Good and Bad Reasons to Take an Antidepressant

Thirty-five years ago, I received a phone call from my friend Lily about a car accident involving a mutual friend of ours, Terry.  The three of us had just graduated from UCLA the week before.  Terry, along with her sister, brother-in-law and niece, had gone on a trip to the Colorado River.  En route, along a two-lane highway, another vehicle tried to pass them and the line of cars ahead.  The driver mis-calculated the distance and as a result, a semi-truck coming from the opposite direction swerved to avoid the passing car, struck our friends’ car and instantly killed Terry’s sister, brother-in-law and niece.  Terry survived but suffered severe and irreparable brain damage.

I had given up my apartment following graduation and was briefly staying with my parents before leaving on a long trip.   When I came out of my room after the call, deeply upset and in tears, my mother immediately went to her bathroom and returned with a blue, 10 mg Valium tablet which she pressed into my hand.  Her response to my grief was to offer me the same medication she used to keep her own pain sedated.  I hadn’t thought about that incident in years, but recently, in considering some of the wrong reasons people take antidepressants, the memory came back to me.


As I’ve said in other posts, I believe that antidepressants have their uses, especially in the short-term, but I also believe they are grossly over-prescribed by untrained physicians and medicating psychiatrists who run prescription drug mills.  This criticism lays most of the blame at the feet of the medical profession, but a conversation with an old friend from Los Angeles reminded me that insistent patients are just as much a part of the problem.  Many people choose to take an antidepressant in order to avoid dealing with a problem they might otherwise have to confront.

My friend — let’s call him Brian — has worked in the film industry for more than 30 years and knows everybody.  Brian told me that he is close with quite a few women who (in his opinion) are on antidepressants because their married life would be otherwise unbearable to them.  They’re married to wealthy, powerful men in the industry whom they don’t love; divorce would mean giving up a financially privileged and superficially glamourous style of life they don’t want to relinquish.  So they take SSRIs … not because they’re depressed but because those drugs make tolerable an emotional situation they wouldn’t otherwise be able to bear.  Brian says this is not an unusual Hollywood story.

A mutual friend of ours is quite candid about using an antidepressant for similar reasons.  She has a child growing up with Asperger’s syndrome, and the very low dosage of her medication makes life bearable.  She tried getting by without the meds but found she simply couldn’t cope.  This friend is not struggling with depression per se but with an extremely stressful life situation.  Her drugs “take the edge off,” numb her out just enough so that she can manage.

Another friend of ours, after her divorce, decided to become an elementary school teacher, though many of us felt she was, by temperament, ill-suited to the profession.  Despite some judicious advice, she went ahead with her career change and suffered a nervous collapse during her first year of teaching.  With mostly sleepless nights and several panic attacks, she wound up in the emergency room more than once.  Instead of reconsidering her career choice and trying to find something more suited to her, she opted for antidepressants instead.

Medication might be the right choice for our friend with the Asperger’s syndrome child; after all, as his mother, there isn’t much she can do to change her basic lot in life.  But in the case of our friend who chose drugs over a career change, it seems to me she’s using antidepressants to avoid confronting something dysfunctional in herself and in her life.
Likewise, the Hollywood wives who take SSRIs rather than file for divorce are surely using those drugs in ways for which they were never intended.

One of the primary rationales given for using antidepressants is that they  may get a depressed mind “unstuck” when psychotherapy is making slow progress; meds are seen as an adjunct to talk therapy, helpful in promoting insight and understanding for the psychotherapy client.  But those Hollywood wives and our friend who made a disastrous career choice are using medication for just the opposite reason; they don’t want insight so they can understand themselves better and thereby confront important choices.  Instead, they’re using drugs in order to avoid facing their problems.

One visitor to this site commented that depression, like pain, can be the body’s way of telling us that something is wrong.   If we listen to our pain and our depression, we might understand what’s wrong and over time, figure out what to do about it.  But if we reach for the little blue pill as my mother did, numbing the pain instead of confronting it, we remain stuck and will never move forward.

*     *    *

While we’re on the subject of antidepressants, you might want to check out an article from the Sunday New York Times by Peter D. Kramer, author of the famous book Listening to Prozac, which gave an enormous public relations boost to antidepressants when it was first published in 1993.  At a time when study after study is questioning whether SSRIs have anything other than a placebo effect, Kramer has written an article in their defense.  He raises some interesting points about how drug trials are structured and carried out, but for the most part, it struck me as dishonest and self-serving.  He criticizes a number of famous studies by name, but resorts to vague language like “studies have shown” when it comes to trials that have reportedly demonstrated the benefits of Prozac and other SSRIs.

From the very beginning, he seems disingenuous, or at least illogical.  His initial piece of evidence is entirely anecdotal, about a friend who suffered a stroke and received some benefit from taking an SSRI.  According to Kramer, an important study has shown that stroke victims who received Prozac rather than a placebo “recovered more of their mobility. Antidepressants are good at treating post-stroke depression and good at preventing it. They also help protect memory. In stroke patients, antidepressants look like a tonic for brain health.”

This is specious argumentation and deceptive prose.  It’s clear from the quoted passage that the study demonstrated how stroke victims recovered “more of their mobility”; but are the following two sentences the author’s opinion or a conclusion of that study?  The statement that antidepressants are “a tonic for brain health” is quite a reach.  Given that the so-called “antidepressants” are actually stimulants (like cocaine and the tricyclics before them), maybe taking Prozac minimized the damage resulting from a stroke by stimulating the brain during a critical period.   That’s very different from concluding that Prozac prevents and relieves post-stroke depression.  Maybe those stroke victims who benefitted from the stimulating effects of Prozac felt less depressed because they recovered more of their mobility.

Read the whole are article here, as well as the comments that follow.  Many highly informed readers, including physicians and researchers, have weighed in on both sides of the subject.

Finding Your Own Way:

Do you know anyone who is taking an anti-depressant when you can see that he or she needs to confront an external problem area instead?  Do you know anyone taking an SSRI because he’s unhappy in his marriage or hates her job?

