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And they work how exactly?
August 9, 2003 1:12 PM   Subscribe

Anxious? Depressed? - you need more brain cells. Just take one of these twice a day. New research shows that antidepressants may not work as we thought at all, rather they actually stimulate growth of cells in the hippocampus area of the brain. This may all be for the good - but it seems strange that we release millions of happy pills and market them as safe without knowing for sure what they do. Perhaps its the money talking.
posted by grahamwell (75 comments total)

 
Here's a fun link: You're depressed because you're a loser. For much more information on depression and antidepressants look here.
posted by grahamwell at 1:22 PM on August 9, 2003


"...rank theory proposes that depression is an adaptive response to losing rank and conceiving of oneself as a loser."

True in some cases but not for all, or most. It's well known that "loss" of any kind triggers depression, not just rank.
posted by stbalbach at 1:52 PM on August 9, 2003


Oh please, this neo-luddite backlast against anti-depressants has gotten way out of hand. Explore antidepressantsfacts.com and you'll see a site that is nothing but agenda. Click on their "love" link for a laugh.

The antidepressant critics seem to come in three flavors:

1. The herbal crowd trying to make a buck off FUD. A google search on a popular anti-depressant usually produces some herbal site full of horror stories with urls that contains the word "facts" as if they aren't there to sell you St. John's wort mixed with caffiene.

2. The knee-jerk denial crowd. These people can't seem to fathom that antidepressants do work for millions of people and usually have crackpot theories regarding what depression is. Stuff like get more sun, find jesus, excersize more, etc. Sorry, but real depression usually requires professional attention like any other illness.

3. Professionals and other people without an agenda discussing what drugs work best (or worst.).

I really feel sorry for the person in need of medical attention who visits the web only to find out that so many sites advocate not taking these drugs, buying herbals, or joining some cult. These sites have an incentive to blow anything criitical of antidepressants out of proportion and use disinformation to help their agenda.

Yes, Virginia, we really do know how SSRI's work.
All SSRI medications function by prolonging (or inhibiting) the process by which serotonin is taken up by neurons (the process referred to as "reuptake"). All SSRIs are designed to prolong the reuptake process only for serotonin. To differentiate between serotonin and a host of other chemicals in the brain, they must be highly selective.

That's how the class came to be known as "selective serotonin reuptake inhibitors" -- they prevent (inhibit) serotonin (and only serotonin) from experiencing too much or too long of a reuptake process. This makes more serotonin available in the brain. According to Sheldon H. Preskorn, M.D., professor and chair of the department of medicine and behavioral sciences at University of Kansas School of Medicine, Wichita, and author of Applied Clinical Psychopharmacology, SSRIs are effective for a significant number of individuals who use them as directed for this purpose.
Of course, any drug, be it antidepressants or the latest allergy medicine (or even old drugs) surprise us and medicine itself isn't this hard science we like to think it is. Something like 30% of all medical treatments end up being effective at all. New discoveries about drugs happen almost all the time, but many don't get the press the hot-button anti-depressant drugs get.

RE: hippocampus

From what I've read, depressed people in general have a smaller hippocampus. This discovery could easily be seen as long-term treatment normalizing brain structures to fall in line with the brain of a non-depressed person.
posted by skallas at 2:04 PM on August 9, 2003


>but it seems strange that we release millions of happy pills

One more thing: when was the last time you were at a party and someone offered you an SSRI? The term "happy pills" is very loaded and somewhat inflammatory. They take weeks to work and help to normalize moods. It ain't like smoking weed

Also, "happy pills" are never "released", they're prescription only and are used under a doctor's care.
posted by skallas at 2:09 PM on August 9, 2003


jeeeeez skallas, it seems like you're taking this personally. yeah, i agree with you that any crackpot group looking to find something wrong will of course find it. otoh, grahamwell's post consists only of recent valid discoveries, and i think grahamwell poses a very good question regarding our possible dependence on drugs (legal or not) to cure all our problems.

Also, "happy pills" are never "released", they're prescription only and are used under a doctor's care.

heh... yeah, right.
posted by poopy at 2:49 PM on August 9, 2003


I get offers of SSRIs pretty frequently in my mailbox I'm afraid. There's a lot of them out there and the concern is that they are still not properly understood. There's been a media frenzy in the UK recently over seroxat/paroxetine leading the manufacturer to withdraw the claim that the drug was not addictive (they have their defenders - the word addictive has very different meanings to different people). Such a backlash shows the danger of prescribing drugs with inadequate information.

Your link and quote as to how antidepressants work is out of date in it's assertion that serotonin and only serotonin reuptake is inhibited. Newer antidepressents also inhibit noradrenaline and are considered much more effective as a result. The antidepressant and smoking cure Wellbutrin (hey, just click and buy!) doesn't affect serotonin at all (in fact it's very unclear how it works). The fact that antidepressants take some two weeks to kick in has always been a puzzle for the serotonin theory, as discussed in the main link above, so the new studies may give us a clearer and better picture as to what's going on.

You missed one important category in your analysis of the critics - those people who have had unpleasant experiences with the drugs and are looking for support - take a look in alt.support.depression.medication and you'll get a good idea as to what's going on.

Don't misunderstand - these drugs are helping millions to improve their lives - but we are still learning about them - how they work, their side effects and their long term impact. That's my only point.
posted by grahamwell at 2:52 PM on August 9, 2003


About time they dropped the claim that paroxetine is non-addictive. The stuff has withdrawal symptoms not unlike those of heroin (only to a lesser degree).
posted by clevershark at 3:04 PM on August 9, 2003


My first response was : There's a way to stimulate growth in the hippocampus?! SIGN ME UP!

Of course, given how the thread's going, I'm off topic. In response to the idea of how well researched the effects of any drugs are, I really think it's a question of need. Almost all emotion related drugs are "dirty", meaning they have lots of unintended or non-specific effects. In my research (neuroscience) there's a common joke that the specificity of any drug is directly related to how long it's being around. In other words, the longer we've had to mess around with something, the more dirty we find it to be. But for several people, taking the risk of complications tomorrow is worth not wanting to kill themselves today. I don't like the idea of making desparate people into unintentional guinea pigs, but I feel worse about waiting to provide them relief because I can't predict everything about a drug.
posted by synapse at 3:12 PM on August 9, 2003


Ouch. That should say " specificity of any drug is directly related to how long it has been around".

Verbs. They're what's for dinner.
posted by synapse at 3:18 PM on August 9, 2003


>Your link and quote as to how antidepressants work is out of date in it's assertion that serotonin and only serotonin reuptake is inhibited. Newer antidepressents also inhibit noradrenaline and are considered much more effective as a result.

Actually, I'm right. Wellbutrin, Serzone, etc are not an SSRIs. The link I posted was specifically was about SSRI's. Your main link mentions Prozac pretty often which is an SSRI.

>those people who have had unpleasant experiences with the drugs and are looking for support

Granted, and I certainly am not making any assertation that these drugs are 100% miracle workers as much as I'm criticizing the critics and your inflammatry post. Really now, you're using the words "happy pills" and expect to be taken seriously? Also I would think that category 3 includes those people in discussion groups, web boards, etc.

>how they work, their side effects and their long term impact. That's my only point

Like I said, if you want to be taken seriously, lay off the rhetoric and don't link to nonsense neo-luddite sites. Is antidepressantfacts.com supposed to convince anyone of anything? It just makes you look like a fellow neoluddite.

