The micro-to-macro realities of antidepressant taking: Users’ experiences in the context of contested science and industry promotion

Abstract

The macro landscape shaping antidepressant use is marked by uncertain and contested research and vigorous pharmaceutical promotion to doctors and (in the U.S.) patients. While prior studies have investigated antidepressant users’ firsthand experiences of the impacts of medication use on their lives and identities, these studies do not explicitly situate users’ experiences within the macro realities that shape the larger system of care. The aim of this Internet-based qualitative study was to advance a uniquely social work perspective on psychotropic medications by thematically examining the everyday experiences of antidepressant users and framing emergent themes within the broader macro context. The largest sample to date (n = 3243) of user reviews of four antidepressants (escitalopram, duloxetine, vilazodone, and vortioxetine) were downloaded from popular patient-reporting websites and analyzed line-by-line by two independent coders in a general inductive coding process. Antidepressant experiences were characterized by trial-and-error experimentation, limited relief, drug cocktails, uncertainty about causes of change, and unforeseen drug withdrawal challenges. Individual-level experiences are contextualized within the larger landscape of publication bias in clinical drug trials and persistent drug industry promotion of newer, costlier, and add-on drugs. Based on the profession’s systems perspective and social justice commitment, social workers should recognize how macro factors contextualize individual experience and strive to support users in cultivating more informed, empowering relationships with psychiatric drugs. Exploring the meaning of medications, validating users’ firsthand experiences, and monitoring changes throughout treatment and discontinuation are appropriate, critical roles that social workers should consider adopting.