How do you feel about my friend who is taking an antidepressant, not because she’s depressed, but because it makes a very painful and difficult life situation bearable to her?  Do you think it’s any different from, say, having a couple of stiff drinks every evening to “take the edge off”?  Do you think it’s any different from people who smoke pot at intervals throughout the day?  How much difference do the side-effects make?

If antidepressants don’t actually correct a chemical imbalance in the brain (the evidence is clear on that point), how do we account for their supposed benefits?  Maybe they function like a sedative, for lack of a better word — numbing us out to pain we can’t tolerate, blinding us to problems we need to face.  What if taking an antidepressant is like taking a pain reliever?  It’s a well-known fact that, when under the influence of a major analgesic, athletes are unable to heed the warning signs their bodies give off and as a result can severely injure themselves.  Maybe in taking an antidepressant, you run the same risk:  by numbing yourself to your depression, one of your body’s ways to signal that something is wrong, you’re in danger of hurting yourself even more.

Thoughts?

Joe is the author and the owner of AfterPsychotherapy.com, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

Seasonal Affective Disorder and the Healing Power of Sunlight

The effect of sunlight upon mental health has been obtruding into my consciousness of late. To begin with, when I needed continuing education hours to renew my license, I took an online video course a…

Benzodiazepines and Dementia

I haven’t written about my opposition to the widespread use of psychiatric medications in quite some time, mostly because I feel I’ve already said most of what I have to say on this issue. (See…

Some Thoughts About Mania

During my recovery from overload (the result of having ignored my personal limitations), I’ve found my thoughts turning to the psychodynamics of mania. Over the last few years as my clinical and theoretical focus has…

68 comments

    I’ve been though myriads of therapy, most of which was useless (save for the last stint, which was useful). Medication has saved my life on several occasions. Placebo? Maybe, though the anti-psychiatry literature has failed to convince me of that. Whatever the case, if it works for some people, it does.

    I agree that taking anti-depressants due to ‘normal’ life events is a bit crap, and they’re certainly over-prescribed by many a cynical and overworked GP. But for some of us, they’ve brought us out of a depression so crippling it’s barely describable. I couldn’t even have started my recent-ish trauma therapy had I first not found relatively stability through anti-psychotics and anti-depression. Dealing with the issues therein would have been way too big, and I’d probably have found myself Google Mapping Beachy Head.

    But that’s only my experience. The thing about all of this, to me, is that we’re all individual and have, where applicable, individual pathology. Medication and psychiatry fail many, work for many; mindfulness and behavioural therapies ruin lives, but complete others; blah blah blah.

    I’ve been accused of being “pro-psychiatry” in the past. I’m merely pro-what-works, and what works in terms of easing mental distress is (or can be) as unique as the sufferer in question.

    *ducks*

    I think your experience describes the actual way these drugs should be used. They can be enormously helpful in pulling people out of crippling depressions and enable them to stabilize enough to confront the core issues. And I agree, that no one answer fits every situation. Unfortunately, the way these drugs have been sold is that depression = chemical imbalance and therefore every depressed person should take these drugs to correct the imbalance.

    Hi Joseph, my partner is on anti-depressants while working through issues from a very awful childhood of physical and sexual abuse. The effect is to not so much to numb the lows as to limit their duration.

    Many years ago now she was on another anti-depressant. It’s effect was to increase motivation. All she was thinking about at the time was suicide, so the boost to motivation meant that she attempted suicide. It would be funny if it wasn’t so awful.

    I think most psychiatrists (in Australia where I live) are really pharmacists. Most of them dispense drugs and have a brief chat about whether the dosage should be adjusted. I don’t know if you find this offensive or if you agree.

    I don’t find that offensive as I agree; it’s pretty much the same here in the United States. There has been a lot of press lately about how psychiatry has moved from talk therapy to the 15-minute med consult. The docs can make more money via insurance reimbursement 4x per hour than they can with one talk therapy client per hour.

    The highest risk for suicide, even without meds, is when the person begins to recover from a debilitating depression — because then they have the energy to follow through on their plan. It makes sense that, with a suicidal client, putting her on meds might increase the risk of actual suicide as her symptoms are alleviated. All the more reason why these drugs need to be carefully monitored, in conjunction with psychotherapy, and not dispensed by an overworked GP or a medicating psychiatrist who sees her once a month for 15 minutes.

    i really agree with what you have written, i feel that there is little difference between the prescribed drugs, and alcohol or cannibis all of these do numb out feeling but some are just framed as legal and “proper”,

    i have come off my antidepressants and stopped drinking 6 months ago, and my emotions are really coming to the fore in my therapy and so i manage without drugs now, but occasionally use valium when things get really bad,

    this for me means that the numbing out is no longer permanent but just a choice when things get overwhelming and scary,

    i was on prozac for a few years, and still made progress with therapy, but something in me just knew it was time to make more progress and to be honest i think the drinking had more of a numing out effect on me,.

    i wasnt encouraged to come off though, and i had to do it secretly, and i went for a year being off them before i told my medic,and because there was no evidence i had gotten worse he couldnt say for me to stay on them,

    i do think that sometimes a person isnt ready to face some deep stuff inside them, and if they face it alone then severe illness can happen, so i can understand having meds as a support to stop crisis (this was me) but there comes a point when a person is perhaps stronger and the crutch has to come away for you to fly solo and work through stuff to live life to the full, otherwise the crutch is no longer a help but a big stick tied to your leg that is getting in the way!

    i think its everyones choice whether they decide to numb out or not, but i think there should be more awareness of what these medicines actually do, so that people really realise the sacrifices they are making when they take these meds, short term alleviation but in the long term not working through stuff that would make there life so much better and more fulfilling,

    i thinks its very personal but i dont regret stopping the daily alcohol and the prozac as i feel ready for the next step of challenging myself to work through deep issues, its bloody hard and scary as some of the emotions hit me like an express train, but i know its where the rewards are already coming, cos any changes i make will not be a drug induced false sense of a cure but a permanent change i have made within me,

    Exactly. I admire your courage in coming off the Prozac in the face of professional opposition. I find it truly disturbing that the medical community so often puts people on these drugs “for life.” Your experience, of using them for a time while you develop some inner strength to address your painful emotions, seems an appropriate use of these drugs.