Also, I'm curious as to why you suggest the pharamcuetical companies would so corrupt the process. Sure, they aren't the most responsible industry around, but wouldn't the problem be the FDA and the government itself? Aren't you better off asking for better standards and transparency then dropping the conspiracy theory card? I would think so.

poopy: heh... yeah, right.

Your point? In a few hours I can probably get almost anything on the black/grey markets of Chicago.
posted by skallas at 3:21 PM on August 9, 2003


it seems strange that we release millions of happy pills and market them as safe without knowing for sure what they do

Hell, we don't even fully understand how aspirin works. Some of its effects are apperntly understood fairly well, but others are not.
posted by kindall at 3:28 PM on August 9, 2003


Paroxetene (Paxil/Seroxat/Aropax) lacks several characteristics that I would consider prerequisites to calling a substance "addictive."

= There is no "high."
= Patients do not require higher and higher doses of it to achieve the same results.
= Patients do not engage in "drug-seeking behavior" when the drug begins to wear off.

There are withdrawal effects -- known as "the zaps" among patients -- I can attest to that. Mine were mild, rather like the jumpy way you get when you've not had enough sleep (except I wasn't fatigued). It went away after a few days. At no time did it get so bad that I took another dose just to avoid it. In fact, when I had tapered down to 5mg a day, I started getting the withdrawal effects in the evening, so I just went cold turkey at that point to get them over with.

A rather small percentage of people do have much more serious withdrawal symptoms. Tapering off, or switching to another SSRI and then tapering that off, can help with that. Your doctor should know how to deal with this. It's important to note that even the patients with serious withdrawal symptoms don't "jones" for the drug, however.

Many drugs have withdrawal symptoms. That doesn't mean they're addictive.
posted by kindall at 3:40 PM on August 9, 2003


skallas, i really believe you should lay off insinuating that grahamwell has somehow made an inflammatory post. ONE link (the last one) pointed to a site that you find objectionable. did you happen to read the first link (or any others) or are you hell-bent on proving your point?

shit, if anyone here has an 'agenda' against the pharmaceutical companies, it'd be me.

Your point? In a few hours I can probably get almost anything on the black/grey markets of Chicago.

heh, yeah... that's my point.
posted by poopy at 3:46 PM on August 9, 2003


kindall -- by your 'standards of addiction' even tobacco isn't addictive, as it lacks the first two preprequisites.
posted by clevershark at 3:49 PM on August 9, 2003


kindall's standards don't make any sense really:

There is no "high."

please define 'high'. is it something that makes you feel good? mind-altering? hallucinogenic?

Patients do not require higher and higher doses of it to achieve the same results.

i've yet to meet a 'drug' that doesn't meet this criteria.

Patients do not engage in "drug-seeking behavior" when the drug begins to wear off.

yet you later state that, "Many drugs have withdrawal symptoms. That doesn't mean they're addictive."

what is this suppossed to mean? that as long as i'm not having DT's then the drug isn't addictive?
posted by poopy at 4:14 PM on August 9, 2003


I think the stuff in Grahamwell's FPP is quite interesting, up to a point. It's true that we don't know exactly how some psychiatric drugs work, but we don't know exactly how lots of other drugs work, either (aspirin, as kindall points out, being one of the most surprising cases).

And, yes, pharmaceutical companies with big cash can speed a drug through the approval process without adequate testing. The stomach medication Propulsid, which cured heartburn but sometimes caused heart attacks and kidney failure, was one recent dramatic example.

However, I love my antidepressant (Effexor) even more than I loved my old antidepressant (Norpramine). This stuff has kept me alive for the past ten years just as much as insulin has kept a kajillion diabetics alive. So you'll pry it out of my cold, dead hands.

Of course, no drug works the same way for everybody. Hell, Nyquil makes my husband jittery, while it puts me in a coma. For some reason, people seem to be more up in arms about side effects, etc., for psychiatric medication than for any other kind of medication.
posted by Sidhedevil at 4:37 PM on August 9, 2003


I think if we're going after the pharmaceutical industry for ramming drugs down peoples' throats, we should start with the especially craven and damn-near-ubiquitous efforts to push the "purple pills" -- the ads for Prilosec and their ilk are, IMHO, much more disturbing than the way antidepressants are marketed.

Good points, skallas. Knee-jerk criticisms of the kind currently being leveled against antidespressants tend to make me dubious. Do we not fully understand how antidepressants work? Sure. Have anti-depressants helped lots of people? Again, sure.

And poopy, I don't quite get your argument here. Antidepressants aren't (AFAIK) addictive -- you don't crave more, et cetera. But, yes, there are withdrawal symptoms, which is why it's vitally important to never just stop taking an anti-depressant cold turkey; doctors tell you you to taper your dosage off.

And they're not "happy pills." You don't have elevated mood or anything like that. They can make it possible for you to feel happiness, since one of the symptoms of depression is a feeling that you'll never be happy again. My experience in taking antidepressants was that they made me feel more like "myself." I didn't feel euphoric or bubbly...I just didn't want to die anymore.
posted by Vidiot at 4:45 PM on August 9, 2003


Really now, you're using the words "happy pills" and expect to be taken seriously?

Antidepressants long ago stopped being medicine for people with genuine medical conditions. First they extended to people who were not satisfied with their lives, and now people are starting to view it as a way to manage their moods.

This article on "Cosmetic Psychopharmacology" astounded me at first. Then I realized that everyone I know in New York has told me an antidepressant story, either about taking pills to deal with an emotional crisis in their lives, or shopping around for at least a year until they found an antidepressant that didn't give them crazy side effects.

You don't have to be a Luddite to question the way antidepressants have been made banal, despite the fact that we have no idea what the long-term effects are. When I was in high school, it was established medical fact that cocaine was not physically addictive.
posted by fuzz at 4:46 PM on August 9, 2003


Antidepressants long ago stopped being medicine for people with genuine medical conditions. First they extended to people who were not satisfied with their lives, and now people are starting to view it as a way to manage their moods.

So no one that takes antidepressants now has a genuine medical condition? What bushwa!

Like any medication, they can be (and often are) misprescribed and even overprescribed. But that doesn't mean that they aren't genuinely useful and even necessary for some people.

Re: "shopping around" -- well, some people respond to medications in varying ways. This seems to be even more pronounced when it comes to psychopharmacology. It's not uncommon to have to try several different antidepressants before you find one that your symptoms will respond to. That, however, doesn't mean that your symptoms aren't real, that you're not genuinely ill, or that antidepressants don't work.

Also, I'd say that a given drug's side effect profile deserves very real consideration in deciding whether or not to take, or continue to take, that drug.
posted by Vidiot at 5:04 PM on August 9, 2003


So no one that takes antidepressants now has a genuine medical condition?

I didn't say that.

The risks of a drug with unknown long-term effects, both psychological and physiological, may be worth it for people who are genuinely ill and suffering. But people who have a genuine medical condition are becoming a small minority of the target market. Or do you believe that clinical depression like your own affects very large percentages of the population?
posted by fuzz at 5:21 PM on August 9, 2003


Knee-jerk criticisms of the kind currently being leveled against antidespressants tend to make me dubious. Do we not fully understand how antidepressants work? Sure. Have anti-depressants helped lots of people? Again, sure.

