most depressives get better naturally: 20% of them stay unwell or get worse if they are not treated, the other 80% start to get better in about six weeks if they are treated and from nine months to a year if they are not. So, even untreated, depression goes away. In other words, most of the people whom psychiatrists admit are in danger of losing their livelihoods if their employers discover they are being treated for depression would recover if they were never treated. A minority would not; about 6% of untreated clinical depressives kill themselves, but most citizens currently taking antidepressants would get better without them. If they rejected both the diagnosis and the prescription they would would avoid any risk of stigmatisation.

My response to the See Me campaign is this. The official estimate that one in four people in Scotland will suffer from a mental illness at some point in their lives is nonsense piled upon fiction and rooted in lies.

The risk of encouraging people to believe they are clinically ill when the truth is that they are facing stress at work or disappointment in their personal lives is too big to take. A minority that is genuinely ill needs and deserves the best treatment available. But before we leap to assume that the song is wrong, and that it is depression not love that is all around, we should think very hard.

Before the stigma of mental illness is even dented, thousands of people will discover that being diagnosed with and treated for depression is infinitely more dangerous then rejecting medical orthodoxy and getting better in private. For every survivor of a breakdown, there are dozens who are told they are suffering clinical depression when they are merely exhausted and miserable.

I threw my pills away. I felt fine after a brief rest. I still do. My response to the depression industry is blunt: sometimes people get knackered. Calling that psychiatric illness is irresponsible. Physicians simply love to diagnose what they think they can treat, but the fact they think they can now treat depression does not mean that many of their patients are clinically depressed. Remember that if your doctor offers you antidepressants. Unless you are contemplating suicide, you do not need them.

The drugs may or may not make you feel better, but accepting the diagnosis is guaranteed to do you harm. So, to the executive’s invitation to stand up and be counted in the effort to eliminate stigma I say, don’t. You would have to be mad.