    I was given some strange tiny white pill when I was 7 or 8, when the tug-of-war within my family got too painful; Nardil in the 80’s after Hollywood and cocaine; Prozac for 8 years in the 90’s as a cure, after I crashed out of grad school; Celexa/citalopram off and on until a couple of months ago. Still crazy and squirming, but I feel better.

    I know how hard it is to get off these nasty drugs. I really admire people who are willing to go through it, and not keep subscribing to the lame medical line about chemical imbalances.

    Yes I agree with you, I never thought that taking an anti depressant was a way to not deal with the problems. I feel like that i am very unhappy about where I live, very isolated and that is what the real problem is . I take an anti depressant because of it.

    I suppose the question is — is it possible to change your situation instead? Sometimes it’s simply not possible, but I hope you’ll find a way to become less isolated and live in a place where you can feel more content.

    I’ve been taking a low dose of Celexa for some time now, on the advice initially of my talk therapist and now under the direction of a psychiatrist specializing in this sort of medication. My family of origin was violently alcoholic, with early severe trauma, eg., seeing my mother stabbed with a bayonet (not fatally).

    The primary effect I notice from the SSRI is a decrease in the feeling that someone is about to sneak up and hit me on the back of the head. I didn’t know I felt that way until it stopped, and then I realized I had always lived that way. At times when I reduced my Celexa dose, the feeling gradually came back. I know I don’t want to live that way.

    My life today is stressful – a severely disabled grandson for whom I’m responsible (a genetic problem from the non-alcoholic side of my family. Sheesh!) and some of the same financial issues most of us are facing now. I do feel the pain and work hard to learn from it and to find the germ of opportunity at the heart of every situation. But when I’m living in a constant flinch, waiting for the next blow, I am much less resilient.

    I’d appreciate your thoughts on whether this is an appropriate use of SSRIs. Thanks for your response and for this blog. So glad I found it.

    I have a good friend who suffered from severe OCD for most of her life until her late 40s; at that time, under the guidance of a skilled psychopharmacologist, she began taking a cocktail of psychoactive drugs that have given her emotional freedom and a kind of life she never had before. I do believe that meds have their place, and surely it’s better to take them for a time rather than living in constant anxiety that someone will club you from behind. If combined with psychotherapy, if you’re carefully monitoring the side effects and working toward developing the mental skills to manage those emotions yourself one day without the meds, that seems like a viable plan.

    Joseph! You keep writing posts that i just have to read and then have to comment on. How relevant this post is to me! Thankyou for allowing me to read your blog and think about it in the context of my journey.

    I felt a deep sense of sadness reading about people that are ‘blocking’ their feelings by using anti-depressants. I am not against anti-depressants but personally cannot take them as they make me suicidal. That is both a blessing and a curse.

    The curse is that our healthcare system (at least here which is not in the US) is a drug based medication model (heavily skewed now towards drug and alcohol rehab). Drugs are therefore seen as the first defence in mood disorders. It is not labour intensive and is cheap because medication is heavily subsidized. Everyone is happy (except possibly for the person taking the anti-depressant!).

    The blessing is that I have had to find other psycyological ways of coping and I am genuinely excited about the research that has been done and is gradually being accepted by the mental health community. Here are some of the things I have tried.

    – Mindfulness is actively now supported by the public health system here.

    – Exercise is seen as crucial for maintaining good mental health (and is now subsidized if you have mental health issues).

    – Somatic expressions of emotions is in my experience often effective in getting extreme feelings in balance. Examples of this are Yoga which combines mindfulness with movement. Also why having a damn good cry is still really effective (if only you remember to stop!) because it releases a lot of hormones. I also do things like hit golf balls really really hard at the golf range when I am angry! It works! If I am sad I listen to a great song on my ipod and walk whilst singing very badly and loudly. The combination for me is really effective for me. Of course we all know the term comfort eating but it is done in a negative context and we forget that a warm milky drink still has its role in comforting us. Knitting is also increasingly promoted within the health system as providing a gentle rhythm that is calming. It does not minimize the feelings that I have but it allows me to reduce the emotional intensity to a point that I can tolerate them.
    – What ultimately works for me however is ‘accepting’ the feeling without judgement, then practicing distraction (get busy preferrably with something I have to concentrate on) coupled with problem-solving (around the current stressor(. It takes effort but it works.
    – Neuroplasticity (which is my current passion) shows that through a sort of positive repetition you can change your experiences. I think this is so crucial because it suggests that change is possible.

    The rationale as you state is that our feelings are stalways stuck. Sometimes they are but in the examples you give it is us that are stuck. My experience is that I am only stuck if I stop. The temptation is so strong when you are not well to do so.

    I realise that mostly why I am sad because of the stories you shared is the impression that these people will never feel joy if they dont feel pain. My experience of myself is that until I move through my extreme negative feelings I cannot feel the positive feelings. Sacrificing feeling happy for not feeling sad. Now that is sad.

    I’m on the same page. I think mindfulness and yoga are excellent tools, and I’ll have to educate myself about “neuroplasticity” — don’t know anything about it. And of course I agree, that you can’t selectively decide what you’re going to feel and what you won’t. If you “numb” out your pain, you’re also quashing joy.