Vidiot, you suggested in the preceding paragraph that we should be at least 'aware' of the potential commercialization of drugs like Prilosec. i agree. one of the most damaging effects of drugs-for-profit is that the companies will, of course, attempt to sell these drugs to people who don't necessarily need it.

i'm not saying - and i'm sure that grahamwell isn't either - that antidepressants are bad; that'd be ludicrous. however, these recent studies might indicate some other effect than what was previously perceived (i.e. a report that may potentially cast a shadow on the reputation of a miracle drug). i wholeheartedly agree with you about 'Prilosec and their ilk', but we've all seen the same amount of marketing for mood-altering drugs: it's big business for the pharmaceutical industry.
posted by poopy at 5:27 PM on August 9, 2003


Lots of drugs are overprescribed. Anti-depressants, Viagra, anti-heartburn medications like Prevacid, antihistamines like Zyrtec and Allegra, anti-ADHD medications like Ritalin, etc., etc.

That doesn't mean that there aren't lots of people who need those drugs. And no third party has any way of knowing whether someone needs them or not.
posted by Sidhedevil at 5:28 PM on August 9, 2003


Interesting convergence: I stopped taking Paxil in 1996 and have had to take Prilosec since then. At the time, there was nothing in the literature about Paxil withdrawal, but every time we lowered the dose, I wound up in the hospital with violent nausea, abdominal pain, and difficulty breathing. I was treated at a hospital about eight times before I managed to stop taking Paxil.

Since then, I've been back in the ER more times than I can count. I've had every test the gastro docs can come up with, and they can't find the problem. Prilosec prevents the attacks, so I take it. What else can I do?

I take Celexa now (after trying several other meds). Something's wacky with my neuro wiring; my sister was severely mentally ill, so it's likely that I got some strange genes as well. I'm just sorry that I ever touched Paxil.
posted by swerve at 5:48 PM on August 9, 2003


Or do you believe that clinical depression like your own affects very large percentages of the population?

I'd see nothing unbelievable about, say, 20% of the adult population being at least dysthymic. I would not be at all surprised to find that the percentage of people's lives that would improve, to them, under a working antidepressant regime could push 50%.
posted by ROU_Xenophobe at 6:02 PM on August 9, 2003


Drugs are good. Yum!

Better living through chemistry.

Long live the shaman, the herbalist, the pharmacist, the distiller, the brewer, and the street dealer!

But seriously, there are no unabused drugs and there has never been a shortage of greed and ignorance. If someone needs anti-depressants they should have them and these drugs have saved lots of lives and made millions of lives better.

Hypochrondiacs unite and get your purple pills today! Oops, slipped back into quonsar mode again!
posted by nofundy at 6:53 PM on August 9, 2003


When I was back in North America for the first time in 5 years last Christmas, I was fucking aghast to find out how many friends and relatives were on antidepressants of one kind or another.

I found it difficult not to feel contempt.

This will probably be perceived as a troll, and yes I know how many people NEED drugs to control their wayward brains, or at least have been convinced of that need by doctors and drug companies, but I'm not trolling. You really have to have the drugs, then OK. Hell, I like my beer, even if I can easily live without it, so there's a degree of potkettling there, I suppose. But that's just how I felt. It seems to me that when half the people I know are having to medicate, that at least some of them have to be abdicating responsibility for their own mental states, and that can't be good.

Are there any of those type of drugs out there that don't require a few weeks run-up time to start working, that you can just pop before you're about to give the big presentation at work or something? I'm curious.
posted by stavrosthewonderchicken at 7:07 PM on August 9, 2003


I don't think there are any fast-acting antidepressants, but I do believe there are some anti-anxiety drugs (and tranquilizers) that do act rather quickly. No personal experience with those, however.
posted by Vidiot at 7:12 PM on August 9, 2003


Like, say, Xanax, the favorite of anxious flyers everywhere?

Xanax is a benzodiazepine, not an SSRI. I know of no SSRI that is commonly prescribed for a short term scenario.

Recently I had a friend ask me if he could try one of my Zolofts. I said to him, "You might as well take one of my birth control pills....it might have more of an effect on you."
posted by gnomeloaf at 8:18 PM on August 9, 2003


I found it difficult not to feel contempt.

I love you, stavros, but I'm finding it difficult not to say "fuck off". Like others in this thread, I need my meds, and no amount of rhetoric about "abdicating responsibility for their own mental states" is going to make it easier for me not to take your crack personally. How can you know which ones are in real need of medication, and which ones aren't? You studied math, IIRC -- surely you know that your acquaintances do not consititute a large enough sample for you to draw conclusions about, well, anything. Further, how are people who actively seek medical help for a perceived problem abdicating responsibility? What should they do, "just snap out of it"?

Be real careful where you aim that contempt of yours.
posted by sennoma at 8:51 PM on August 9, 2003


When I was back in North America for the first time in 5 years last Christmas, I was fucking aghast to find out how many friends and relatives were on antidepressants of one kind or another.

I found it difficult not to feel contempt.


[way too bitchy]
With relatives who feel like that helping them to know just how awful and worthless they are, it's hardly surprising they're on antidepressants
[/way too bitchy]

Why not, instead, be aghast at the internal misery your relatives were suffering?
posted by ROU_Xenophobe at 9:17 PM on August 9, 2003


*zing*
posted by inpHilltr8r at 9:53 PM on August 9, 2003


stavros: I agree with you to some degree.

On one hand, I find it hard to believe that so many people are clinically depressed. What did these people do 10/20 years ago? Were there legions of miserable people everywhere, wandering our streets, suffering in a quiet melancholy?

Further, part of me believes that if some of the "depressed" would actually try to eat right, drink fluids, get adequate rest, and exercise, they might not need to medicate. In my experience, when I start burning the candle at both ends, eating like shit, and skipping the gym, I become a cruel, miserable bastard.

On the other hand, no one is qualified to judge how someone else deserves to "feel". I can't say that Bob or Sally isn't really depressed. I can't say that anyone other than Bob or Sally would know for sure.

Last, I have seen a person very close to me go on, off, and back on SSRIs. The difference is night and day. Yet, years before the drugs, she seemed perfectly happy and well-adjusted. What to make of it? Beats me. The drugs make her feel better. Who am I to judge?
posted by trharlan at 10:16 PM on August 9, 2003


Sorry guys, but that's the way I felt. You got a problem with that, that's fine. I had a feeling folks would get all riled by my comment here. But I certainly did not say or indicate anything of the kind to the people back home, people I love and support in any way I can - like nofundy, I'm fine with better living through chemistry, where appropriate.

Why not, instead, be aghast at the internal misery your relatives were suffering?

Well, sure. But if that many people are all of a sudden experiencing all this 'internal misery,' my suspicion is that either the indicator that once pointed to 'discomfort' has been relabelled 'misery'.

Once again, I don't deny that there are people, like my annoyed friend sennoma, above, perhaps, who need these medications because they suffer from some sort of organic brain dysfunction or something of the kind.

I suspect that those people are in the minority, though. I suspect that many who depend on things like SSRIs to make their lives endurable need to change their lives rather than simply medicate.

Why not, instead, be aghast at the internal misery your relatives were suffering?

In the end, though, fuck that for a weak joke. Unlike you, Mr Smarmy, I am intimately familiar with the situations and people I mentioned, and in most cases these people of which I spoke need SSRIs less than they need a swift kick in the fucking ass. Your mileage may vary, of course. Oh sorry, was that [too bitchy]?

I am all about compassion in the face of misery. Trust me. I do not judge for a second anyone with whose situation I am not intimately, familially familiar.

