A qualitative study of women’s experiences of long-term antidepressant use

Abstract

Women are two times more likely to experience Major Depression, and to take antidepressants in comparison to men. Prescriptions for antidepressants have risen drastically over the past twenty years, and are now the most widely utilised treatment for depression in the western world. The rise in antidepressant use has been linked to increases in long-term prescriptions. However, research has raised doubts about the effectiveness of antidepressants, alongside concerns regarding adverse side effects associated with these medications. There is little research undertaken regarding perceptions of agency in depression management while using antidepressants over the long term. This thesis study aimed to explore women's views and experiences of long-term antidepressant use. In particular, it aimed to examine how long-term antidepressant use impacts on women's sense of self and agency, and how women's views and experiences of antidepressants change over time. Eighteen women, with a minimum of five years continuous use of antidepressant medication, were interviewed for this thesis study. These women participated in semi-structured interviews, which focussed on their experiences and views of antidepressant use from initial prescription through to current times. A thematic analysis of the data was conducted. The results of the thematic analysis indicated that the women's views and experiences of long-term antidepressant use were influenced by a number of experiences. These included the experience of severe and debilitating depressive episodes; their exposure and internalisation of stigma regarding depression and antidepressants; and the degree to which they endorsed and practiced gendered social roles and norms. Alongside these experiences, women perceived that long-term antidepressant use was effective, but was also associated with on-going depressive symptoms and aversive side effects. Antidepressant use was associated with some increase in agency and functionality, and allowed the women to undertake other practices and activities which facilitated a sense of agency in depression management. Severe withdrawal effects following discontinuation were associated with a diminished sense of agency about whether they could come off antidepressants, concerns about psychological dependence to antidepressants, and reinforced beliefs regarding biomedical aetiologies. Women came to feel that taking antidepressants was necessary, and ultimately resumed taking them. The women also noted that developing tailored self-care plans, a sense of self-acceptance and willingness to address cultural and gendered norms facilitated a sense of well-being, and that this process was aided through engagement with talking therapies. The findings of this study are discussed in relation to existing literature, considers the implications for clinical practice and recommendations for future research. This research offers an important perspective on the impact and experiences of taking antidepressants and managing depression over the long-term to the field of research on antidepressant use and depression.