    THIS IS SUCH A USEFUL ARTICLE. NON JUDGEMENTAL…CLEARLY USING EXAMPLES ANYONE CAN RELATE; TO OF BAD DECISIONS THAT CAN RULE YOUR WORLD. I LOVE THAT THE MESSAGE CLARIFIES COURAGE AND THE CONFIDENCE TO ADDRESS CHANGE WITHOUT BEING PREACHY…AND I THINK IT MIGHT BE EASIER FOR A LOT OF PEOPLE TO BE REALLY HONEST WITH THEMSELVES WHILE NOT BEING, IN FRONT OF A THERAPIST. I AM VERY GRATEFUL YOU TAKE THE TIME TO WRITE COGENTLY ABOUT THINGS EVERYONE NEEDS TO BETTER UNDERSTAND. THANK YOU

    Does therapy fix a “chemical imbalance of the brain?” When mania happens, a fire alarm goes off that no talk can cure. Neuroplasticity suggests the ” job of living” as opposed to the “joy of living.” Doctors prescribe antidepressants so freely, they validate hiding your feelings behind a pill. People used to take hallucinogenic drugs, snort cocaine and smoke pot. If you can take medication legally prescribed by a doctor, which is condoned by society, why not? Or you can spend thousands of dollars on therapy, which most cannot afford.

    Thanks for the insightful posts. I’m really enjoying them.

    I personally have never taken anti-depressants despite being offered them on numerous occasions. My reasons – seeing both my NM and my damaged brother both taking pills to ‘prop themselves up’ but seeing very little change in their destructive behaviours. I am coming close to being healed by working very hard with psychotherapy and emotional mindfullness – allowing the pain.
    I am however coming to realise that my experience was of people abusing these drugs.
    I have friends who live anxiety and depression riddled lives and who I believe could heal themselves. But I have to admit to myself that I am the lucky one in terms of having the resources (time,money,resilience,inner strength) to deal with my past. Could it be possible that some people don’t have the resources, especially if they are too damaged and too scared to find their inner strength, (don’t get me wrong, I believe everyone has it somewhere), and their safety net is anti-depressants? In this case others can be encouraging and offer an alternative to drugs, or suggest therapy with medication, but only the individual can make the choice.

    I think we’re going through a transition now where the truth about psychoactive drugs is being publicized and as a result, more and more people (health care providers as well as users) are questioning the prevailing paradigm. I do think that “talk therapy” will be given more credence as people come to understand that meds are not the answer we have been led to believe it is. Then it is, as you say, it is up to the individual to find the courage and strength to undertake the real work.

    I would not be afraid of the work involved in good therapy, but being realistic in today’s economy, there is the financial obstacle. I know you do not care for analogies, but I don’t want to trust my mental health to Wal Mart, when what it really requires is Bloomingdales.

    I think that’s a great analogy! However, not everyone who is good at this work charges an arm and a leg.

    I would like to see a society which acknowledges that individuals may need to do this work and gives values to mental health and well-being. Rather than the current model which is only concerned with whether you can “function”. This would lead to people going through this process given the credit for the courage it takes. If they were given the same support as people get for physical life-threatening illness then -wow- how much easier it would be to ask for the help and get it in the first place. Less drug-pushing and more compassion. A pipe dream maybe, but worth aspiring to?

    I hope you do not discourage the truly depressed/bipolar people to discontinue taking their medication. I am one of those people who was born with this crap. Being off my meds (and I have done that before) is extremely dangerous and leads to suicideal ideation (no attempts, knock on wood). If you are not a physician or even you are, please exercise caution when talking like this to impressional (reallly) sick people.

    I don’t believe in giving most kinds of advice. If a client were considering taking meds, I’d encourage him or her to read up and get informed first. With clients already on meds, if I hear from their material that they have doubts about continuing on meds or hate the side effects, I’d encourage them to do the same. I would recommend that, whatever they do, they do it under a physician’s guidance.

    Medication can be very helpful for some-your friend with the highly stressful situation would seem to be justified in taking an anti-depressant. However, I also know people who simply do not want to look at changing unhealthy lifestyles, toxic relationships, and unwise health decisions and take medication just to avoid doing anything proactive about their situations. Still, everything is relative and how do we decide for others what is appropriate? I do agree that medications should only be prescribed by a professional and after much consideration.

    I have been taking an antidepressant for almost a year now, for anxiety. At first I was very hesitant to even consider taking a drug. Obviously sides effects are the main concern, but I am not a person who is a big fan of psychiatry and pill popping modern “medicine”.

    Modern Psychiatry is a cycle of creating disorders and “treating” them with drugs, unfortunately. The diagnostic criteria of mental illness is so vague, and treatment is believed to be necessary for anything, such as a different personality or emotions.

    Yes I think getting help for something that is interfering with your life is important, but the use of drugs is too much. Antidepressants are now prescribed for anything, ranging from anxiety to depression and even pain, autism, etc. The “chemical imbalance” theory is a joke. I will not trust greedy pharmaceutical companies to tell me what is wrong with me, nor would I trust corrupt psychiatrists to drug me who receive money from big pharma.

    We say to the youth “Don’t smoke weed, it can cause anxiety and increased appetite. it’s terrible what it can do to your body”

    And then turn around and say “SSRI’s are fine, even though they’re proven to double the risk of suicide in children, they are often addicting, have side effects ranging from anxiety to seizures and severe weight gain, can increase hostility and agitation, and their actions in the body are not even known. The only theories behind the chemical imbalance theory is done by a mass propaganda campaign, by the drug companies. Look in magazines, watch TV. Their advertising is pure propaganda. I say this even though I am 15 years old.

    I’m glad you figured this out at such an early age. Too many people sucked in by the propaganda.

    I really wish people would knock it off about “Big Pharma”. Most antidepressants are perscribed as generics, which in no way profits ” Big Pharma”. I would guess that Prozac is very rarely perscribed anymore, the bottles picked up at the pharmicist are all stamped Fluoxetine. The same goes with Ritalin; nobody uses the brand-name drug—that stuff’s dang expensive!
    I am ever grateful for my generic antidepressant. It makes coping with adult ADD a lot easier to do.

    I have read an article about a survey, which says that about 40% of Americans qualify for a “mental illness” according to the DSM. How ridiculous this is, that nearly 150,000,000 people in this country are in need of powerful psychotropic drugs.