Once again, Senn, though, I was very careful not to 'aim my contempt' at anyone but a subset of the people I know back in Canada; no more, no less. Certainly not at people I don't even know in person, which includes everyone here. I have no feelings either way about your use of antidepressants or that of anyone else in this thread, because I don't know you well enough to do so. After 10 or 20 or 30 years, I might. I'm sure in many cases that that use is a lifesaver and a godsend.

Medicate away, my friend, medicate away, if it improves your life. Like I said before, I have my own self-medication routine, which I am certain is held in contempt by some people too, including ones who don't know me well enough to judge me.
posted by stavrosthewonderchicken at 10:25 PM on August 9, 2003


Well, sure. But if that many people are all of a sudden experiencing all this 'internal misery,' my suspicion is that either the indicator that once pointed to 'discomfort' has been relabelled 'misery'

I don't know them, as you'll note in a minute. In my experience though, there's no all of a sudden anything. People see an all-of-a-sudden because our society intensely frowns on not being ebullient and happy, and most people are good at maintaining the face of it even when their internal state is pretty unpleasant. The only all of a sudden is to suddenly stop pretending you're happy, not to suddenly switch over from happy to dysthymic.

I suspect that many who depend on things like SSRIs to make their lives endurable need to change their lives rather than simply medicate.

(1) Who are you to judge it? And you can say you're not, but here you are doing it. Why is a serotonin flow arising from medication to be deprecated in favor of a serotonin flow from some nonpharmaceutical purpose? Their neurons don't give a shit. Why should you?

(2) People are a lot more likely to "change their lives" with antidepressants and on antidepressants than they are to change them instead of taking antidepressants.

Unlike you, Mr Smarmy, I am intimately familiar with the situations and people I mentioned, and in most cases these people of which I spoke need SSRIs less than they need a swift kick in the fucking ass. Your mileage may vary, of course. Oh sorry, was that [too bitchy]?

Not at all. I'm curious as to why you know what they need better than they do.

I do not judge for a second anyone with whose situation I am not intimately, familially familiar

Nobody is intimately, familially familiar with somebody else's mindstate. Half the time, people aren't even intimately familiar with their own mindstate.
posted by ROU_Xenophobe at 12:08 AM on August 10, 2003


What did these people do 10/20 years ago? Were there legions of miserable people everywhere, wandering our streets, suffering in a quiet melancholy?

Yes, there were. Yes, there still are. Contempt and kicks in the ass do not help, stavros. I say this with all due respect.
posted by jokeefe at 12:32 AM on August 10, 2003


>People are a lot more likely to "change their lives" with antidepressants and on antidepressants than they are to change them instead of taking antidepressants.

Exactly. I got a chuckle out of one of the poster's recommendation for people to eat right and get excersize. Heh, imagine telling that to a cancer patient. Oh wait, I forgot, cancer is real and major depression is a conspiracy by big medicine to sell SSRIs. Just ask any cultist or at herbs4UNow.com or whatever crackpot site was linked here.

When on medication many people suddenly have the energy, will, and lack of neurosis to engage in social activities like working out in a gym, strolling on the beachfront, cooking (thus eating better), etc.

What really gets me about the FPP is that grahamwell takes an asset - the ability of long term SSRI treatment to increase the hippocampus and spins it into some kind of "do we know what we're doing here" attack on the drug. Hell, SSRI researchers, doctors who prescribe them, and people taking them should be dancing in the streets that the treatment is not just attacking the symptoms but may be making permanent or semi-permanent fixes also.

What's really lacking here is the knowledge that much of medicine is a gamble. Just focusing on SSRIs is simply a lame straw man, easily knocked over with the facts.

I think starvos should get off the neo-luddite wagon and realize that society has tried kicks in the pants, self-help books, extra-strong doses or religion, cults, wacky therapies, etc and found them lacking.
posted by skallas at 12:45 AM on August 10, 2003


Also, there's more good news regarding SSRIs. It recently was found that more folate (folic acid, vitiman b-5, etc) along with SSRIs dramatically improves the performance of the drug.

Also low folate correlated with depression.
posted by skallas at 1:09 AM on August 10, 2003


i'd be less depressed if skallas would folate me.
posted by quonsar at 1:39 AM on August 10, 2003


Hey, whatever. If folks want continue down their merry pathway to chemical happiness, hating their jobs and their wives, their husbands and their lives, and making it endurable with little pills, I say fuck 'em, let 'em do it.

Let them dose their kids, medicate themselves, let them find rx happiness, I don't give a shit, really. Everyone's got to find their own way to what they consider the good life.

Nobody is intimately, familially familiar with somebody else's mindstate.

Nor did I claim to be. What do I find risible is your inexplicable belief that you somehow know more about people that I've known for two or three decades than I do.

I'm curious as to why you know what they need better than they do.

I don't. But I still think a good half of them (and keep in mind here, please, that by 'them' I mean solely the dozen or so people I referred to back in my first comment) are pathetic, and using their prescriptions to smooth over the sort of problems that Real Adults should (in my opinion alone) deal with without the assistance of their doctors.

>People are a lot more likely to "change their lives" with antidepressants and on antidepressants than they are to change them instead of taking antidepressants.

Exactly.


Congratulations! The winner for the most inane circular argument I've heard all week. That's not the point, boys. The point is to find a life that you can live without having to tweak your unhappiness out of existence with medication. And to accuse me of being on a 'neo-luddite wagon,' convenient as it may be, is beneath you, skallas, and just silly.

Contempt and kicks in the ass do not help, stavros.

Goddamn it, I know that! At least a good part of the time, and never for those who are truly in need assistance.

For fuck's sakes - (I sense y2karl somewhere in the wings about to kick my ass for repeating myself but) I have said at least three times in this thread that I am totally convinced that many many people need these drugs and that they are a good thing for those people. But at least half of the group of medicated friends and relatives I met, in Canada, over Christmas, were not a part of that group, in my opinion.

You jokeefe, or you sennoma, or you Xenophobe or skallas, may well be part of the group for whom medication is necessary and life-enhancing, if not live-saving. I just don't care, don't you see? I'm not talking about you.
posted by stavrosthewonderchicken at 1:49 AM on August 10, 2003


Or, to put in terms that won't confuse :

SSRIs can be good things, for the people whose lives would be unbearably miserable without them. [this is good]

Many people seem to be medicating with SSRIs when such medication is not strictly necessary. [this is bad]

There is a grey area between the groups, as there always is. [this might be inconvenient]
posted by stavrosthewonderchicken at 1:53 AM on August 10, 2003


>Congratulations! The winner for the most inane circular argument


Circular reasoning my ass. Non-depressed people act in socially positive ways that may include the suggestions of the other poster about diet and excersize. The point being that the depressed sometimes need a "leg up" and that people who do have better diets and excersize are not necessarily fighting depression they may just be expressing themselves naturally, e.g. a depressed person does not engage in this behavior because of her illness.

Stavros, all you have is your limited experience and opinions. Not much up against peer-reviewed journals and meta-analysis. If you firmly believe your peers are abusing pharmaceuticals then you should call them on it and make an effort to see if they're seeing a sub-standard doctor. Like someone else posted there is no drug out there that hasn't been abused.
posted by skallas at 2:00 AM on August 10, 2003


Stavros, all you have is your limited experience and opinions.

Which is different from you how, precisely?

