Medication is a hot subject on the internet, so I need to say up front that I’m not opposed to the use of medications to treat long-term depression. I have a live-and-let-live attitude about treatment. Finding anything that works for each person is the key, with or without drugs or any of the many other therapies available. But I’ve read a lot about the limitations, in particular, of the drugs that operate primarily on serotonin and a few other neurotransmitters.
As Peter Kramer has summarized in Against Depression, the model on which that approach is based (though prevalent for 50 years) has been surpassed by much more complicated theories that examine multiple factors. Of course, advertising by the companies producing Prozac and related drugs hasn’t changed at all.
Over the last 16 years, I’ve taken many different antidepressants based on the neurotransmitter model but have not found them to provide lasting benefit. Most have worked for a while, usually a few months, perhaps half a year at the most, but eventually they’ve lost effectiveness. The response is usually to increase the dosage, and that often helps, but not for long. Then I get a prescription for a different drug – only to repeat the same cycle.
As I say, my experience hasn’t turned me against medications, perhaps because I’ve never had the devastating effects – including permanent damage to health – that many bloggers have described. But it should be obvious that something is wrong when a psychiatrist has to play a kind of shell game to find the drug that works best. Is the right one under here? There? That one? No? OK – let’s turn them over all at once. What? Nowhere? We must have the wrong shells – let’s get a new set and start over! OK – this time, you pick.
To change the metaphor, I’ve toured many of the pharmacological vacation spots, journeying in a chemical time machine backward from the newest to the oldest. The current stop on this tour has the best beach yet. It’s a combination of Emsam and Lamictal. Emsam is a high-tech patch (I’m sorry – transdermal system) powered by selegiline, an MAOI – that early class of drugs avoided these days because of the dietary restrictions that have to be followed. This combo is working better than anything else I’ve tried – at least for now.
I’ve made life-changing progress in recovery over the last couple of years, and I attribute that to the overall effect of everything I’ve been doing. The medication this time around has certainly helped but is by no means the driving force. That has much more to do with major changes in life, work and inner belief.
All that said – I’d like to describe what happened while I was taking the first drug I tried – Prozac. As I look back, the effects of all the selective serotonin reuptake inhibitors that I’ve used (a pretty complete list of those available from circa 1993 to 2005) did much the same thing. The sign that they had lost the ability to improve mood (though I didn’t recognize it at the time) was the deepening of an emotional disconnection from life.
As I discussed in the last post, one of the states I’ve lived with leads to isolation, withdrawal and a loss of connection to anyone or anything. This loss of feeling creeps into me so gradually that I usually don’t notice what’s happening. Nevertheless, this condition creates problems that undermine family life no less deeply than aggressive abuse or extreme despair.
I can go into this emotional distance even when I am otherwise functional and appear to be quite well. I might even imagine that I’m fine – after all, I’m not in an obviously terrible condition. I’m quietly losing interest and attachment until I become cut off from everyone and everything. I can undergo this change and not even realize that I’m emptying out the feelings that bond me to people and life itself.
It is only in hindsight that I can see the worst periods of this condition as coinciding with my use of Prozac and its relatives. What made it hard to grasp what was happening was the initial, very positive impact. I felt restored to the “real me.” It was like magic. A short time after I started taking Prozac, I was back in my healthy mind and feelings, responsive to everyone around me, energetic, enjoying life and work. Finally, I thought, I had found something that could help turn me around.
After a few months, though, a number of problems arose. At work I grew increasingly indifferent. While managing meetings, I found myself not caring, letting things drift, even losing track of what was being said – despite knowing the subject matter in great detail. It was impossible to focus while trying to prepare for these sessions. When I tried to write a memo or an article, my mind kept blanking out, and I had to struggle to keep going on something I had lost interest in.
At home, I was there, but not there, walking and talking, thinking I was relating quite well to everyone. But my wife immediately picked up the signs and was especially discouraged at the return of problems that had seemed to disappear with the beginning of the medication. All I could think at the time was – well, I guess the medication isn’t holding up – let’s increase the dose or try another one. I was afraid to stop taking them altogether because I thought that without the antidepressants I would be in much worse condition.
I had a long way to go before I could put myself at the center of my treatment instead of medication – or therapy, for that matter, or anything I expected to be the cause of improvement.
I drifted like this for a long time, and the continuing withdrawal was as hurtful to my wife as any anger or rage. In effect, I had left, emotionally if not physically. After a while, I had to admit that Prozac wasn’t doing me any good and so went on to newer drugs of this same type. The feeling of no-feeling kept on until my wife grew desperate and demanded that I get other forms of help to turn this around – or the relationship would be lost for good.
That woke me up, and I began a long period of searching and testing that has brought me to the present turnaround. As I say, I haven’t abandoned medication altogether. I simply don’t expect it to be the central element in treatment. It’s a tool that I’m using in combination with many others, not the complete answer.
I know there are many stories about ineffective and devastatingly harmful experience with medications – as well as many positive ones. What have antidepressants done for – or to – you?