One Good Thing

what I think of antidepressants

The script is white and green and printed on special paper with a perforated seam for the pharmacist to tear easily in half. I sign and date their yellow print-out in my neat, smooth handwriting, the sort of handwriting that says, ‘I am a person who is in control of my life. I am educated and meticulous and I know how to do things.’

Then I carry the plastic tray to the counter where a sales clerk asks me, ‘How are you today?’ Her tone is bright and cheerful and mine is a good match when I reply: ‘Fine thanks. The airconditioning is nice in here.’

But I take that paper packet home and I tear apart the sticky-taped seal and I remove the sheets of tablets from the packet and I break a capsule from the foil and I swallow it with a little mouthful of water and I do this every day because I am not in control of my life and the doctor has decided to help me remedy this with something called an antidepressant.

I have taken antidepressants (and antipsychotics) for around a third of my life. First it was Zoloft. Then Cipramil for many years. Now Cymbalta, an SNRI that comes in 30mg and 60mg doses. Candy-coloured, granule-filled capsules that look like happy little bullets.

But I have my doubts.

When I turn 29 in a few months’ time, it will mark the first occasion in more than eight years that I will be drug free. No SSRIs or SNRIs, no Avanza, no Neulactil, no Seroquel. I have waited a long time for this opportunity.

Several years ago now, I sat in my GP’s office and asked her how long I might have to stay on Cipramil for. Cipramil made me feel a bleary nothingness that was, in some ways, just as bad as feeling low all the time. She shrugged. ‘Maybe you’re just one of those people who needs to stay on antidepressant medication forever.’ Something about those words was revolting to me. I say ‘revolting’ because a small, nameless, furled-up part of my soul suddenly revolted against this idea — that chemical dependence was the only way for ‘someone like me’ to claw my way through life feeling vaguely ‘normal’.

The thing is, antidepressants don’t make you feel normal. Not long-term. And they certainly don’t make you feel happy. For a time, antidepressants can do a particular job spectacularly well: they can lift your physiology from a mucky, complex mire for long enough to get a loose grip on the many other factors that have contributed to your illness in the first place.

But the problem is that many doctors and patients stop right there. Doctors prescribe the medication after a brief, formal, standardised survey during a 10-minute billable time-slot; patients fill the script and take that medication, often for years and years and years afterwards.

Even though the brain uses many neurotransmitters to do its work of maintaining metabolic functions, administrating mood, and managing cognition (glycine, taurine, GABA, glutamate, PEA, and histamine are just some), SSRIs and SNRIs selectively boost only serotonin and norepinephrine, which certain researchers and pharmaceutical companies still insist are primarily responsible for depressive illness — when they are ‘out of balance’.

What many others now realise, however, is that depression is a multi-factorial disease that therefore requires multi-modal treatment. Genetics, developmental glitches, grief and stress, unhealthy circadian patterns, nutritional deficiency, chronic illness, exposure to toxins, frontal lobe damage/disorder, and addictions can all play a role, in combination, towards an individual’s becoming depressed.

So why do most doctors continue to treat depression solely by prescribing antidepressant medication?

If you went to your doctor with a sore elbow, a poor physician would apply a bandaid and send you on your way. A better physician would seek to find the root cause of that pain: inflammation, injury, neuropathy. Their treatment would be based on the root cause of the pain. Treatment might involve anti-inflammatories, debriding and dressing, physiotherapy, or pain management psychotherapy — or a combination of two or three. But it would be sensitive and targeted to the actual cause of the pain.

What antidepressants do, in many cases, I believe, is to provide people with a tacky bandaid that does little to help long-term.

In their 2012 article, ‘Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011′, authors Chris Stephenson, Emily Karanges, and Iain McGregor state that ‘there was a 58.2% increase in the dispensing of psychotropic drugs in Australia from 2000 to 2011, driven by major increases in antidepressants (95.3% increase in DDDs/1000/day), atypical antipsychotics (217.7% increase) and ADHD medications (72.9% increase), and that ‘the dramatic increase in antidepressant prescriptions’ is concerning because it’s occurring ‘despite questions about the efficacy of these drugs in mild to moderate depression’.

Someone who has never suffered from depression might find the illness difficult to understand. David Foster Wallace, a pre-eminent American author who suicided in 2008 at the age of 46, described depression like this: ‘It is a level of psychic pain wholly incompatible with human life as we know it. It is a sense of radical and thoroughgoing evil not just as a feature but as the essence of conscious existence. It is a sense of poisoning that pervades the self at the self’s most elementary levels. It is a nausea of the cells and soul.’

I am not in the league of DFW and I cannot hope to explain the sensations and reality of depression any better, but I can tell you that, at my worst, I either slept or cried. That was it, really. I often sat on the ground and sobbed and beat my hands against the carpet or the floorboards or the grass. Daytime hours were intolerable stretches of time between the opportunity to sleep. Tears leaked from my eyes involuntarily during long car trips, during lectures, during church services, and films. I vomited, I trembled, I sweated, I palpitated, and I wanted to stop living.

Throughout this entire time, I took antidepressant medication.

I saw a psychiatrist every second week.

‘Are you feeling any better?’ he would ask. He would weigh me. I would have gained a kilo or two. Then he would increase a dose of something or add another medication into the mix. At one point in time, early in 2010, I was taking seven different medications, some twice a day. And I still wanted to die.

What this tells me is that chemical therapy isn’t always effective. I could cite multiple recent studies to the same effect, but this isn’t an academic paper. This is about my experience and the experiences of others that I’ve drawn out in frank and horrible conversations over the last three years.

What I think happens is that, for a time, chemical therapy provides the change in — an alleviation of — one hit in the combination of ‘hits’ that the depression sufferer is contending with. But over time, if nothing else in the sufferer’s life or body changes, the physiology veers back to their ‘normal’ — however bad that might be

In fact, recovery can feel frightening. Feeling good can feel ‘wrong’. A depression sufferer can feel overwhelmed by change (positive change!), and this in itself becomes a stressor.

A sufferer of depression may not very well want to be ‘better’ because ‘better’, in their mind, represents dealing with all of those things that they find so tiring and terrible and un-doable in the first place: interacting with others, exercising regularly, sleeping right, eating right, talking through their feelings, altering their environment and lifestyle, eliminating or improving relationships, taking this supplement, or seeing that practitioner. It feels like too much. And depression is the big I Can’t.

So, this is how I feel about antidepressants. I feel that it is irresponsible for doctors to leave patients stranded in an increasingly dim expanse of chemical dependency for extended periods of time.

I feel that it is irresponsible for doctors to leave out details of sometimes horrific side effects — nightmares, profuse sweating, nausea and gut illness, metabolic syndrome, increased anxiety — when they prescribe antidepressant medication because that’s the knee-jerk, textbook treatment for anybody suffering from a highly complex illness that depletes the mind and body in a devastating, self-perpetuating cycle.

I feel that it is irresponsible for doctors to neglect to warn patients of intense withdrawal effects, some of which leave the patient unable to taper at all, stuck on the not-so-merry-go-round because ceasing the medication is akin to narcotic withdrawal and nobody says so. The leaflets don’t say so.

We have a problem with mental illness in this country, and I don’t believe that the problem is stigma any more. I believe that the problem is a square-shaped solution for a dodecagon problem.

Where to from here?

I don’t know.

But my future actually looks brighter without the glint of a silver foil pill sheet in its midst.

Tagged with: antidepressants, depression

Categorised as: health+mind+body