    The reason psychiatry is so abused is that it can be. The criteria is so vague, the “professionals” seem so intelligent, and the medications seem so efficient. The truth is the disorders don’t exist. The drug companies can sell their drugs for so much, why should they give a discount? The patient isn’t paying it, the insurance companies are. They also need to save themselves from lawsuits, because Little Tommy just went on a shooting rampage on Zoloft.

    Mental illness diagnoses have increased about 200% since the 1990’s. Why is this? I thought in the 90’s came the happy pills, and bipolar pills. Zoloft came out, etc. But depression, anxiety, and bipolar disorders have increased!

    And of course, the chemical imbalance is their theory. In the 50’s, opioid were used for depression. Now, a magic pill that alerts brain chemistry is the new hope. Antidepressants cure depression by creating an artificial sense of well-being, antidepressants cure anxiety by acting as a sedative.

    I do think thought that some drugs might be alright for symptoms that cause serious problems in life. I have lived with anxiety my life. Ranging from panic disorder, to OCD, SAD, etc. Zoloft has reduced by anxiety, and my obsessions are nearly gone. I am taking a low dosage. It can help some..

    Psychoactive drugs do have their place; it’s the widespread over-prescribing, as you point out, that’s the real problem.

    Definitely a complex topic.

    There is certainly a popular groundswell of anti-medication feeling out there. That’s unfortunate …

    I view it much like other areas of health. Yes, it’s great if someone can manage their blood pressure through diet and exercise. But we don’t (generally) make them the subject of social disapproval if medications are also used.

    Your parent of a child with Aspergers – an “approved” life problem, I note in passing – what makes her different from a second parent, who also has a child with Aspergers, but can, for whatever reason, cope? It *could* be a different set of skills, a lack of trying new ways of acceptance or changing her own thinking or behavior. Or it could simply be that her brain is less resilient in the face of stress. Or it could be both.

    If a simple generic med can help her have just enough resilience … is that a worse choice than five years of therapy that *might* help? We’ll know a lot sooner with a trial of the med, BTW.

    Just some thoughts on the topic.

    Interesting, and I wouldn’t disagree. I think it’s a little more complicated, however. For instance, what about the potentially quite serious side-effects of those meds? And as for the two parents with challenging children, I didn’t mean to imply that I approved of the decision to take meds in order to cope. I can understand that decision and I sympathize, but I think I better choice would have been to enter intensive long-term therapy (money in this case is no object) in order to develop the skills and resiliency possessed by the other hypothetical parent.

    Very interesting question/topic indeed! I am one of those who uses meds to “numb” or take the edge off occassionally. I have been off and on different meds (seroquel, topomax, lexapro, lamictal, etc.) for many years and am currently not actively on anything b/c the side effects make it impossible to hold down a job and a couple of them make me more suicidal than usual. (many attempts, none successful-obviously). I have been off meds for almost a year and, due largely to a fabulous therapist, I am doing ok. They were originally prescribed for me by a Dr. who had known me all of fifteen minutes and saw me twice a year after that – even if I was needing dose adjustment. He’s still my doctor (limited hmo choices) but i dont go see him anymore – he considers me non-compliant and i consider him a prison officer who imprisoned an innocent person. But the thing is – even though I dont want to be on the meds and i dont like what they do to me, I cant throw them away. I am too afraid to be without them when things get really bad. That is when I take them. And even that I do less of now b/c I’ve been learning better coping skills (mindfulness, distraction, etc. As mentioned before). But I am pretty sure I would dead now if not for the occassional numbing.

    I see anti-depressants as a bridge, back to level emotional state so that therapy can even take place. I have a teen who has gone off the deep end into depression and anger, stopped doing everything he once did, and has detached from freinds. He barely talks now and sleeps all day. To get any movement on this hard issue, we have to get him to level ground again, and I’m hoping AD will help. But right now he won’t even see a therapist so not sure how to get past that problem.

    You’re right, sometimes anti-depressants are a necessary bridge to therapy. I hope they can help your son take the next step.

    Hi Joseph

    I’ve been going to a therapist for 5 years and he thinks that I should consider taking SSRIs for my depression. One of his reasons for saying so is that he thinks that the causes of my depression are partly “characterological” by which he means they can be traced to my life history, but they are also partly genetic. This is something he feels from having known me for 5 years.

    As for me, I think my father has depressive tendencies too, so my therapist may be right. On the other hand, I might have picked up the depressive tendencies as a response to difficult life situations from my father, when I was a child.

    What do you think of diagnoses such as these, where the therapist seems to clearly understand what is genetic and what isn’t?

    Fiak

    I don’t believe that a therapist can “clearly understand what is genetic and what isn’t.” So often, these studies are published that seem to indicate a genetic origin for this or that mental issue but they’re soon debunked. The important distinction is between something that is “heritable” versus something that is “genetic”. I think that depression, as a psychological tendency, can be inherited from one’s parents through identification, modeling, projection, etc. There are many different ways of “picking up” depressive tendencies, as you put it.

    My concern is that, because your therapist views your depression as genetic, he also views it as a lifelong condition and will therefore assume you should take anti-depressants for life. I’ve written extensively about different books that discuss the very serious long-term consequences of taking SSRIs and you should educate yourself thoroughly before agreeing to take them. In my view, anti-depressants have their value for short-term, acute cases of depression but are a bad idea for long-term, chronic conditions.

    Everything I’ve written on this subject can be found under the category heading “The Medicalization of Mental Health” over to the right.

    Thanks so much for your opinion. My therapist prescribed me an SSRI (he’s a psychiatrist also), and asked me to take it for 6 months, if I see any change in 3 weeks. He said it does not cause dependence, and that I do not need to take it all my life, but might need it a few times in my life, for similar durations. I didn’t quite understand the logic behind that.

    Anyhow, I am not taking them, partly because I feel better in the last fortnight and partly because I have indeed been reading your posts on medication, especially the ones that discuss Robert Whitaker’s book. And more generally, I don’t like to think of myself as a chemical machine.

    At the same time, I don’t quite understand how a rational, mature person such as him (and several other psychiatrists) could so easily misunderstand and mislead others on the causes of depression and the effects of SSRIs, because what you wrote, especially in the third post on Whitaker’s book, seems to be so easy to grasp.

