Hmm. Why am I not surprised?

June 6, 2000 7:05 PM

Hmm. Why am I not surprised? Muddling with your serotonin in such a drastic way has always struck me as an overreaction to depression. Let's be honest. In a world jam-packed with aggressive apes who deny that they are apes, a little depression is a healthy response. Taking a serotonin re-uptake inhibitor just because you feel blue is like taking 10000 micrograms of Acid because you like the Harry Potter books.
posted by Ezrael (30 comments total)

Sure. But the almighty pharmaceutical industry keeps airing tv spots that encourage some people to take a pill. Even when it's a pill with a shady history. Instead of getting real counseling help, a troubled teen is prescribed the pill and look what happens.
The tv prozac ads make me sick. Sure, some tv programs can be helpful, but the big picture is TV = Prostitution.
posted by goodhelp at 7:59 PM on June 6, 2000

... marketing and publicity are, I think, not exactly the best motivating factors for prescriptions of any drugs, it's true, and that medical drugs are being marketed to the public is something that does concern me. but I don't think you can imply that pills are not "real help", that they can't be the right way to go *for some people*. Traditional "talking" therapy and psychopharmaceutical treatment are different, not necessarily mutually exclusive, sorts of therapy. Different treatments for different illnesses, and I think the valid point is not that Prozac is Bad and turns kids into killers, but rather that Prozac is being overprescribed and misperceived as a pick-me-up rather than a medical treatment of a specific chemical disorder.

Not that, by any means, clinical depression has been pinned down as an exact and constant thing by the medical establishment---they can't even predict with any accuracy what anti-depressant (SSRIs or other older drugs) will be best to treat a particular patient, it's all about trial-and-error which personally scares me to death, but I've known more than one person diagnosed with clinical depression who will swear to you up and down that Prozac saved them---or Lithium or Zoloft or any number of other drugs. No amount of talking will correct a chemical imbalance.

"The blues" != "depression" ... most doctors *should* know that, but I think most of the public does not.
posted by Sapphireblue at 10:11 PM on June 6, 2000

Mathew, you are an insensitive jackass. What the hell do you know about it?

A person suffering from clinical depression is 30 times more likely than a healthy person to commit suicide. A person suffering from Bipolar Disorder (Manic Depression) has one chance in five of ending their own life.

Clinical depression is not "just a case of the blues". It is a very real and very serious disease, with drastic consequences if untreated.

The attitude that a person suffering from it should try to tough it through based solely on strength of will is an attitude which condemns thousands of people to needless deaths every year, and thousands more to nearly intolerable levels of suffering.

Somehow some people have this idea that diseases of the brain are somehow qualitatively different than diseases of any other organ, and that they uniquely should not be treated with drugs. This is one of the largest hurdles which prevent truly sick people from getting the treatments they need to survive and recover.

Would you mock diabetics for using insulin? Would you mock an asthmatic for using an inhaler?

Go read this page. Then keep laughing, funny boy.

[By the way, Sapphireblue is not correct about something. There is a precise and unambiguous definition of clinical depression. What is missing is any understanding of the underlying cause. But the fact that we can't explain something doesn't mean it doesn't exist.]

posted by Steven Den Beste at 11:35 PM on June 6, 2000 [1 favorite]

Steven: the DSM may be full of "precise and unambiguous definitions", but it's just as ideological as a political handbook. Ever tried looking up "hysteria", a disorder which has been discussed by doctors since Galen? Not there any more. An un-disease. Expunged in Orwellian fashion, as syndrome after syndrome appears in its place to pathologise behaviour that would have been regarded as merely aberrant a few years ago. I'm with Thomas Szasz: mental illnesses are qualitatively different, because by their nature they disrupt the diagnostic process which drives medical treatment. And I say "mental illnesses", not "diseases of the brain", because depression isn't "a disease of the brain" in the way that angina is a "disease of the heart": it's a disease of the self.

Even Prozac and the post-Prozac generation of SSRIs are basically sledgehammer treatments for neurochemical nuts (if you pardon the pun); ask the people who develop them for an explanation of what they really do, and the honest ones will shrug. Which is why blanket prescription, and the pop-success of Prozac, is perhaps even more insidious than the cures for "the nerves" prescribed in the 1750s. At least a few glasses of the waters at Bath were only likely to give you a water-borne infection.

