I am standing on the platform at St John’s Wood Tube station, thoughts racing through my mind. The indicator board says a Stratford train is approaching… and I am trying to decide whether to step in front of it.
The passengers around me are oblivious to my turmoil. To jump or not to jump? I just want to put a stop to my mental anguish but, at the last moment, I run back to the escalators, where I sit panting with fear.
What just happened? Did I really want to end my life?
Not knowing what to do next, but sure that trains had become a danger for me, I took a taxi to work – as editor of the glossy magazine Good Housekeeping. Later that day, at a celebrity photoshoot, self-destructive thoughts kept racing through my head.
In desperation, I called my GP surgery and the receptionist told me to come in immediately as an emergency.
They knew me – I’d had numerous appointments over the past few weeks. Something was wrong with my life, but I didn’t know what. I had been in a bad car crash a little more than three months before, but surely this level of distress was an over-reaction. I had cried every day since.
Indeed, a fortnight before my crisis on the platform, as I sobbed to my GP that I was getting no sleep and couldn’t function in my high-powered job, she’d reluctantly agreed to prescribe an antidepressant – citalopram.
As she filled out the form, she commented: ‘I can see from your notes that you are resilient.’
Lindsay Nicholson recalls standing on the platform of St John’s Wood Tube station, trying to decide whether or not to step in front of the fast-approaching train
By that she meant I had managed to rebuild my life after the deaths of both my first husband and eldest child some 20 years earlier. By incomprehensible coincidence, both had died of the blood cancer leukaemia. What could be harder to deal with than that?
The GP looked directly at me and said: ‘I think there is something in your life you are not facing up to.’ I took no notice.
I agreed to see a therapist, too, but mostly wanted to get my hands on drugs to stop the pain. I wanted to be able to sleep through the night and complete the day without crying. If I could do that, I told myself, then I could deal with whatever else was going on.
After about ten days on citalopram I started to sleep, just for three hours or so at night, but I felt brighter and more energetic.
Then, two weeks after popping that first pill, I found myself contemplating whether to throw myself under a Tube train.
Was the citalopram to blame for my suicidal thoughts? Fresh evidence has since emerged that the class of drug known as SSRIs (which stands for selective serotonin reuptake inhibitors) can in the first few weeks of usage trigger suicidal thoughts.
This was tragically brought to wider attention with the death last year of Thomas Kingston, husband of Lady Gabriella Windsor, the King’s second cousin. Kingston took his own life after being prescribed antidepressants. An inquest heard he was struggling with stress at work and had been prescribed an SSRI called sertraline – but had a bad reaction and changed to citalopram shortly before his death.
Was that what happened to me? It was eight years ago now and almost impossible to know. Citalopram is not prescribed to young people for this very reason – but at 60 years old, I was well out of that danger zone.
When I arrived home after my emergency visit to the GP, who let me talk and talk until she was sure I wasn’t going to harm myself, I had an argument with my husband.
He had been behaving strangely for some time and that evening he was busily texting someone, yet refused to tell me who. Suspecting he was having an affair, I foolishly made a grab for the phone. He appeared to let me take it but then held on to it until we both let go at the same time.
The phone fell on the floor and smashed… at which point, remarkably, he called the police. I was arrested and held overnight in a police cell – hardly a therapeutic environment for someone receiving medical attention for insomnia, depression and suicidal thoughts.
The next morning I was released without charge. The day after that my husband admitted that he was, indeed, having an affair. I moved out of the family home and didn’t spend another night there for eight months until I won the right to return in a court case.
Who would stop taking antidepressants in such circumstances? I certainly didn’t, least of all because I was made redundant from the job I loved while the divorce was going through. I clung on to the medication like a drowning woman – until another little-known side effect of citalopram kicked-in.
Known as tardive dyskinesia, it affected me in such a way that I became unable to stop pacing up and down. In my unemployed state, I went for long walks every day, only to carry on walking round and round my living room for hours when I got back.
An inquest into the death last year of Thomas Kingston, husband of Lady Gabriella Windsor, heard how he was struggling with stress at work and had been prescribed an antidepressant called sertraline
I stopped sleeping again and sometimes got up in the middle of the night, unable to resist the urge to march around the house.
Back to the GP I went. She changed my prescription to mirtazapine, a different kind of antidepressant – not an SSRI, but specifically helpful for anxiety. She warned that I couldn’t stop taking the citalopram immediately, so for several months I took both.
Eventually, by cutting down gradually, I got off the citalopram, and with just the mirtazapine in my system I relaxed and stopped the endless pacing.
My recovery was long and arduous: I tell how I rebuilt my mental health step by step in my memoir, Perfect Bound, out soon in paperback. On mirtazapine, I was sleeping the sleep of the dead, for at least nine hours a night. When I did wake, I was groggy, needing several cups of coffee to get me going.
I avoided attending meetings before 11am because I simply wasn’t alert enough before then. Any sort of alcohol made me feel worse, so I instead treated myself with cake, biscuits and chocolate for plodding through another dreary day. My face grew round, my tummy spilled over the top of my jeans and none of the smart clothes I used to wear for work fitted anymore.
One day, I ordered a huge box of chocolates online to be sent to an old schoolfriend who was very unwell. They were delivered to my address by mistake. I put them on a high shelf in the utility room, meaning to re-wrap them and send them on; I ate the lot in 24 hours, repeatedly pulling up a chair to stand on in order to reach the goodies.