    I think it’s because the theory has been so relentlessly pushed by the drug companies, and is taught in medical school, that everyone just believes it’s true. And while your therapist may be technically correct, that SSRIs don’t cause “dependence” per se, your body does habituate and if you stop taking medication later, you will go through withdrawal symptoms — often misinterpreted as “evidence” that the drugs were actually working.

    Absolutely true! SSRIs do have physical side effects that make people believe they are working. The best study of them would be to put them alongside placebos that also cause e.g. dry mouth, or flushing, or vivid dreams, or whatever.

    I think the general idea is relevant to many conditions. After years of not needing medications to control my migraines, I suddenly found myself experiencing them – and depression – again. As I was about to make my second trip to the ER for the headache and considering seeing someone for another course of SSRIs, it dawned on me – I did not need medications. I had been self-medicating enough already to ignore the fact that I had entered into a marriage that had become quite emotionally and verbally abusive. I needed a divorce. Once the decision was made and separation took place, I ended all of it – self-medication, migraines, depression. I needed a divorce – much cheaper and more freeing than a ton of meds or self-medication. I’ve used this story in working with others who do not realize what may be the true causes of their suffering.

    That’s a wonderful account of waking up to the truth. In reading, it made me think about the concept of somatizing — how we may experience something as physical pain instead of emotional anguish, as a way of avoiding the truth.

    this article is very insightful! i know someone who has been taking antidepressants for over 10 years now, for something that happened in their childhood. he has tried to get weaned off them, but hasnt made headway. how best can he be assisted?

    Peter Breggin offers some useful guidelines for weaning yourself off psychiatric medication in his book Your Drug May Be Your Problem.

    Finally got around to reading this fascinating and provocative post.

    This was telling: “Medication might be the right choice for our friend with the Asperger’s syndrome child; after all, as his mother, there isn’t much she can do to change her basic lot in life. ”

    Do you think that psychotherapy really can’t help in a situation like this? Or, say, an analogous situation…say, being married to someone with a chronic and progressive illness. Or, say, a partner who has irretrievably lost sexual functioning.

    Let me clarify. Sure, it’s possible to develop some coping skills. But not everyone can get those skills, just as not everyone can hit a golf driver 300 yards. At that point, do you suggest meds?

    I’m an optimist and believe that everyone has the potential to develop those skills. I never, under any circumstances, recommend medication to my clients. I know too much about the side-effects to inflict them on anyone.

    I think I might have written that a little carelessly. I do believe that psychotherapy can help people in those situations, but it would mean helping them to bear with pain and profound loss instead of drugging it away. It just can’t change the external situation, of course, or remove the pain.

    I have what my neurologist calls transformed migraines and take norpress to (mostly) control them. The next option to try is beta blockers and I love sport so I feel I’ve reached the end of the road. I’m told the jury is out on whether the depression causes the daily migraines or the daily migraines cause the depression. Either way, I handle the constant headaches better and I no longer assess trees/power poles/etc on the roadside for their potential as something to drive my car into.

    I get what you say about having the courage to make changes in your life but sometimes those changes will cause more pain to people you love than you can justify and it is less selfish to wait it out.

    I found this blog, however, while googling “shame” as I’m sure many of us have. My situation is more in line with the generally accepted definition. I’d appreciate some direction on handling the shame of doing the wrong thing and never being able to put things right as the person I let down has passed away. I have no support, everyone tells me I did the right thing but in my heart I know I didn’t. A year has passed and it gets worse, if anything.

    What you’re describing sounds like guilt more than shame; I discuss the difference in this earlier post. Without knowing more about your experience, it’s hard to offer direction, but my guess is that the trouble comes not so much from the guilt but the savagery with which you torture yourself for having made the wrong choice. Just a hunch.

    This article is great.
    I fell under GAD 2 months ago, getting anxiety attacks every hour and was rushed to the emergency room 3 times. Right away I was prescribed xanax and celexa by my therapist.After doing some research before taking the pills I didn’t wasn’t to take then and I let them know but they wanted to force me to take then to “hurry the healing process” but I refused and although I did take xanax for a couple weeks I completely stopped taking then and progress is slow but the important party is to gave your problem because if not you will be dependent on something rather than yourself and that can lead to bigger problems

    Very shortly after major cancer surgery, at the appointment to remove the drains actually, my surgeon prescribed a “mild” lowdose antidepressant at the urging of my family. She said it would help me work through my feeling of loss. Instead, I could not stay awake by day, nor sleep at night. I was so nauseated I could not eat. I remember wishing I had died. Then I had one night of nightmares or anxiety attacks or something. At any rate I kept waking up screaming and shaking. I refused to take antidepressants any more and my husband strongly agreed. I spent the next day suffering the worst headache of my life. When I was well enough to go to my cancer support group (my husband drove me so this was still less than a month after surgery) the ladies there told me I was normal to be sad and mourning the loss of my breast. Some that had had less disfiguring surgeries, or who had been able to have immediate reconstruction (I have to wait a year due to more treatments) said even their surgeries caused great emotional pain. All said you have to cry it out and give it time. They told me my reaction was normal. One said her family couldn’t handle her crying either, she said cry in the shower and they won’t hear you. My husband, friends, and the rest of my family are pleased to see that I am slowing coming out of my mourning (I now refuse to call it depression), and they are also beginning to understand there is a difference between physical fatigue from my ongoing treatments and depression. All except one daughter (young adult out-of-the-house) who goes back and forth between wanting me to try another antidepressant and telling me Christians are commanded to be joyful. (We are also commanded to comfort one another – something I think more appropriate.) My support group has told me she, and the rest of my family, want the “old mom” back and are impatient. I know this was long, but I really wonder how many cancer patients get put on antidepressants by surgeons and oncologists when counseling for themselves AND their families might be more appropriate to try first? By the way, my cancer center has a social worker/counselor available, and when I talked with her after this (at my request – not doctor’s or family’s), she also said that grief for the loss of my breast is normal, even when the surgeon says she got all the cancer.