The point being that the depressed sometimes need a "leg up"

I see your point. I even think that in some cases that's precisely what happens. I also think it's may be the worst possible path for someone to 'get better.' Of course, if they do get better, and off medication, then the end justifies the means, I suppose. In this case. Maybe.

Like someone else posted there is no drug out there that hasn't been abused.

Don't I know it. Hoooooo-ee!
posted by stavrosthewonderchicken at 2:07 AM on August 10, 2003


To circular reason is to be human. Henceforth, meds can kind of help you to break that cycle.

For me, before meds, I continually sought answers to existentialist, nihilistic connundrums until it made me fearful I'd swerve my car into crowds, kids, old ladies etc. I became very afraid of this freedom we all have and I simply couldn't get the reality of what I was capable of out of my head. That's some circular-ass unreasoning if you ask me. Depressing, debilitating and all that. Before SSRIs (Fluvoxomine in particular) I could not escape the cycle on my own. I knew no way other than doing myself in. I could guarantee myself nothing as far as what I was capable of.

Sometime in 1996 I peered down into the bottle of Luvox I was first prescribed and asked whoever would listen, "So these little fuckers are supposed to make this all go away?"

Supposedly.

Meds have helped me to put creative emphasis where it is needed and to recognize and control where it is not. No, it's not completely perfect, but it's worked for me. I finally have a semblance of control and I am able to live.
posted by crasspastor at 2:24 AM on August 10, 2003


>Which is different from you how, precisely?

I like to think most of the stuff I've posted are non-controversial accepted facts in the medical profession, e.g. how SSRIs work, whether they can be considered addictive in the classical sense, how hippocampus enlargement is an asset and not a liability, etc. Feel free to criticize this stuff with links.

Regardless, I've seen med abuse caused by apathetic or incompetent doctors and if your loved ones are in that situation then its a bad place to be, but the SSRI itself, psychotropics as popular remedies, etc are not necessarily wrong. I think your issue with this is not the drug, or the drug companies, or the press, but with the specific doctors your friends and family are using. Of course, you'll have to accept the agnostic fact that they may have a legitimate need for such drugs; as you may may have absolutely no idea of their inner workings even if you've known them all their lives.

That's one of the downsides of the stigma of psychitric treatment, people will put up a happy face for years until their coping mechanism can't take it anymore. You may have been fooled by that happy face. Many are.
posted by skallas at 2:25 AM on August 10, 2003


"A semblance of control" makes me seem still, probably nutty.

Those in the throes of OCD, Mania, Depression normally are not nutty at all with or without their meds. They are merely preoccupied with a cycle they can not escape. They gnaw on themselves seeking something static and solid. That's where the illness that meds seem to be able to treat exemplifies itself.

Whether we want to admit it or not, there are perfectly normal people with nothing constructive to do with their thoughts. I have no idea, but the advent of the usefulness of these mixtures of chemicals could very well be correlative to the manifestation of impersonality in our time. Whaddarya gonna do?
posted by crasspastor at 2:51 AM on August 10, 2003


when I start burning the candle at both ends, eating like shit, and skipping the gym

i just wanted to stick my head up and say, well, probably i'm not clinically depressed, and yes, therefore i know far too little about clinical depression to add anything to a pharmaceutical argument, but man, when i have a regular regimen i feel a hell of a lot better about myself, and i definitely think it's something for people to try. i really felt the need to say HELL YES to this particular aside.

it takes like three weeks to make it a habit, and then you'll feel great. it's hard to get out there for those first three weeks, but stick with it. I obviously can't speak for other people's experiences, but regular exercise has done a shitload of good for my bad moods. seriously, if you're feeling down, see your doctor, of course, but also, get outside and get some exercise -- that might be all you need. it works wonders for me.

posted by fishfucker at 3:03 AM on August 10, 2003


Skallas: Here's my problem. We thought we knew how antidepressants work. Your 'yes Veronica' link is a fair statement of the prevailing orthodoxy. There are problems with this account however - the two week lead time and the fact that some antidepressants don't seem to affect the Serotonin system.

This new research suggests an alternative mechanism, it may be complementary to the understood effect, it may in fact be the real cause of the effectiveness of the drugs. We don't know.

This alternative mechanism is pretty radical. It permanently changes the physical architecture of your brain - something we didn't previously belive possible. If this were a new drug newly discovered we'd want to test it extremely thoroughly before releasing it to patients - we would want to properly understand the impact and long term effects of such changes.

However these drugs are everywhere. We don't have that option. So, as you succinctly paraphrased above, do we know what we're doing?
posted by grahamwell at 3:33 AM on August 10, 2003


Those in the throes of OCD, Mania, Depression normally are not nutty at all with or without their meds.

No, they can be very nutty indeed. These are serious, often debilitating, and, the case of bipolar disorder and depression, sometimes fatal diseases.
posted by Slithy_Tove at 3:54 AM on August 10, 2003


A decent diet and exercise will work for moderately depressed people, but not for all of them. It would be nice if we could give medicated people the benefit of the doubt about the severity of their condition. Just because you didn't see the signs doesn't mean they weren't there. Depressed people fake it and get away with it, even with people living in the same house. I can't imagine how easy it would be to successfully fake it for someone who lived in an entirely different country.

And you know what? If one of the previously unknown "side-effects" of antidepressants is a reversal of depression-damaged parts of the brain, I'll take it. Since I know that one of the long-term effects of depression is possible death, the risk/benefit analysis comes out pretty clearly in favor of taking the damn meds, even if that means people will make insulting and ill-informed comments about choosing to do so.
posted by stefanie at 4:13 AM on August 10, 2003


...and I am able to live.


i still want to die, but man, i feel a whole lot better about it thanks to SSRI's.
posted by quonsar at 5:15 AM on August 10, 2003


I have to say I agree with stavros for the most part (what he wrote, not what some people think he meant).

While a lot of people are genuinely mentally ill and need medication, I think a lot of others are using pills as a way to avoid the trouble and strife involved in improving their personal situations.

Maybe they're in a crappy relationship and they don't know how to get out of it, maybe they're working long hours in high-stress jobs, maybe they have severe financial problems that they can't see an end to. Given a choice between the extra emotional suffering involved in fixing those issues and the ability to take pills and feel better about everything (or at least numb to it), a lot of people take the latter. And it's not hard to see why.

Given the temprament of this thread I do feel the need to state again that some people do need the pills. Just not everyone who takes them.

There may well be an increase in legitimate consumers too, due to the pace, stress and ultimate futility inherent in modern lifestyles.

*pops blue pill
posted by cell at 5:17 AM on August 10, 2003


I like to think most of the stuff I've posted are non-controversial accepted facts in the medical profession [...] Feel free to criticize this stuff with links.

Once again, I don't want to criticize any of it. Whatever gave you the impression that I did? Peace, already.

Now I'm kinda tempted to try and scare up a sawbones who'll scribble me a scrip, and get on them little babies myself! Hell, I have long stretches of time where I am deeply, morbidly depressed, when I consider suicide almost daily, when I'm sure there's no light at the end of the tunnel, when I hate life itself and everyone around me.

Shucks, who doesn't, though, eh?

Look, I've been devil's advocating to some extent in this thread, because (dead giveaway upthread) I really am a proponent of better living through chemistry, in a big way. I just distrust - not that's not strong enough - loathe doctors and their chem-whoring with an eyepopping vitriol.