Salon recently wrote of the parlous state of mental health in the US, where your choice of health plan decides whether you receive something akin to therapy. It's not much better in the UK, where the Tories' "Care in the Community" released the mentally ill onto the streets, with inadequate provision to ensure they took their medicines and received therapy and shelter.

And yes, I have been prescribed Prozac for depression, at a time when I needed it. Writing a doctoral thesis dealing with medical liturature on mental illness is likely to bring on those effects. And having a fiancée who works with the mentally ill disavows me of any of my more extreme anti-psychiatric sentiments. Mental health care starts with care, in all its respects.
posted by holgate at 4:20 AM on June 7, 2000

<DELURK>
Perhaps it's over-prescribed, and perhaps some who take it contemplate - or succeed at - suicide. But if the original poster had ever been diagnosed as clinically depressed and been prescribed an SSRI as one component of a treatment regimen, he would recognize that healthy people who take a drug they don't need are merely stupid; people with the illness these drugs are designed to treat, on the other hand, can remain living because of it (myself included).
<DELURK>
posted by m.polo at 4:36 AM on June 7, 2000

I have no strong opinion about whether or not prozac-like drugs are harmful (though it is, of course, an important issue to look into). But I DO have an opinion about the article that sparked this thread: it sucks.

Some researcher suggests that there's a link between prozac and suicide. Ok. EVIDENCE??? We really need something more than one story about a woman who had a bad dream and "felt suicidal" before we leap to conclusions.

I'm not suggesting that there isn't a strong link, but it's impossible to tell from the article, which is full of words like "may" "could" and "suggests."

Are we dealing with a public-health risk or bad journalism?
posted by grumblebee at 5:00 AM on June 7, 2000

We're *dealing*...

with bad HTML.
posted by baylink at 7:07 AM on June 7, 2000

Bold off now, I hope.

The article was a little breezy. There is certainly a risk with taking any psychoactive drug, and doing so without the supervision of a trained professional is probably a bad idea. Prozac and the SSRIs have become popular, not because depression is the "hysteria" of our day, but because SSRIs are very difficult to overdose.

Unfortunately much of the criticism of Prozac (which gets all the flack, even though Zoloft and Paxil are both in the same class: go figure) was stirred up by such widely admired critics of modern psychiatry as the Church of Scientology. This has muddied the waters, and perhaps led Lilly to play down the risks more than they should. This isn't the first study to find that a small minority of patients "become dangerously suicidal" using an SSRI. If more were known about the precise chemical process, perhaps we could know who would be prone to this side-effect. But still, we have to remember that people getting a drug like this are usually already suicidal. Their serotonin is already out of whack. Ironically, they may be too depressed to follow through with their plans ... until they take a drug that gives them the energy.

I, too, spent time on Prozac. I think it saved my life.
posted by dhartung at 7:52 AM on June 7, 2000

Steven, I feel you are out of line. You had an empassioned reaction to implications that were not made. Ezrael did not say that no one should take Prozac or that depression does not exist, just that it is over-prescribed and over-hyped. It is a bad idea to take a seratonin re-uptake inhibitor when you only feel a little blue.

I've taken Prozac. I no longer do. It or therapy or aging got me out of a bleak period. It also made me jittery and paranoid because they were adjusting my dosage on a hit-or-miss strategy.

I think the entire field of psychology is soft science--and questionable soft science at that. Part of my degree included psych classes; at the undergrad level, at least, the scientific method is nigh unheard of.

And don't forget: Approved by the FDA means only, "Won't kill you...immediately."
posted by Spyderella at 8:10 AM on June 7, 2000

I have been forced to take prozac: It didn't save mine. Steven, how do you know I don't know anything about Clinical Depression? Why do people assume that if you suspect Prozac has been overprescribed, you are some kind of anti-drug bigot? Hell, I've probably seen more shrinks than most people in the world, and I've probably seen as many people with clinical depression (including myself) than a lot of people.