    I’m grateful there are enough people out there telling you that to grieve or mourn is normal. When did we become a society that views it as abnormal, and that all pain must be eliminated by a medical intervention?

    I was a porn addict for 2 years, and after a while i ran out of excuses to justify watching it. I don’t know your opinion of porn but i’ve always been digussed it and yet i became addicted to it. In 2011 I decided enough was enough and I vowed I would never watch it again. It took me all of 2011 to stop watching porn, but I finally felt like I was in control. But I faced a much bigger problem in 2012. I think one reason that it was so hard for me to quit was because it was an escape from my guilt, even though it was the source of it. After watching it, it would sort of numb me out in the same way you describe the drugs in this article. In march of 2012 I became incredibly depressed, and since then I’ve been battling. At first I thought that I had given myself a chemical imbalance by watching porn and that after a while my brain would repair itself, but now I think all my pain is rooted from years guilt that has built up inside of me. I can’t take drugs because that would just mask the problem in the same way the porn did. How do I get rid of this guilt and move on with my life?

    My guess is that the guilt (what I’d call shame) pre-dates the porn. I don’t think you can move on until you explore the roots of the shame.

    I’m glad to see this post speaking of the good and bad reasons of taking anti-depressants. I was beginning to be a bit disappointed when I read the few other articles where you supported the idea that anti-depressants weren’t effective at all.

    I have seemed to have encountered the range of different experiences you’re exploring. I have seen the abused teenager be prescribed an anti-depressant from his GP. I have spoken with the brother whose sister killed herself just 6 weeks after her GP prescribed her anti-depressants. It makes me firmly believe that 1) no one should prescribe psychotropic medications unless they specialize in psychiatric illness, and 2) never take these medications without talk therapy.

    But I also don’t believe they are ineffective. Although the majority of our society are quite nonchalant when it comes to taking medicine, making it difficult to conclude if medication is beneficial to an individual, not all of us go straight to the medicine cabinet at the first sniffle. I and many in my circles are very against medication. I personally took my first advil at the age of 23 because I was in a lot of pain and at a wedding. And yet, after all these years resisting any sort of medication, let alone something so serious as an anti-depressant, a few of us finally caved and agreed to try an anti-depressant and are happy with the result.

    For 12 years I was in talk therapy and I refused to take any medication, but I wasn’t getting any better. I did make career changes. I did explore my feelings and shape my life to minimize my stress, anxiety and pain, but I still wasn’t getting any better. I had become so exhausted with my random incapability to be, well, sane that I finally gave up and I said, “Ok. I will do whatever you say to do,” and I was prescribed an anti-depressant. I have since never been more stable before in my entire life (3 years, knock on wood). I still have a long way to go, but, damn, am I not finally able to make actual progress.

    I know these are just anecdotes, but anecdotes are the only thing someone like me can offer to the discussion. But I can tell you what I think is going on. You say the profession is saturated, I agree, and I think its making people not get the proper care they need. There’s misdiagnosis, and improper medications being prescribed all the time. My mind constantly boggles when I see someone is suffering from one type of depression and they get prescribed a medication that is optimized for a different type of depression. Sometimes I don’t even think these doctors are even paying attention closely enough. (In a different field, I recently discovered a woman was about to go into surgery when her doctor hadn’t even tried this other medication for migraines. The doctor was going to cut into this woman’s brain because he had apparently never heard of one of the first migraine preventatives which is, like, completely harmless?)

    Medication is a tool, not a fix, so I can completely see it being used incorrectly when it is being used first before anything else. Beforehand I was stuck in a constant cycle of cleaning up the mess from the prior attack barely in time before I fell into the next attack. But now I am using medication to make it more difficult to trigger a depression attack and lengthen the time between attacks so that I can have time to think things through and make changes before the next attack occurs. It is just one tool of many I am using to put myself back together again.

    So, I have to ask. Are the studies finding ineffective or poor results with the usage of psychotropic medication uncovering a problem with the medicine itself, or the prescribers who issue them?

    It has been very interesting and insightful
    Reading this article and all the comments.
    Currently I am have been taking anti-depressants for almost 5 years.
    I was prescribed them at age 17 after my father past away suddenly and life seemed to be cruel and all I wanted was to cry.
    Obviously I was grieving and needed time and help to deal with it.
    Now I wish I had never taken them I feel like half of who I use to be, I don’t have passion or drive, nothing really gets me going. I have been to therapy and honestly found it a total waste of time, I never felt like they tried to understand me or what I was feeling just gave me their opinion without really listening. Then again I may just need to find a good therapist.
    At this point in my life I am in a dilemma I feel like antidepressant have numbed out everything even causing me not to feel excited or happy about good things that are happening. They have destroyed my sex drive and even desensitised the feeling of it all. This is just causing strain to me and in my relationship. I still experience anxiety and the feeling of hopelessness. But I also feel I don’t want to come off them I am very afraid I may break down or not cope with the stress of day to day life. I’m scared to come off them but I can’t stay on them feeling lost and foggy not knowing what to do. I have not discussed it with my GP as I feel uncomfortable. I feel like I was handed antidepressants like it was candy without any real advice on what it can do and then given more or a different type when it wasn’t working or caused me to have intense nightmares. I use to really believe that they really helped me but now I see they just numbed me out, I have dealt with my fathers death and accept it so why am I still on antidepressants? Why do I feel like I need them? Any opinions on my situation would be great because I am thinking of weening myself off them slowly instead of increasing the dose as recommend by my doctor after a 10 minute discussion on how I was feeling !
    Help me I’m kind of stuck on the fence!

    Many other people share your fears about coming off anti-depressants. You need to find a therapist who will help you come off of them slowly and provide you with the kind of empathic support you will need during this time. Peter Breggin’s Empathic Therapy Organization has a national directory of therapists who work in this fashion.

    Dear Anna,

    I am sad to hear about your situation. Please hang in there. I went through a similar situation and I did improve. There is hope.