'Better living' is a phrase which bears a very great deal of very careful examination, I think. 'Better' and 'easier' are frequently orthogonal, I have found.

(what he wrote, not what some people think he meant)

Thank you, cell. I sometimes despair at trying to clearly explain what I believe, especially on hotbutton issues, and when my temper gets in the way.
posted by stavrosthewonderchicken at 6:20 AM on August 10, 2003


But for several people, taking the risk of complications tomorrow is worth not wanting to kill themselves today.

Then, according to this research, they should reconsider taking such medication:
...unpublished studies about Paxil show that it carries a substantial risk of prompting teenagers and children to consider suicide....While the regulators' recent warnings address only Paxil, many of the panel members said that SSRI's act similarly, so the concerns could apply to all.
Blind faith in human techniques to alter brain chemistry and process is a religious methodology, not a scientific one. I have seen people helped dramatically by SSRIs; I have seen people (in some cases, the same people as above) dramatically screwed up by them. I have also experienced clinical depression, so I know what is at stake. But none of that relieves one of the responsibility to fairly and openly evaluate cause-and-effect data as new information is discovered. That's what progress is all about. Treatment should not be prescribed or undertaken by those with their eyes squeezed shut, whatever their motivation.
posted by rushmc at 7:13 AM on August 10, 2003


ROU: Nobody is intimately, familially familiar with somebody else's mindstate. Half the time, people aren't even intimately familiar with their own mindstate.

Which blends well into another concern I have. The mythologizing of the psychology profession and doctors as being better capable of diagnosing what is wrong with your life than the patient.

Skalas: Exactly. I got a chuckle out of one of the poster's recommendation for people to eat right and get exercise. Heh, imagine telling that to a cancer patient. Oh wait, I forgot, cancer is real and major depression is a conspiracy by big medicine to sell SSRIs. Just ask any cultist or at herbs4UNow.com or whatever crackpot site was linked here.

I don't think the concerns are just coming from the new-wave herbalist folks. About every three months or so, the proposal by some pharmaceutical company linked doctor to prescribe prophylactic anti-depressants to a new market makes the science periodicals with associated debate. Drug companies are rather honest about the fact that they try to expand their markets by finding new uses for their existing products, so I don't think it is a concern coming out of left field.

starvos: Congratulations! The winner for the most inane circular argument I've heard all week. That's not the point, boys. The point is to find a life that you can live without having to tweak your unhappiness out of existence with medication. And to accuse me of being on a 'neo-luddite wagon,' convenient as it may be, is beneath you, skallas, and just silly.

Hrm, I think you are dramatically overestimating both the claims about these drugs, and what they actually do. None of the people I know who are on drug therapy are "cured" or become "happy". The drug treatment simply makes the symptoms manageable to the point where all of the other suggestions you make are possible. In fact, the latest evidence suggests that a mix of drug/behavior/cognitive therapies are more effective than drug treatments alone.

In general: I feel a bit frustrated at how polarized this discussion is. A healthy skepticism about our understanding of the way drug therapies work, and the drive to expand their use into new markets is not an attack on people who are depressed or people who are taking SSRIs. I'm concerned about this because this is a health issue that affects me and my experiences with the medical community in regards to other health issues has not given me unshakeable confidance in their abilities or understanding of what is best for me.
posted by KirkJobSluder at 8:45 AM on August 10, 2003


One a practical note (from a *gasp* Wellbutrin taker) - clinical studies have shown that regular (daily) exercise for at least 45 minutes or an hour a day - exercise which also elevates heart rate above a certain level - is just as effective (for most, anyway) as antidepressant medication. I'd advocate both for those who feel depressed and, going even further:

Exercise, good nutrition, antidepressants, travel, learning, sex, social interaction, meditation (not to mention positive belief structures too) and above all change, and newness (new situations) themselves have all been shown to enhance brain function or promote the release of human brain growth factors which stimulate the growth of new neurons and - taken together as a therapeutic regimen - fight depression and enhance overall wellbeing far more powerfully than any one practice, medication, or therapy.

Moving right along - I'm surprised that no one on this thread has thought to mention, as factors causing depression on the societal level:

1) Overall societal dysfunction (crime, social pathologies of all sorts), auto culture, fast food culture (and poor dietary habits in general - too much sugar, saturated fat, hydrogenated fat, white flour, food additives, and so on), lack of exercise, lack of daily social contact (loneliness), atomized and frayed social networks.......excessive TV watching, inadequate daily use of brains (the "Thought Gap").........

2) Environmental toxicity - Mercury, lead, PCB's, Dioxin, persistent organic pollutants which mimic/block/alter hormonal and endocrine function, pesticides, insecticides, radiation, depleted Uranium, Carbon Monoxide, Nitrous Oxide.......and on and on and on..........

3) The fact that all factors (above or already mentioned in the thread) are relevant - including (some would argue) belief structures (faith, religion, mysticism), and the exercise of "Free Will" (not especially helpful for some suffering from depression) - and that they all feed into the complex, dynamical system which is a human being and a human life.

On a wider note, too, Homo Sapiens has come a long, long way from it's recent hunter/gatherer tribal origins, both socially, culturally, technologically, and environmentally. It stands to reason that we are, as a species, undergoing a type of systemic stress from all of these rapid changes.


Further, here's a thought experiment - assume that Stavroswonderschicken is on to something in his observation that it's a little weird, the extent to which Americans rely on antidepressants. When does the "normalization function" of antidepressants (or psychoactive pharmaceutical drugs in general) become such a powerful effect that it blinds Americans to pathological daily realities which are feeding their depressions?

Can an entire nation become so heavily medicated as to become truly insane, or delusional? ( to external observers ); this is the theme of Stanislaw Lem's "The Futurological Congress", the possibility that psychoactive pharmaceutical will eventually be able to general effects so precise and powerful that they can obscure an underlying reality which otherwise would be unacceptable or even nightmarish.
posted by troutfishing at 8:46 AM on August 10, 2003


The bottom line of any discussion about depression and its treatments is the almost fanatical resistance of many people who don't suffer from it to legitimizing the symptoms at all. Obviously that is changing, and one reason is the prevalence of SSRIs. Of course the backlash against the former status quo is overkill, it always is. But when I step back and take a hard look at the way non-depressives react to my depression symptoms, and how in turn I have often internalized those reactions, it does make me angry when someone claims a good swift kick in the ass would solve the problem.

That may be true for some people, but I've never met those people. It's just the argument of someone who has never had to deal with the insidious creeping conviction that life is pointless, and does not want to face the consequences of accepting that life is a shockingly different experience for every human being.
posted by divrsional at 9:39 AM on August 10, 2003


divrsional: The bottom line of any discussion about depression and its treatments is the almost fanatical resistance of many people who don't suffer from it to legitimizing the symptoms at all. Obviously that is changing, and one reason is the prevalence of SSRIs. Of course the backlash against the former status quo is overkill, it always is. But when I step back and take a hard look at the way non-depressives react to my depression symptoms, and how in turn I have often internalized those reactions, it does make me angry when someone claims a good swift kick in the ass would solve the problem.

I see what you are saying here, but is it not possible to consider the symptoms as legitimate while having honest concerns about how people suffering from the symptoms are being treated? For example, I see a huge ammount of dissonance between what the advertisments say and what the people who take SSRIs say about the results. So much so that I have strong doubts about ROU_Xenophobe's claim that huge numbers can benefit. While they do benefit in that the symptoms became more managable, they also have very real concerns about side effects and safety.

