in defense of drugs: anti-depressant medication saves and improves lives

Friends, if this post sounds like a conversation we've had, please don't take it personally. I've had the same or similar conversations with many people. This is a subject that seems to arise periodically - here, on Allan's blog, on Facebook, in any forum I frequent. That's why I thought it was time to gather my thoughts and put them in a post.

The conversation is about the illness known as depression - also called clinical depression - and the treatment of that illness with anti-depressant medications. Every so often, an athlete or an artist will go public about their struggles with depression, or a new study about either the good or evil of anti-depressants will appear, and I find myself having this familiar conversation. Often, I agree with many of the arguments, but disagree with the conclusion.

I don't use anti-depressants myself, but many people I love do. I've seen anti-depressants, especially the class of drugs known as Selective Serotonin Re-uptake Inhibitors (SSRIs), do tremendous good. I've seen them change lives and save lives. Without these medications, many people I love would lead dire, desperate, lonely lives. In some cases, I don't think they'd be alive at all.

These are some arguments I've heard against the use of anti-depressants, and my response to each.

Big Pharma is evil. True. Pharmaceutical companies are purely profit-driven, and will stop at nothing in their quest for a fatter bottom line. They falsify data from clinical trials. They create biased studies driven by marketing. They re-package normal behaviour into "syndromes," then market drugs to treat the fake diseases. They are engines of the capitalist un-health system that has more incentive to perpetuate disease than to promote health. All this is true.

However, some people need anti-depressants in order to live decent, productive, balanced lives. And Big Pharma is where those drugs come from.

I've never heard the greed and deception of pharmaceutical companies used as an argument against taking medication for arthritis, diabetes, hypertension (high blood pressure), or any other chronic disease. Only for depression.

We don't know how they work. Somewhat true. It is known how SSRIs work, but it's not clear why different SSRIs have such different effects on different people. The chemistry of the brain remains, in many ways, uncharted territory.

However, "we don't know how it works" may be a partial statement of fact, but it's not an argument against taking the drugs. No one knows what causes fibromyalgia. But I know I have it and I know how it affects my life. Science advances unevenly. One day the medical science behind SSRIs may be fully known. Until then, why should that knowledge gap bother us?

They are over-prescribed. True. They are also underprescribed. I have no doubt that since the advent of SSRIs, some doctors prescribe medication for conditions that might be treated equally well (or possibly better, in some cases) with talk therapy, or perhaps not treated at all. At the same time, many people who suffer from serious depression could be helped by these medications, but won't take them, because of bias from their doctors, their families, or themselves.

The simple fact of over-prescription does not mean all prescriptions for anti-depressants are unnecessary. "Baby with the bathwater" caution applies.

Every mood does not need to be medicated away. True. But depression is not a mood. People who use anti-depressants to treat clinical depression still have bad moods. They still feel anger, sadness, pain, and so on.

Consider this. How many people would go to the trouble of seeing a doctor, asking for a prescription, trying different medications, struggling with the inevitable side effects, and so on, because they feel normal sadness? Generally by the time a person seeks help for depression, they have been suffering for a very long time. Just as these medications are under-prescribed, they are under-requested.

The drugs are institutionally abused. True. The United States Army hands them out like Tic Tacs to any soldier feeling the effects of trauma. Many hospitals use them routinely. This fact does not change the condition of people with clinical depression, nor change the fact that SSRIs help them.

There are side effects, some of them potentially dangerous. True. This is true for most, if not all, drugs. Each of us weighs the costs and benefits, the risks and rewards, of taking medication. When conditions are serious enough, most of us are willing to put up with some risk. This is as true for depression as it is for arthritis, diabetes, and high cholesterol.

Medication is a shortcut. The only real treatment for depression is talk therapy. First of all, what's wrong with shortcuts? The moral imperative to do things the hard way should be tossed in the trash next to the whalebone corset and carbon paper. More importantly, many people with serious depression cannot participate in effective talk therapy without first taking medication. Medical therapy and talk therapy often work together to produce real results.

