A Cure for Darkness by Alex Riley books interview: How I live with mental illness

Lobotomies, electroshock therapy and crippling medication are just some of the treatments that have been used to treat depression in the past. Science writer and sufferer, Alex Riley decided to write a book about the history and treatment of depression, partly to help heal himself, he tells Katie Law

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Alex Riley

Ebury Press

Katie Law @jkatielaw

13 April 2021

What is depression? How did people in the past regard it, and how was it treated? How is it treated today? Is medication effective and if not, what are the alternatives? Have things improved? Bristol-based science writer Alex Riley had been pondering these questions, while simultaneously suffering from severe symptoms himself.

Now he has written a book about it, in which he combines his own story - from overcoming his suicidal thoughts to the devastating effects of being prescribed powerful antidepressants - with a fascinating history of mental health, treatments, practitioners and therapies.

What made you decide to write such an encyclopaedic history of depression?

I was curious to learn where my own experience fits within a much larger story. Memoirs into depression are often guided by one person’s experience and whether or not a particular treatment worked. Recently, antidepressants have come in for criticism, largely because an author didn’t find them helpful. But the term depression includes diverse experiences, not only around the world today, but throughout history.

I was intrigued and found comfort in my own mental struggles by learning just how ancient and common these mental illnesses are. I also enjoy reading through scientific papers and old books in the library, so it was a form of treatment just as previous authors — such as Robert Burton in the 17th century — found while researching their own investigations into melancholia.

How did your own story of living with depression play into this?

When I first reached out for help with my depression in 2015, I was trying to make ends meet as a science writer living in a house share in south London. I had left my PhD, my first job, and was going through my first break up. I didn’t consider writing about my struggles with mental illness as I still hadn’t told friends and family. In spring 2017, however, I was very open about my experience with psychotherapy and antidepressants and wrote my first article on living with a mental illness and being a science writer.

The positive response gave me the confidence to consider turning my science writing inward, onto my own history and what the science of mental health was saying. As I’ve mentioned, there were a lot of conflicting personal stories, and I had many questions that needed answers. Is depression a recent phenomenon? Is it a product of civilisation? Do current treatments work and what may lie on the horizon? I found hope in these stories, and I hope that people may find some comfort in my book.

What were the hardest parts of the book to write?

The parts that required the most effort were definitely the personal sections, even though they only take up a small portion of the book. I had to try and be neutral. For example, I started out with real anger towards the pharmaceutical approach, how drugs are overprescribed and only marginally effective. But anger wouldn’t help someone reach out for treatment and these drugs really can help.

The hardest stories to write about were lobotomy, early use of electroshock therapy, and the murder of mentally ill people in Nazi Germany. There was so much raw suffering and misunderstanding, often in the pursuit of progress in medicine. The only example that has been transformed, thankfully, is electroshock therapy or electroconvulsive therapy (ECT).

What were the biggest surprises in the course of your research?

I came into this project thinking that ECT was a barbaric throwback. I had watched One Flew Over the Cuckoo’s Nest. But I’d never checked the facts. There was concern that it had been used in my own family history, that my grandmother had been given it in a mental institution. To then learn — and see — the potential in severe psychotic depressions was a surprise. As was looking at depression from a global perspective and learning that it isn’t a useful term in the majority of countries. It made me realise how westernised, or ethnocentric science can become, and the importance of including diverse voices and life experiences.

The weirdest fact?

Oh wow, let me think. Either that the first antidepressants of the 1950s were essentially cancelled for their potentially fatal reactions with mature cheese, or that there are more bacterial genes in our bodies (in our microbiome) than there are our own genes. In both, cell count and number of genes, we are more bacteria than human.

And then there’s the image of Sigmund Freud as a young man, drinking cocaine solutions and thinking that he was about to cure every disease known to science.

What role do you think antidepressants have in psychiatry today?

First of all, I hope they can be used more efficiently. They come with some awful side-effects — such as loss of libido — and they don’t work for everyone. Plus, it can be really difficult to come off them again. I worry that they are being prescribed to people who could benefit from other measures such as exercise, changes in diet, and talking therapies. These should always be tried first, unless someone is in a very dangerous place and doesn’t have access or the opportunity for such options.

One reason that antidepressants can be ineffective is if a person has high levels of inflammation from being overweight or eating a poor diet. If these problems are tackled first, and the depression is still a problem, then antidepressants will have a better chance of success. So its place in psychiatry is as a second or third-line treatment. Talking therapies, personal trainers, and changes in diet would require more government funding but they would also have more lasting impacts . Antidepressants are a short-term solution to a complex problem.

What has your own experience of taking them taught you, and has that changed since you began taking them?

They can only do so much. They aren’t providing my brain with the opposite of what depression is. There is no imbalance of serotonin or noradrenaline, but by increasing these brain chemicals these drugs can make life a little less stressful. They buffer the sharpness of the world and can allow depression to lift. My own experience has taught me that these aren’t drugs without side-effects. They affect our sex lives, our feeling of connectedness to others, and can sometimes feel like we’re disconnected from the things happening around us.