And Steven, did I say we should ban Prozac? Jesus. You act like it's impossible for anyone to overprescribe a drug. If you need to use the drug, use it. All I ask is that some thought be given to the possibility that children might not need it, and that it certainly gets overprescribed, like many other drugs.

Here's another site on the drug. Here's the most recent manufacturers site. Also, a monograph on the drug from a Canadian group.

I realize people take some things so personally that they are willing to write letters that condemn a person to hell, but Prozac? It's just a drug. Why is it sacrosanct from suspicion? Why is this one chemical so magical that I must bow down before it and talk about how great it is, or I'm an insensitive bastard? All fluoxitine did when I was made to take it was turn me into an imbecile.

Am I saying don't take it? Read through the post again. I'm saying think about it. Is that so goddamn horrible?

dhartung, I wasn't aware of the Scientology connection, and frankly, I'm more than a little surprised. Not being an admirer of their or modern psychiatry, this doesn't easily jibe with my own experiences with the drug. But just because something is helpful to some doesn't mean it doesn't carry risks that can be examined, does it? It's a little scary that I find myself on the same side of an issue as Ariana Huffington, though. Does anyone know anything about this site? Are these people on the level?

Finally, although I am apparently a monster who should go to hell because I don't like the American tendency to overprescribe powerful serotonin re-uptake inhibitors, I also found Prose on Prozac, and thought it was pretty cool.
posted by Ezrael at 8:21 AM on June 7, 2000

Can we talk about Ritalin too, while we're at it? Toddlers being forcefed the drug?

There are people who need Prozac. I have no doubt about that.

But Eli Lilly certainly isn't going to complain if their drugs get overprescribed.
posted by solistrato at 8:32 AM on June 7, 2000

Hell, yes, we can talk about kids being forced to take Ritalin. If that doesn't make me a monster, of course. Anyway, it's another example of what I'm talking about: a useful drug that can, if used judiciously, help people being taken by people who don't need it. This doesn't mean that there aren't people who do need it.

My cousin Emily was on Ritalin for her supposed ADD, which they diagnosed her with when she was six. Then, when she hit eight, they discovered she had an eyesight problem, and that was why she was fidgety in class. She couldn't see the board, and got rambunctuous because she was bored. No one bothered to ask her.

This horror story does not invalidate Ritalin use, by the way. I accept and agree with that. Just in case anyone thinks that I have anywhere in this post said it should be banned...which I have not.
posted by Ezrael at 8:42 AM on June 7, 2000

"It's hard to carry out double-blind tests on the human mind."
posted by holgate at 8:57 AM on June 7, 2000

>Mathew, you are an insensitive jackass. What the hell
>do you know about it?

>Steven, I feel you are out of line.

>And Steven, did I say we should ban Prozac? Jesus.

Um... where is all this bile coming from? I reread this thread a couple of times to try to figure it out. At the top, some people give their opinions and speculate--then all the sudden it becomes personal and agry. Why? Did I miss something that happened offline or in email? Is this part of a revenge cycle that spans back through many generations?



posted by grumblebee at 10:20 AM on June 7, 2000

If you haven't suffered from clinical depression, you have no business commenting on it, period. Just my opinion. Of course we live in a culture that wants easy answers and solutions; i.e. let's throw drugs at the problem. The sick part is that drug companies make obscene profits off of our suffering. That is completely unethical and immoral. OTOH, if there was any pill that would help me overcome my depression and anxiety, I'd take it no matter what the cost. Getting ripped off sucks, but not as much as being miserable all the time.
posted by Mr. skullhead at 10:50 AM on June 7, 2000

If you haven't suffered from clinical depression, you have no business commenting on it, period.

If you aren't a woman, you have no business commenting on issues of women's rights.

If you haven't been divorced, you have no business commenting on divorce.

If you haven't had an attempt made on your life, you have no business commenting on murder.

-Mars

posted by Mars Saxman at 11:52 AM on June 7, 2000

If you haven't posted links on MetaFilter, you have no business commenting on other people's links on MetaFilter.

Have we reductio'd all the way to absurdum yet?
posted by baylink at 12:31 PM on June 7, 2000

If you haven't read this sentence, you have no business reading this sentence!
posted by grumblebee at 1:16 PM on June 7, 2000

And besides, I have experienced clinical depression and taken prozac. Have I established my bona-fides yet? Or would you like to see my medical records?