A study proved they don't work. I've noticed that articles about anti-depressants often graft sensational headlines onto banal stories, or present skewed and sketchy non-arguments. The headline "Study Shows Anti-Depressant Drugs Use Placebo Effect" may sit atop a story saying that one-quarter of the people studied experienced no results. But it's already known that these drugs don't work for everyone. On a website promoting non-pharmaceutical medication for depression, I saw: "Only 1 in 4 had positive results with the first medication tried." That only tells us that most people had to try several drugs before they determined whether medication was effective or not.

People who use anti-depressants know that they work. A friend of mine who struggled with suicidal thoughts and uncontrollable sadness and rage every single day of her life is now a happy and productive person. Without the drugs, the black cloud descends. These are facts for millions of people.

Depression is not a disease. It's part of the human condition. It's a normal part of life. I submit that the person who says this does not understand what depression is, or else has experienced a form so different that it rightly could be called something else entirely.

To split hairs, everything that humans experience is "part of the human condition". Arthritis and diabetes are part of the human condition, but we don't suggest that people suffer and die from those chronic illnesses when they can be easily treated.

It is not normal to be unable to get out of bed every morning because one's limbs are weighed down with despair. It is not normal to fight thoughts of suicide, every day. It is not normal to find no pleasure in anyone, anything, any time.

I'm not suggesting that feelings of depression are never a normal and temporary state, a reaction to a tragic or traumatic event in one's life. But when those feelings persist over time, drowning out all other feelings, until life doesn't seem worth living, separate from any situation or event, something else is going on.

I tried them and didn't like them. I hear this often, and I think this response gets closest to the heart of the problem with all of these arguments - and with so many arguments. Our experiences are not universal. Each of us is unique. The word "depression" may be - probably is - used to describe several different conditions. Your experience with depression may be totally different than someone else's. It may feel different, and respond to treatment differently.

I suffered from depression as a teenager. I didn't have medication. My depression passed from a combination of events: leaving an abusive home, stopping or reducing recreational drugging, and talk therapy. But why should I assume that my experience will apply to anyone else? In the grand mosaic of humanity, nothing seems to be one-size-fits-all - not sexuality or worldview or learning style or anything else, including mental health.

A few assumptions underlie most of these are arguments.

One assumption is the persistent stigma surrounding mental illness and mental health. Very few people would urge someone with diabetes, arthritis, or hypertension (all chronic conditions) to not seek medical treatment. Most of us believe we should extend our life expectancies by using medications when needed, in addition to making whatever lifestyle changes we can. Yet so many people won't extend that latitude to mental health, and insist that lifestyle changes should be enough. Get more exercise, suck it up, and get on with your life.

Another assumption, as I wrote above, is the universality of our own experience. If you tried anti-depressants and they either didn't help you or made you feel worse, then surely you shouldn't use them. If your own depression passed without using drugs and you are glad for that, then so be it. The challenge might be to own your experience without trying to apply it to anyone else.

And finally, I believe that many of the arguments against the use of anti-depressants stem from a lack of understanding of what clinical depression is. It's not "the blues," it's not a moral weakness, it's not a deeper understanding of life, it's not the price we pay for living. For a view into that heart of darkness, I recommend reading William Styron's Darkness Visible, and The Noonday Demon by Andrew Solomon. These works bring you as close as you will ever come to understanding another human's experience.


johngoldfine said...

Hell of a post, full of strong & rich points, but much as I admire this post and like Styron's book (Solomon's very much not-so- much), I still want to continue to thump on Robert Whitaker's 'Anatomy of an Epidemic.'

laura k said...

Thank you very much, John. That book sounds very interesting. I'd naturally be very wary of the assumptions behind the research. For example, to many people, it appears that homosexuality is a contemporary epidemic - because before a certain point, gayness was invisible. People have similar ideas about rape - all these women "crying rape" now, you didn't hear about that in the old days - because conditions have somewhat changed that help women recognize the crime and report it.