I don't think that anyone here is advocating "a good swift kick in the ass." I will say that some people, such as myself, have found that behavioral and cognitive therapies are a better option than SSRIs for managing depression symptoms.
posted by KirkJobSluder at 10:02 AM on August 10, 2003


rushmc: Blind faith in human techniques to alter brain chemistry and process is a religious methodology, not a scientific one. I have seen people helped dramatically by SSRIs; I have seen people (in some cases, the same people as above) dramatically screwed up by them. I have also experienced clinical depression, so I know what is at stake. But none of that relieves one of the responsibility to fairly and openly evaluate cause-and-effect data as new information is discovered. That's what progress is all about. Treatment should not be prescribed or undertaken by those with their eyes squeezed shut, whatever their motivation.

Well, I'm not convinced that it's just "blind faith" without a lick of "science." All drug therapies are subjected to basically the same reseach methodology: double-blind experiment on human subjects. There is more than enough research to show that SSRIs do help moderate symptoms for many people.
posted by KirkJobSluder at 10:16 AM on August 10, 2003


Maybe they're in a crappy relationship and they don't know how to get out of it, maybe they're working long hours in high-stress jobs, maybe they have severe financial problems that they can't see an end to. Given a choice between the extra emotional suffering involved in fixing those issues and the ability to take pills and feel better about everything (or at least numb to it), a lot of people take the latter.

It's quite the opposite, actually. When your problems are so overwhelming that you feel as though you have lost control of your life (which is very depressing), the drugs can give you that sense of control back and allow you to take the steps you need to take to put your life back in order. Without antidepressants, I would probably still be in Detroit (a depressing place to live if ever there was one) with my nose to the grindstone trying to dig myself out from under a mountain of debt using a teaspoon. Although I knew my financial situation was bad, I was always terrified to sit down and add up the numbers and figure out how bad it was, because I was afraid it would be impossible to solve. The issue weighed on my mind so heavily that it was causing me to have trouble working, which, since I was freelancing at the time, just dug me deeper in the hole.

But thanks to a six-month prescription for Paxil, I'm living in the Seattle area -- where I'd wanted to live since I first visited on vacation in 1990 -- and the debt is completely gone after just four years. I've had some stress, being laid off twice since I got here, but I've got my spending worked out such that I can pay all my bills entirely on unemployment for as long as they'll give it to me, if that becomes necessary. Having addressed the debt and recovered my confidence, this one was easy.

Your problems always look bigger when they're sitting on your shoulders. If what it takes to help you put the load down and get some perspective on it is a "happy pill," then take the damn pill already. Don't worry if others snidely refer to it as "just a crutch." If your leg were broken, you'd use a crutch without shame while it mends, and there's no shame in finding something to lean on while you fix your life either. Whatever works.
posted by kindall at 11:38 AM on August 10, 2003


Robber cleared by drug defence - charges dropped after report links Seroxat to threatening behaviour

'I'm a fairly timid guy,' Douglas-Hamilton told The Observer last week. 'I had only been prescribed [Seroxat] because I suffered from anxiety and some depression. It seemed to destroy my conscience and my fear. I found myself walking out of the house with knives; I had every intention of killing people.'

Douglas-Hamilton, who lives near Hereford, was due to face trial this week in Oxford on two charges of theft. But the case was unexpectedly dropped last Thursday by the CPS [similar to the DA], which did not give a reason for the discontinuance .

...A spokeswoman for GlaxoSmithKline said: 'Violence and aggression are a feature of anxiety and depression disorders. Seroxat will reduce levels of these, and neither violence or aggression are withdrawal symptoms.'

I post this, not as an alarmist, but as a past user of seroxat [paroxetine], though my withdrawal symptoms were more like the heady, groggy ones other users have alluded to. I do think that for some users, the side effects can be catastrophic and unpredictable. How we live with that - I do not know.
posted by dash_slot- at 11:44 AM on August 10, 2003


The bottom line of any discussion about depression and its treatments is the almost fanatical resistance of many people who don't suffer from it to legitimizing the symptoms at all.

I think you are showing a bit of your bias here. Certainly there are many people who are dismissive about depression, and I can understand why people such as yourself who have experienced both the depression and such uninformed, cavalier attitudes toward it might have a negative emotional reaction to such viewpoints. But don't be so quick to generalize: it could equally be said that "the bottom line of any discussion about depression and its treatments is the almost fanatical eagerness of many people who do suffer from it to reject out of hand any objective inquiry into the disorder or its treatment options." Neither of these extreme reaction should preclude a rational, productive examination and discussion of the facts.

Well, I'm not convinced that it's just "blind faith" without a lick of "science."

I wasn't referring to the medical testing procedures in that comment, but to the unthinking devotion of many who use the products that they produce. For certain individuals, believing in an easy fix—be it snake oil or miracle cure—seems to be more important than really coming to understand what is actually happening with their bodies, pro and con. It is this desire to transfer responsibility to a "magical" external fix (be it a pill, a particular therapeutic approach, a charismatic guru, or baths in holy spring water) that disturbs me, because it is a choice for ignorance over knowledge.

At this point, any and all treatments of cognitive conditions are stop-gap, scattershot, and poorly understood. If a person understands this and chooses to proceed in order to obtain some demonstrable (or even a perceived) benefit, that's fine, but to sell "cures" to the unsophisticated (and the desperate, and those who because of their very mental and emotional states may least be in a position to judge impartially) strictly on the basis of the reputations of physicians and pharmaceutical companies without accompanying education about their limitations/potential side effects (known and unknown) is reprehensible.
posted by rushmc at 11:46 AM on August 10, 2003


Hell, I have long stretches of time where I am deeply, morbidly depressed, when I consider suicide almost daily, when I'm sure there's no light at the end of the tunnel, when I hate life itself and everyone around me.

Shucks, who doesn't, though, eh?


Actually, stavros, this was my reasoning for years. It went like this: If everyone felt the way I did (and I had been experiencing this since I was eight years old) then I was even more marked for destruction than they, who could somehow feel the same void at their feet every second of the day and still manage to engage with the world, go to work, take University seriously, start careers, etc. This assumption was even more paralyzing than the depression itself, which for me was like a continual squall of emotional feedback which fucked up everything I tried to do and every relationship I tried to have. It was astonishing, revelatory, to find out that, in fact, most people did not have this noise going on in their heads, and that this was in fact how they managed to get through the world. The point being that no, not everyone feels that way. So this, I thought, is how normal people manage to get so much done. Astonishing.

I take your point and understand what you are saying. I don't know if antidepressants are overprescribed or not, but I do know that some, at least, probably regard them as a quick fix for more complicated underlying problems. I suspect that it was your use of the word "contempt" that made foks go ballistic here; depressed people generate enough of their own internal contempt, and don't need any more of it... I think of all my alcoholic relatives, the beaten wives, the divorces, and think, yes, life can suck, but whatever helps the walking wounded be better people, more generous, and less preoccupied with their pain is a good thing.

Personally, I've been utterly humbled by the facts of my biochemistry.
posted by jokeefe at 1:17 PM on August 10, 2003


Feelings are not reliable.

(I'd expound on this at length, detailing the amount of pain and suffering as well as pleasure and joy that I experienced in course of learning this simple—perhaps too simple—fact. But I don't feel like it. And yet I can't let it just go out there alone and unsupported hence this angsty, and ultimately worthless, parenthetical note.)
posted by wobh at 1:17 PM on August 10, 2003


Feelings are not reliable.

