We need to talk about pill shaming

I dedicate this piece to my longstanding GP and psych. Thank you for your dedication, care and decency.

You know that there are issues surrounding mental health medication – specifically antidepressants – when you worry about dropping an empty pill packet in the bin next to your desk at work. I think it’s fair to say that all sides of the pill shaming debate can agree on that.

I often find myself pulling the empty Effexor (venlafaxine) pill packets out of my bin at work and dumping them in the communal bin in the kitchen. That way it can’t make its way back to me. No one will be able to work it out, I think to myself.

Don’t get it twisted: pill shaming is real. It has been around, in a variety of forms, for centuries. The truth is that it has played a significant role in the development of modern masculinity, femininity and our comprehension of ‘strength’ and ‘weakness’.

What is pill shaming?

Instead of regurgitating some highfalutin definition, allow me to show you examples of pill shaming.

Disclaimer: Many of us have, at some time in our lives, unknowingly thought or said something akin to pill shaming. Our aim shouldn’t be to slam or shame. That inhibits our ability to pursue knowledge and uncover new ground.

Now we’re ready:

Pills are a sign of weakness.
Don’t you feel weird taking medicine for that?
Why don’t you just exercise more?
Have you thought about ditching it and improving your diet?
I read that pills do nothing but make you dependent and weak.

If you still want a definition, Urban Dictionary’s is more helpful (and colourful!) than many.

Pill shaming is most-often directed at people who take/endorse taking psychotropic medications are part of a mental health relapse-prevention/recovery plan. As with fat shaming, pill shaming… frustrates and humiliates individuals who may already be feeling self-conscious and vulnerable.

I’m not sure if I’d go that far, but I would add that pill shaming often comes from a place of ignorance. For example, you won’t find as many doctors overlook the role of medication in assisting with mental health illnesses today as you would have twenty years ago. In fact, my GP professes to “specialise” in mental health issues and has played a pivotal role in assisting me with medical advice and educating me on mental health community services available. (It’s invaluable to find a GP who takes an interest in mental health illnesses and issues. Don’t be afraid to ask practitioners questions!)

When I was initially dealing with my anxiety, I went to my doctor who spent a total of five minutes with me before he sent me out of the door with a written prescription for an SSRI. Being young and inexperienced, I had no clue how to administer this, what to look for, or even how my recovery process would look like. I resulted to watching YouTube videos and hosting my own “trial and error” session. Had I known from my doctor what to expect, I probably would have given that brand a chance. Or, I would have asked for alternative options. - Kassidy Mi’chal, CoolForThought

My pill journey

Pill shaming first entered my life through observation. Watching and listening to what family, friends, even acquaintances and strangers said about medication and those suspected of taking pills. I recall one memory in particular where someone I was close to scoffed at the proposition of someone else going on medication due to learning and mental health difficulties. When you mix these memories with a fear of standing out or being exposed, it’s no wonder my reaction to my doctor’s suggestion of antidepressants was negative. (I was seventeen at the time.) Actually, my response was aggressively negative. I recall riding home with mum and reflecting on what the doctor had suggested.

I don’t need pills! I’m not like that, right?

I don’t have anxiety issues.

I’m definitely not depressed.

I just need my girlfriend back.

I need to stop drinking and knuckle down.

Looking back, I wish I had aired these thoughts. Then again, not only was I not ready to hear what I know now, I don’t think anyone I trusted would’ve been able to have the conversation.

Despite my mother’s best efforts, I refused to take the antidepressant (Zoloft) the GP had suggested. Nine years would pass before I dared to walk into another doctor’s office and have an honest and frank conversation about depression, anxiety and medication.

There is a lot of misinformation about antidepressant medication and there is no simple explanation as to how it works. Medication can be important in the treatment of moderate to severe depression and in some anxiety conditions. - Beyond Blue

Beyond Blue’s words (above) were among the first I read about mental health medication in nine years. I sat perched on the edge of a black leather couch in the GP clinic, my left hand trembling as I attempted to digest the information on the stylish pamphlet.

After filling out a gruelling but necessary mental health assessment, the GP scored my stress, anxiety and depression levels and proceeded to inform me about the role antidepressants can play in my recovery. The picture she painted wasn’t black and white, and I appreciated that. She also worked out that I’m someone prepared to do research so long as I am guided to reliable sources. It was then that I started to understand the complexity of the medication. Antidepressants weren’t as straightforward as taking paracetamol for a throbbing headache. Various side effects can take hold: nausea, fatigue, drowsiness, weight gain, insomnia, blurred vision, to name a few. While there is a decent body of knowledge when it comes to what these drugs can do to assist consumers, side effects and the all too common need to switch medication need to be discussed openly.

To date, I have been on four anti-depressants. I currently take a high dosage of venlafaxine each morning. You have no idea how difficult it is for me to write that last sentence. I continue to feel shame for having to take a high dosage. Part of me continues to think along the lines that someone with a wonderful wife, 18-month-old daughter and a decent job and life shouldn’t need to take pills. Yet this thought pattern and narrative has festered and grown out of pill shaming. I’ve believed the lie that to do well and appreciate life one has to be free of medication.

Parting thoughts

Medication is not a sign of weakness

Would you shame someone for taking medicine to assist with a disease? No. Then why shame someone who needs, say, a selective serotonin reuptake inhibitor (SSRI) to increase serotonin to improve mental clarity and assist with mood swings? Yes, there are various ways we, as individuals, improve health and well-being, so why be shut off to medical options?

Please remember that many antidepressants take four to six weeks to take full effect. This is painful—especially when you consider dosages often need to be tinkered with. Therefore, it is essential to go in with your eyes open; understand that you need to create scaffolding. This may take the shape of medication, (frequent) GP meetings, counselling, psychiatry, dietary assistance, etc. It also pays to read the fine print that comes with antidepressants. Don’t neglect the instructions and information given by manufacturers.

Sharing is caring and educating

It has taken me the better part of a decade to come to a place where I feel OK sharing my story. I’m willing to tell others what I’ve experienced to assist and break down stigmas and barriers. If you know my beautiful wife, Claire, feel free to ask her about my journey. There have been times I’ve (rudely) chewed her out after learning that she shared part of my mental health journey and issues with others. In the past I’ve felt exposed… as if Claire sharing will lead others to look down on me.

Claire first brought Journeys with the Black Dog to my attention during a mental health crisis in 2017. For Claire (the carer) the book helped her work through and digest accounts of other sufferers. It challenged her assumptions and gave insight into what her partner might be contemplating. The writing is frank and reflects the depth of the individual’s story. It doesn’t try and shove products down your throat, it’s about riding shotgun with those who have (and continue to) struggle with depression. Through beautifully crafted and edited stories, sufferers, carers and anyone who wants to understand the depth of depression are informed.

The first choice I had to make involved using a medication to correct the chemical imbalance in my brain. I was terrified. The prospect of lifelong drug dependence hung over me like a dark spectre. I took the first step out of desperation, rather than courage, and was pleasantly surprised. - Journeys with the Black Dog

At the end of the day, if you are suffering—if the clouds have rolled over and darkened your horizon, please know that steps don’t have to be defined by leaps. What may look like stagnation to some may feel significant to you. Own that. One of the most significant steps I took was picking that Beyond Blue pamphlet up off the table in the GP practice. And when they try and shame you (and they will), remember that your life is determined by a lot more than the thoughts of a few.