It's possible the incidence of depression in our society has not changed, but the recognition and treatment of it has. Or it's possible that some other factor (environmental, eg) could be causing a great increase in depression. Or... the author's thesis could be correct.

I'll see if I can read it without wanting to burn it. :)

laura k said...

I haven't read Solomon's book yet. It's been highly recommended by Allan and by AWE, two of the people alluded to in this post.

Dharma Seeker said...

I wholeheartedly agree with John's comments about this post. So beautifully and thoughtfully written and I love the images peppered throughout. You nailed everything, there really isn't much I can add. I hope many, many people read this post.

I've experienced many of the things you articulated so very well. When things went very downhill with my depression a few years ago I found it was incredibly liberating to be open about it with my close friends. It was also incredibly reassuring that none of them rejected me (except one who clearly wasn't much of a friend). I think that was my fear, that people wouldn't want a friend with that kind of baggage. I felt like my diagnosis made me "less than". Fortunately my good friends didn't feel that way at all, and we don't shy away from discussing it at all. I love that we can actually joke about it the same way we joke about everything else.

This post gave me the extra nudge I needed to openly admit I have depression beyond my circle of friends, to strangers even. It's kind of scary, and I am concerned that some people reading this might think I'm "less than", but as you pointed out on FB the way to combat stigma is to be open and own it.

laura k said...

Thanks, Dharma, for your kind words about the post but more importantly for starting to be public when you can be.

Maybe try extending the same compassion and understanding you would give to anyone else to yourself. I know you wouldn't think any person was "less than" because they struggled with mental health issues. (Hell, who doesn't?) So maybe try giving that to yourself as well.

The more you're out, the more you'll find people will come out to you. When you get to the point where you casually mention that you take anti-depressants, and people say, "Oh yeah, me too," or "Oh yeah, my partner does, too" (and etc.), and you don't think any less of them... you know the rest. :)

Dharma Seeker said...

Thanks Laura. I just left you a very crackly message from my land phone (my BB died today). You are right in everything you wrote. Sometimes the hardest idea to come to terms with is that it's ok to be me when I feel so flawed, so inadequate. The "friend" who turned on me was a roommate I'd known since kindergarten. Once I went in to a day program she asked me to move out of her house because she wasn't comfortable living with someone who "has a mental illness".

It's hard to embrace my depression (actual diagnosis is major depression + disthymia). Until your FB response, and your response here, nobody has ever suggested to me that it's something to be "owned" rather than something to be ashamed of. The idea of being proud of who I am brought me to tears because I've been so secretive for so long.

I am so grateful for this post but also to have you for a friend.

Dharma Seeker said...

I should clarify I went to great lengths to keep it hidden, except from my good friends (incl. you) as previously mentioned.

laura k said...

OK then, we're sniffling and getting choked up in comments again... :)

Thank you thank you.

Your former friend has an unfortunate prejudice. It's sad to lose a friend that way. Maybe one day she'll discover a more generous and compassionate (and LESS FUCKED UP) view, or not.

It's an incredibly powerful feeling when you own a part of you you once thought was a liability - when you discover it can actually be a source of strength.

And you know that whole flawed and inadequate thing? Pretty sure that's known as being human.

Amy said...

Great post, Laura. I am slowly catching up here and just wanted to echo the other comments about how important your message is. Like most people, I often say,"I was depressed," or "That movie is depressing." But that is not at all what it means to be clinically depressed. Thankfully, I have escaped so far being truly depressed, but I do think many people think it is being sad or blue because of that common usage. Like most mental health problems, until you or someone you love has experienced it, many people just do not get it.

laura k said...

Thanks, Amy. I'm sure you're right, the common usage of the word "depression" - perfectly legitimate, many words have more than one meaning and use - leads to greater misconceptions.

Maybe we should start using other words for other conditions that way. "Gee, I'm so polio today..." "That movie was really measles..." ?