Man, this wasn't so controversial to me when I posted it originally, in all sincerity. I thought we could have a discussion about this. The Gun Debate was less heated. Thanks to Mars, Bay and Grumblebee (who often do not share my opinions) for pointing out that, even if I had never been clinically depressed or on prozac (which I have) I would still have the right to a considered opinion on our tendency to prescribe medication for people who may not need it.

And again, if you actually do need it, then by all means, take it.

I wonder if this is another sign of the American Gulag. Will we all have to publish our curriculum vitae every time we want to address an issue?
posted by Ezrael at 3:05 PM on June 7, 2000

I have a lot of experience with clinical depression, not directly, but because my boyfriend was suffering from it pretty badly when I first met him.

Probably the only reason he wasn't taking some sort of medication for it is because he refuses to take any medication where it's not almost essential. (For example, he gladly takes novocane at the dentist's office, but won't take anything for a headache.)

Anyway, perhaps it's a good thing that he didn't take anything for it. It's been just under a year and a half since then, and while his depression does still show up in some areas, it's nowhere near what it used to be, and certainly isn't life-threatening anymore. (He's attempted suicide several times in the past.)

On the other hand, while Ryan's depression appears to have been more psychological in nature, some people really do have a chemical imbalance causing their depression. (Disclaimer: If this is wrong, blame the doctors, not me.) For these people, I think re-balancing those chemicals would be the best solution.
posted by CrayDrygu at 4:12 PM on June 7, 2000

The challenge is trying to write authoritatively on a subject as serious as this and not sounding snap-judgemental (my word) without having to display all your curriculum vitae. Hard to do. Maybe impossible in a short-form forum such as this.
posted by wendell at 4:16 PM on June 7, 2000

And from MY anecdotal experience (self- and those-close-to-me), human nature drives us to both overmedication in the face of minor distress AND avoidance of medication (or other things that CAN help) in the worst cases. And as long as we, as humans, keep erring on both sides, the struggle to find the right answers somewhere in the middle can be... kinda... depressing.
posted by wendell at 4:22 PM on June 7, 2000

While there have been several posts in this thread asking me for answers, I'm afraid I will have to eschew answering them or explaining anything further about my reaction in a previous post, because to provide coherent answers or explanations would require me to reveal things about myself which I ordinarily only show to very close friends during long and deep heart-to-heart sessions.

This is not an appropriate forum for such information, and I do not feel comfortable revealing those things here.

I would, however, like to make the following statement: "The mind is what the brain does." At some irreducible level, all thought is the result of chemical activity.

"Mind-body duality" is a myth. There is no mind independent of the brain.

To say, as Cray does, that a certain problem is "more psychological than chemical" is a nonsensical distinction; they're one and the same.

By that I do not mean to imply that all such problems can be treated with pills. But I want to make sure everyone understands that the human brain is the most complex and intricate object for its size known to us, and we may never fully understand it. ANY simplistic statement about it is nearly certain to be at least partially wrong.

And some malfunctions of the brain can be treated quite successfully with pills. For instance, Parkinson's disease can be held in remission for as much as ten years with proper chemical treatment. And there is hope of a real cure with transplant surgery. Treating Parkinsoniasm with talking therapy would be as useless as treating diabetes that way.
posted by Steven Den Beste at 6:58 PM on June 7, 2000 [1 favorite]

Uhm...man, how do I respond? I believe in a soul. I believe in mind-body duality. The very fact that my brain is composed of subatomic particles, which have been shown to be capable of affecting other subatomic particles anywhere in the universe, means that in part I could be said to be thinking with the entire universe. That's just a mega-simplified version of the Quantum Physics standpoint, not even arguing on a theological or metaphysical standpoint. I do not accept that you can prove that all thought is chemical; some people have awakened from comatose states where their neurotransmitters have been inactive and reported thoughts and dreams. It's a complex issue.

