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This post originally appeared on VICE UK.
Since starting antidepressants a year ago, I haven't once added to the tapestry of cigarette burns and penknife cuts pockmarking my left arm.
In fact, my thoughts of self-harm faded after around six weeks on Citalopram—once, that is, I got through the initial stage of grinding my teeth every night like I'd done a gram of dark web MDMA; or feeling sheer terror at the mere prospect of being alive; or just floating from one day to the next, apathetic about everything going on around me. After all that, I started to feel just a little bit better. Everything seemed real again, not blurry, indistinct and intangible. I felt like I had someone on my side, a defense mechanism that I could swallow every day.
Over the last few months, feeling the most stable I've felt for a long while, I've repeatedly come back to the idea that there's someone out there who invented Citalopram. Someone I've never met, but who has—through research and development in some faraway pharmaceutical lab—touched my life in ways as intimate as making me actually want to live again.
Of course, all it took to find out was Google. Turns out the man I can thank is Klaus Bogeso—a scientist for the Danish company Lundbeck Pharmaceuticals—who formed the compound in 1989, 19 years before it was approved as a medicine in 1998.
There was something poignant about talking to him over the phone, this invisible man who had unknowingly done so much for me. But he wouldn't take all the credit, telling me that it was "Professor [Arvind] Carlsson who put forward the theory that serotonin was involved in mood. In August, 1972, I created the compound now known as Citalopram."
Citalopram is a selective serotonin re-uptake inhibitor (SSRI). Unlike older antidepressants, SSRIs are thought to work by essentially increasing levels of serotonin—the "joy chemical"—in the brain. Although there are plenty of SSRIs available, Citalopram is the most widely prescribed in the UK. Why? "It's by far the most selective compound, compared to other SSRIs that affect other neurotransmitters and interact with more metabolizing enzymes," says its creator. "Other SSRIs are more problematic when combined with other drugs."
When the patent for Citalopram expired, Lundbeck released Escitalopram, an updated version of the compound sold under the brand names Cipralex and Lexapro, among others. This drug came second in the Lancet's 2009 list of the best antidepressants, and Kanye West name-checks it in "FML" on Life of Pablo.
Unsurprisingly, Kanye talking about his antidepressant use garnered plenty of media attention—partly, no doubt, because of the stigma that still exists around medication for mental health disorders. "People are confused about psychiatric illnesses and don't associate them with medication," says Klaus. "People think it's a matter of 'pulling yourself together.'"
Much of this confusion comes from misrepresentation in the media. Antidepressants can cause dependence and withdrawal symptoms, but are not addictive and have no recreational value. There is, of course, certainly valid discussion about their drawbacks, with one recent study stating that some SSRIs "pose a very small but serious heart risk." Another criticism is the fact that they take several weeks to start acting.
This is something Niels Plath—vice president the Synaptic Transmission division of Lundbeck—is aiming to solve. Plath notes that "this is a very unfortunate situation if you are in a mental state that doesn't give you courage to go into treatment. It means many patients will stop the medication before it has a chance to properly take effect. Suicidal ideation during these weeks can be fatal."
It's not yet known why SSRIs take so long to come on, especially as studies on rodents show significant improvement "instantly." As Niels puts it: "We have to accept the very frank answer that we don't know right now."
Problems also arise over conflicting arguments on whether serotonin is actually the catalyst for depression. Many recent studies have suggested that low serotonin is actually not correlative to a depressed state. Plath and Lundbeck, however, stick by this hypothesis for the most part. Plath argues that "beyond a doubt, there are populations that show symptoms of depression due to a lack of serotonergic action in the brain." However, he concedes that "not the entire population" show a response to SSRIs like Citalopram.
As much as I can comprehend these criticisms, I know for a fact that Citalopram has changed—and possibly saved—my life.
When I ask Klaus if he considers how many lives he has helped, he says, "It's the dream to make a drug that is actually sold. I have been fortunate to make two, and especially to see that it is a good drug. It makes me very happy to think that many people day-in and day-out are treated by this drug. It's the ultimate dream of any chemist."
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