Since changing from citalopram to sertraline, my view has changed a lot. The first drug had little effect on my fluctuating moods and thoughts of suicide, and I was prescribed higher and higher doses until we realised that it wasn’t working. I felt nauseous on this drug, every day. Then sertraline was a much better experience. I felt more stable, more content, but it was still imperfect. My depressions were more infrequent but still occurred once or twice a year and could leave me feeling suicidal. Friends and family would visit and essentially babysit to make sure I was safe. They couldn’t help me recover or feel better, but I now appreciate their efforts to simply be present. My partner, Lucy had to leave work meetings in the past to make sure I was okay, I dread to think what she thought she might find when she got back to our flat.

How are you now, and are you still taking them? If so, do you see that as permanent?

I had a mental health crisis from December to February this year and it was recommended that my dose of SSRIs was increased and that I should start psychodynamic therapy, a modern version of psychoanalysis. I think this most recent lockdown was particularly tough and may have triggered my recent crisis — as well as being a father for the first time and the pressures of this book being published — but they aren’t permanent stressors.

Similarly, I don’t think antidepressants have a permanent place in my life. If it weren’t for the pandemic, I would probably have remained off them since March 2020. Once again, I am hoping to come off them, slowly reducing my dose and increasing the other facets of treatment such as eating well, exercising regularly, and continuing my talking therapy every week. I can’t live with the side-effects of antidepressants forever. That said, I know that others might require longer-term treatment, whether it’s because of their type of depression, the stresses in their life, or a lack of alternatives. Not everyone can afford a healthy diet. Not everyone has access to long-term therapy. Running trainers are expensive and time is limited.

Explain how pills and talking therapies can complement each other

As I have been told during my CBT sessions over the years, pills can allow someone to be motivated enough to work through the homework that this form of talking therapy requires. They can help someone open up a little more than they would if they were still suffering from baseless guilt, sleeplessness, or hopelessness.

I also find the work of Myrna Weissman — one of the creators of interpersonal therapy and who I mention in the book — to be compelling. Along with her colleagues at Yale in the 1970s, she found that tricyclic antidepressants and talking therapy work for different symptoms of depression. While the pills were particularly effective at combatting sleeplessness and sluggish cognition, interpersonal therapy reduced levels of suicidal ideation, guilt, and increased self-esteem. This study went against decades of thought that concluded that psychotherapy could only hamper the effects of drug therapy.

I do think there is a balance between drugs and talking therapy. Especially now I’m working through psychodynamic therapy and its focus on childhood, memories, and trauma. I was told that certain drugs — or doses — can impede the emotional response needed for catharsis or acceptance. I would, at some level, agree with this. A high dose of SSRIs, for example, makes me feel disconnected and it is quite hard to cry.

How has having a baby affected you?

It’s been tough. I love her above and beyond what I thought possible but it has been a huge life transition. I’ve had to carve out a niche of time to work and read, pastimes that were always available to me at any time of day. But my main concern is that she might see me struggling, or suicidal, and that might influence her mental health in the future. This has made it even more important for me to lead a healthy lifestyle and do psychotherapy.

What adaptations to your routine have most helped (eg sleep, exercise, diet, being outdoors..?)

If I’m feeling down or lacking motivation, then exercise can be a double edged sword. It can either give me the boost I needed or, if I feel the same afterwards, much worse. The disappointment of trying without a positive outcome is always difficult. Similarly, being outdoors when I’m unable to feel pleasure can only make me feel worse. I ask myself, ‘Why can’t I enjoy this?’ I know this is a beautiful view but why can’t I feel it?’ It seems like everyone else can enjoy life while I don’t even have the capability to enjoy. This passes, of course. But it is crippling when it continues for days or weeks.

Are we getting better as a nation at discussing and dealing with depression more openly?

We are mentioning mental health more but not necessarily understanding what that means. Is it stress? Is it psychosis? Suicide? I worry that for all the conversation around mental heath, we might be trivialising the impact that severe mental illness brings into a person’s life. There’s still a lot of stigma around certain treatments such as antidepressants and ECT. I see these treatments being used for the severe mental illnesses that haven’t responded to other options.

Psychotic depression — when someone believes that they are rotting from within or have committed a shameful crime and are deeply suicidal — is as different to poor mental health as a heart attack is to a sedentary lifestyle. The two are related, but there’s a much bigger story. As we start to discuss mental health, we also need to realise that what works for one person with depression might be completely different to another person. Realising that it is a diverse cluster of mental illnesses — some with more anxiety and others more related to mood or psychosis — can help destigmatise treatments.

What else needs to be done?

More funding and research for preventative measures in children. We know that three quarters of mental illness first takes root before the age of 18. Early intervention, in the form of talking therapy and education into healthy lifestyles, is the most powerful way to reduce mental illness in adulthood. Treatments will never be perfect. But prevention can make a big impact, just as vaccinations have prevented some of the most deadly diseases in history.

We immunise children against tuberculosis, measles, meningitis, and I think psychiatry can also help immunise the next generation against mental illness through psychotherapy for high risk individuals and making sure that a healthy diet is a reality for every child. With one in four children living in poverty, this country has a lot of work to do.

A Cure for Darkness: The Story of Depression and How We Treat It by Alex Riley (Ebury, £18.99)

Buy it here

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