Other than that, I don't disagree that if you need treatment for an illness (be it a chemical imbalance in the brain or a series of T-Cells attacking your Isles of Langerhans, making you a diabetic) than you should seek it. There's no reason to avoid it, if it's available and appropriate to your condition. In my case, I found I was better off learning to alter and expand the content of my thoughts with education, meditation and, in one case, ordeal. I currently practice a hybrid form of visionary agnosticism and mysticism that allows for such.

The brain is chemical, yes. But it can be more. The fact that a photon in a lab in Germany can affect one in a lab in Japan instantaneously proves that all matter and energy are interconnected, or at least strongly suggests it. John Gribbin explains it all better than I could. He's a scientist, and I'm from the humanities. At any rate, it's beginning to look a lot like reality is in fact not only stranger than we imagine, it in fact really is stranger than we can imagine.

Ultimately, I feel this way. Do whatever you have to in order to get through life. It's cold, hostile, and not really designed for us poor monkeys. If there's a medicine you really need, than take it. But be sure it's really in your best interests, that's all I suggest. I made the mistake once of trusting others to look out for my interests, and they chemically neutered my brain for a year. I'll never forget how that felt.
posted by Ezrael at 7:13 PM on June 7, 2000

<< To say, as Cray does, that a certain problem is "more psychological than chemical" is a nonsensical distinction; they're one and the same. >>

No, it is not. Or rather, yes, it is, if you prefer the simplistic "Phychology for Dummies" approach.

In reality, however, there is a difference between depression with psychological causes, and depression with chemical causes.

A purely pyschological case of depression is generally caused directly by a negative self-image or low self-esteem, indirectly caused by environmental factors which affect one's view of one's self. This kind of depression is the kind my boyfriend had, at least primarily, and it best treated by some sort of therapy, whether it be a professional psychiatrist or psychologist, or simply by changing the environment.

Chemically-induced depressions, however, are caused by an imbalance in chemicals in the brain, and are unrelated to environmental factors, though they may be worsened by accompanying psychological depression. This type is caused by over- or under-production of certain hormones (I'm not sure which, and it could be both). Therefore, the best (or at least, most common) treatment would be to restore the hormonal balance to "normal" levels.

The distinction is not nonsensical. Ignoring it, however, is potentially dangerous. Someone with depression caused by hormonal imbalance can go through all the therapy you can throw at them, and it won't make a difference. By ignoring the distinction, you rule out any possibility of giving this person the proper treatment.

(As a side note, these often occur together, as I believe they did with my boyfriend. His "natural" (hormonal-based) depression, however, is mild enough that it generally only serves as a fuel for psychological depression. Or, in layman's terms, when he gets depressed, he gets depressed. YMMV. [Your Milage May Vary])

Remember, depression of both types can and does lead to suicide in many cases. The real cause of these deaths, however, is not the depression, but rather, improper actions and ineffective treatment.
posted by CrayDrygu at 7:45 PM on June 7, 2000

I suppose I should post this as well:

I am not a doctor, nor do I pretend to be one. I am also not a psychologist. I am a high school graduate with a deep interest in and love for psychology, and a deeper interest in and love for my boyfriend. Due to both these, I naturally became interested in what was causing his depression, and set out on a personal quest to learn as much as possible about depression, both through research and experience. The statements I make here are based on my own personal research, and may or may not be entirely correct. I do, however, have faith in them, or I would not be posting them here.
posted by CrayDrygu at 7:48 PM on June 7, 2000

The text file containing my thesis is held in a code that is interpreted by an operating system, which in turn is written in code which is executed as machine instructions which resolve themselves into zeroes and ones.

But you can't explain the complexities of eighteenth century literature with zeroes and ones, just as you can't explain the complexities of depression with a chemistry textbook. Gerard Edelman talks about this better than I could.
posted by holgate at 5:26 AM on June 8, 2000

Assuming that there is a distinction between chemical-imbalance and purely-psychological depressions, how does one distinguish between the two? Other than trying different types of therapy (counseling or chemicals) and seeing what works?
posted by harmful at 7:30 AM on June 8, 2000

<< how does one distinguish between the two? >>

Pretty much what you suggested: If therapy doesn't work -- and therapy should always be the first step here -- then you try medication. I don't know if they've developed tests yet that can check for the right kind of chemical imbalance.
posted by CrayDrygu at 1:59 PM on June 8, 2000