Amen. I have found my life improved tremendously when I stopped thinking of my emotions as part and parcel of myself and started thinking them of things that happen to me, like weather. Thus they are neither right nor wrong, they just are. They may be overpowering at times, but with a little preparation, you can learn to live with them.
posted by kindall at 2:19 PM on August 10, 2003


Zoloft. Best thing since sliced bread -- particulary effective when consumed with a tall cold one.
posted by {savg*pncl} at 9:54 PM on August 10, 2003


By the way, if anyone still cares, Wellbutrin (bupropion) does muck with one's serotonin levels, in addition to the already cited norepinephrine (-adrenaline) and dopamine. It's not an SSRI, but apparently it indirectly raises serotonin levels.
posted by LimePi at 10:39 PM on August 10, 2003


If folks want continue down their merry pathway to chemical happiness, hating their jobs and their wives, their husbands and their lives, and making it endurable with little pills, I say fuck 'em, let 'em do it.

Except that it's been noted numerous times in this thread, by several folks, that antidepressants aren't happy pills. They don't bliss you out, they're not Mother's little helper, they don't make you able to endure a miserable life, they don't numb the pain. They just don't work that way. I think what people were responding to, besides your use of the word "contempt", was your dismissive tone. Moreover, depression isn't just "unhappiness" or not being able to deal with the vagaries of daily life. That "kick 'em in the ass/they just need pep-up pills/they need to snap out of it" attitude frankly doesn't help anything.

That's one of the downsides of the stigma of psychiatric treatment, people will put up a happy face for years until their coping mechanism can't take it anymore. You may have been fooled by that happy face. Many are.

Damn straight. Depression turned me into a *very* good actor, because I was working so hard not to let on to anyone what I was going through. I'd get home, lock the door, and collapse onto my bed exhausted...not because of work or daily activities, but because it took so much energy to maintain that facade. (If someone asked "how's it going?" and I actually told them, they'd have been on the wrong end of a 20+ minute tearful rant, which I assume isn't what they'd have expected.)

That happy face started to crack for me, and I thank God that I found good help when I did (after some stints with truly awful and ineffectual psychiatrists, including one who didn't want to ask me questions or listen to me, but instead wanted me to rate my feelings on a 1-5 scale and look at the answer sheet, telling me that she'd commit me if it reached "1.") If I hadn't gotten onto the right meds at the right time, I seriously doubt I'd be here today. (Fortunately, I progressed to the point where I could get off the meds over a year ago.)

What surprised me the most during my most recent bout with depression was that there seems to be a division between care providers who prescribe drugs and who provide talk therapy. From what I've read, most depression responds best to a combination of these approaches, and it took quite a lot of looking to find someone who was willing to both prescribe medication and engage in regular talk therapy. What frightens me about that setup is that there are lots of psychiatrists out there who will reel off the DSM symptoms for major depression like a checklist and spit out a scrip for an antidepressant without bothering (nor even seeing the need) to delve any deeper.

on preview: That is why it's a good idea not to post when you're really sleepy.
posted by Vidiot at 12:10 AM on August 11, 2003 [1 favorite]


Vidiot - ( re : "it took quite a lot of looking to find someone who was willing to both prescribe medication and engage in regular talk therapy." ) Bottom line - "Pill Therapy" is cheap for health care providers because, in many cases, antidepressants are prescribed by a MD and then followed up by very cursory appointments which tend to devolve into "every 3-6-12 month rubber stamp" affairs. Talk therapy, however, involves lots of talk, hence time, hence $. So the pills are pushed over the talk. But you were lucky to find an MD who would both prescribe pills and talk - a very expensive proposition. Usually the talk therapy is relegated to counselors who specialize in talk therapy or who could even be priests or clergy, and who get paid less than MD's are paid.
posted by troutfishing at 2:11 AM on August 11, 2003


Amen. I have found my life improved tremendously when I stopped thinking of my emotions as part and parcel of myself and started thinking them of things that happen to me, like weather. Thus they are neither right nor wrong, they just are. They may be overpowering at times, but with a little preparation, you can learn to live with them.

Kindall, that really sums it up. Well said.
posted by crasspastor at 2:13 AM on August 11, 2003


Troutfishing:

My experience was, with the talking 80 buck an hour (I'm giving you a deal) psychotherapists, you deal mainly in their effectiveness insofar as their schedule allows.

I always felt that the depth to my problems flew smack into their just-so hourly answers, rendering the psychotherapist's expertise, at least to me, moot and pretty much useless. I mean fuck, they take notes! Who takes notes if they really give a damn about you? (I know that's the way it is, but when you're in the depths of thinking about doing yourself in, that's the last straw as far as proof that nothing really does matter)

All in all, it was $80 an hour for the luxury of sitting in a hyper-comfortable (yet, you never are), well pillowed lounge with coral reef scuba prints everywhere that my shrink could continually point to (as he'd snapped the photos himself) as proof to what I could do if I got with it. Uhh, talk about anti-climax when you need it the least. I could sit in a bar for much less than that.

My problem was never with being able to talk to someone, it was getting answers that I needed about unanswerable questions. I didn't understand that having no answer at all was okay.

Today, I'm happy seeking, apparently growing my hippocampus along the way.
posted by crasspastor at 2:40 AM on August 11, 2003


For what it's worth, here's my approach to my chronic depression, worked out over many years:

1. Psychopharmacologist for meds. That's all he does. He writes my Celexa script and checks to make sure there are no problematic interactions (e.g. I need to wait an hour to let my thyroid medication absorb, or the Celexa will block it). We chat about my life, but just the headlines.

2. Cognitive-behavioral psychologist. I see him for a month or so a few times a year and e-mail him regularly. We like each other. No hashing out sadness from my childhood, just solving problems happening now. The more time I spend in CBT, the more problems I can solve on my own. I spent years accomplishing nothing in humanist talk therapy before I found this.

The rest is making sure I have proper medical care, lots of sunlight, exercise/physical therapy, people I love, and a good cat. YMMV.
posted by swerve at 6:52 AM on August 11, 2003


Amen. I have found my life improved tremendously when I stopped thinking of my emotions as part and parcel of myself and started thinking them of things that happen to me, like weather. Thus they are neither right nor wrong, they just are. They may be overpowering at times, but with a little preparation, you can learn to live with them.


Yes I agree too....and if memory serves me well, I do remember a quote from you Kindall along similar lines.....that when a devestating thought hits us and the feelings kick in, just to observe what is happening....and the observation itself becomes a kind of detachment from the feelings. Thoughts give rise to feelings, as the Buddha says, but we can also detach ourselves from the feelings through observation of these feelings. Incredibly hard to do, but I've found myself strangely numb from crushing thoughts simply because I stop the feeling process in it's tracks via observation.
posted by SpaceCadet at 9:29 AM on August 11, 2003


Not that I entirely disagree, but I can't help but wonder what is lost when emotions are banished.
posted by rushmc at 10:46 AM on August 11, 2003


There's a big difference between waiting out the storm and banishing the storm.
posted by kindall at 10:59 AM on August 11, 2003


True, but my concern would be that some would fail to make that distinction and overcompensate. A totally flat affect is also unhealthy. Used with care and restraint, I'm sure it's an effective strategy at least some of the time, however.
posted by rushmc at 2:04 PM on August 11, 2003


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