I checked the side effects leaflet for mirtazapine and discovered to my horror that the drug is prescribed to anorexics for increasing appetite – something I hardly needed.
By now I had passed the one-year anniversary since my divorce was finalised and was rebuilding my career, too. I decided I no longer needed the drugs – but had no idea how hard it would be, nor how long it would take to come off them.
As I did with the citalopram, I decided to cut down by just half a tablet per week. I cut the white mirtazapine tablets with a sharp knife, noting my progress in my diary. Week one, six and a half tablets. Week two, six tablets. I got to four tablets per week before becoming so overwhelmed with anxiety again that I went straight back up to seven.
I considered returning to my GP and asking to switch back to citalopram, but then I remembered the endless pacing up and down. I was determined to cut down again.
By the spring of 2019, I was on four and a half tablets a week. I felt good and took up horse riding, which I used to love as a teenager – I even booked to go on a riding holiday. But my horse spooked and, although I didn’t fall off, I wrenched my back. I was in such pain I had to walk with a stick for several weeks. Naturally, I couldn’t sleep, and without it the anxiety came back, worse than ever. Before I knew it, I was having a tablet every night.
I told myself 2020 would be the year I would definitely stop taking mirtazapine. I started slowly, reducing by half a tablet, and was doing well until the whole country launched into Covid lockdown in March.
Living alone, there were months where I didn’t have any contact with another human except for on Zoom. Naturally, I went back to a whole tablet every night – it seemed like the entire population was on antidepressants anyway, or at least asking for them.
Sertraline can cause side effects such as suicidal thoughts – particularly in men aged under 25
As the pandemic ended in 2022, I became resigned to the fact that I might be on mirtazapine for life. I hated that it made it hard to lose weight, especially as my daughter’s wedding was coming up, and that I felt groggy in the morning.
But then I start reading reports in the Press, based on research by Professor Joanna Moncrieff of University College London, that antidepressants might not in fact be the cure for depression. This year, Professor Moncrieff published a lay person’s guide, Chemically Imbalanced: The Making And Unmaking Of The Serotonin Myth, in which she provides evidence that something as simple and health-giving as taking more exercise could do more to improve mood than drugs.
Had I been taking them for five years for nothing? What if I had jumped under a train that morning when I teetered on the edge of the Tube platform? The thought of what that would have done to my elderly mother and my daughter was too awful to contemplate.
Of course, I was no longer on citalopram, but it made me question whether chemically altering my brain with any drug, including mirtazapine, was the wisest way to tackle the ups and downs of life.
With more time on my hands, I’ve been studying university-level courses in psychology and earned a life-coaching qualification. As I gained a deeper understanding about how the mind works, it no longer made any sense to me to chemically alter my mood.
Depression, I now believe, is an emotional state caused by reactions to circumstances. The reason I couldn’t stop crying when I first went to the GP wasn’t because anything was wrong with my brain – it was because my husband was cheating on me and refusing to admit it.
How could me being medicated for five years alter that fact? Because that’s the issue: you start taking antidepressants to fix a problem that seems insoluble. Then, when life improves, the drugs become the problem, and often an even bigger one.
In the end, it wasn’t science but vanity that provided the necessary incentive to power me through quitting completely. As a post-menopausal woman, keeping my weight under control was already hard enough. Taking medication which increased my appetite felt insane.
My daughter got married in March 2022 and I practically starved myself for the six months it took to slim into my mother-of-the-bride outfit. Once the stress of the wedding was over – good stress, but stress nonetheless – I told myself that the drugs had to go.
I set about improving my sleep patterns naturally, using an invaluable little book called The Sleep Prescription by Aric Prather which advocates a strict timetable of going to bed and getting up at the same time every single day – and strictly no napping. It proved remarkably effective for me, and I began reducing the mirtazapine by half a tablet a fortnight.
Progress was slow, but six months later – five and a half years after my first prescription – I finally took my last tablet in September 2022. I haven’t had one since.
When I look back on that first prescription, I ask what could I or my GP have done differently? She certainly didn’t push the tablets on me – I begged for them, believing I was unwell and they would help me cope. On the other hand, it is clearly not a GP’s job to say: ‘I think your husband is cheating. Is that why you’re depressed?’
If I was ever in a situation again where I couldn’t sleep and couldn’t stop crying, would I take anti-depressants? Never! Not after being stuck on them for five years – with all the pacing, grogginess and sleep issues – let alone the risk of suicide.
I would, I hope, be prepared to take a closer look at what was going on in my life and to make hard choices – even if it meant facing up to the fact that something about my life was not what it seemed.
The family of Thomas Kingston have suggested that anyone being prescribed citalopram should be made to sign a consent form showing they understand the risks of suicide. They should also be asked who will support them during the first weeks in case they do feel suicidal. This simple question is a brilliant idea.
If I had been asked that, I might have had to face up to the fact that my then husband was not being in the least bit supportive. And that might have revealed his affair without the broken phone, the night in the police cell – and the tablets.
Instead, I learned the hard way that popping a pill will not make unpalatable truths go away. It’s just going to make it even harder to deal with them.
For confidential support, call the Samaritans on 116 123 or visit samaritans.org