    You must realize that some of those drugs are habit forming… in other words addictive. Don’t stop them suddenly, please work with a caring professional and get off of them gradually and slowly.

    May you find true peace of spirit. I wish you all the best.

    In my case, the drugs prescribed by a psychiatrist almost drove me completely insane. The withdrawals were the most horrible experience of my life. I actually felt “zaps” in my brain… physical feelings that frightened me beyond description.

    That was two years ago, and I thank goodness that is over. If you search youtube, you can see people who are in withdrawals from these drugs. Frightening to even look at.

    A lot of these drugs are prescribed for a short period of time but can not be stopped suddenly. Ever think what would happen to the unfortunate person who, all of a sudden, loses his job and medical insurance? He would be forced to stop suddenly because he could not afford the medications anymore.

    That abrupt stoppage can lead a person to suicide. It’s in the literature that comes with these drugs. It is this fact that should alert everyone. These drugs must not be prescribed lightly.

    The thing that helped me most in my ongoing anxiety and depression was cannabis. It did not dull me at all because I used it in moderation. (No “stoner” life for me!) It relieved depression and enabled me to tolerate life and people much better. It is medicine.

    Unfortunately, I live in a backward State where cannabis is still illegal. I have not used it in a long time for several reasons… mainly because I don’t want to go to jail! I am also back in the job market and I am facing drug tests.

    It is a shame that something that can help so many people is banned. I can smoke all the tobacco in the world (and develop cancer) and I can get drunk every night (and destroy my liver) but all that is fine in this sick society. But heaven forbid someone use cannabis… oh my!!!

    I would not encourage anyone to break local laws, because you could wind up in jail. That would make things even worse. If you do use cannabis in an enlightened place where it is legal, I would not recommend smoking it. (Smoking anything is bad for you.) Vaporize, use edibles or make tea.

    This is all based in science. Cannabis, when used in moderation and not smoked, is harmless for most people. I had NO problem quitting cannabis. Quitting coffee was worse for me.

    The big issue is that big pharma can’t patent cannabis, nor can they prevent people from growing it themselves. There’s simply no money to be made with it, so they work to keep it banned. They’d rather sell their patented, for-profit drugs.

    OK, I’m off my soap-box now. I wish you all a happy day!

    I know this is an old post, so I won’t be upset if there is no reply. This post caught my attention because my therapist recently recommended that I speak to a GP about meds. I’m not completely opposed to the idea, all things considered. But at the same time things in my life are getting ready to transition. Part of me wants to wait until those changes happen to see how they affect things but part of me is also starting to recognize that I cant force myself out of bed most days to even DO what I have to do ti be ready for thise changes. Things like cleaning and packing so I am ready to move.

    I come from a family of ‘functional alcoholics’ and to borrow that term I could describe myself as ‘functionaly depressed’ at least until the last few months. If I do agree to meds I don’t want to be on them for the rest of my life, but I am giving it consideration as a way to help get through this season of crisis.

    Any input and thoughts would be appreciated.
    Thanks!

    A doctor on advise from a nurse prescribed an antidepressant to my mother, when she was in the hospital due to shingles, why she was never given a good reason, now she has went from 25 to 100 mg with again no explanation.

    Joseph,

    I lost my adult son of 41 years of age a year and a ha;f ago. I started taking an anti-depressant along with lorazepam to help with my grief. i stopped about a month ago (with withdrawals), hoping I could cope with his death. I find that I am now going through what I might have initially gone through in my grief now. In other words, Im wondering if I just postponed my grief to a degree. I feel awful and struggle every day with the loss of my beautiful son. I just want him back and i know that is not possible. He was my best friend and my son. We could talk about anything. My love for him is so strong it touches every part of me. I am a year and half out and am stuck. I don’t want to do anything, go anywhere. I just want to cry. But I don’t know if I want to go back on anti-depressants. They didn’t help all that much but I at least went places and talked to people, begrudgingly. I know I will never get over the death of my son, and I don’t really want to I just have to be able to move forward and take this with me. It is who I am now. If i take anti-depressant again im afraid I will just prolong my initial suffering and go backwards again. I would like to try talking but everyone I call is so expensive. I would like to get back to exercise because Ive gained so much weight and start eating healthy but it seems so hard to push myself. I feel no one can help me with this but me. I continue to take lorazepam when it gets to bad. I’m afraid to stop that. I feel it helps get me over the roughest times. I feel anti-depressants can not help grief like this, sometime you just have to face it and face it alone, because no one (unless you’ve lost a child as well) can feel and carry that kind of grief.

    I can’t imagine anything more painful than losing a beloved child. Are there any grief support groups around you? Granted that therapists are expensive, but support groups are usually free. You need to be in contact people who will understand your grief and won’t expect you to “get over it” or take a drug.

    I have mixed thoughts about this topic both as a therapist and a someone who struggles with anxiety and depression. From a professional point-of-view, meds are overprescribed, often because insurance companies would rather pay for medication than psychotherapy. Additionally, one can’t help but begin to believe in the miracles of psychotropics with all the commercials claiming these drugs will give one their life back. As a therapist, I believe it is important to understand what lies at the heart of a symptom. Depression, anxiety, OCD, etc. – these are symptoms that are often the result of some unknown internal struggle. We live in a world of impatience where we have little time to sort out our problems. We have been promised that one pill a day can fix our lives without realizing the damage of slide effects. As a therapist, it is difficult to fight this trend. There is surmounting pressure to provide “quick” therapy” before the patient or the insurance company gets tired of paying.

    As a patient, I have to say that taking a certain anti-depressant is key to keeping me balanced. Does that mean it is a substitute for therapy. No way. But it does help take the edge off. But at least I understand the pros and cons and have made and informed choice. Most patients have no idea what they are giving up by choosing medication over good psychotherapy. And most patients have no idea what side effects these medications will cause. It is scary business and I worry where we will be, as a profession, in twenty years.

Leave a Reply

Your email address will not be published.