ANTI-DEPRESSANTS: WHAT’S REAL AND WHAT’S NOT?
To: The Rittenhouse Review
From: M. B.
Date: January 26, 2003
I almost never agree with Norah Vincent but I think she’s right about SSRIs [See fifth item, “Take a Powder.”] (selective serotonin-reuptake inhibitors).
Obviously for people who are clinically depressed, they’re a real break-through. But it didn’t seem Vincent’s column was aimed at these folks. By definition, clinical depression happens for no good reason. It’s not clinical depression if you’re quite reasonably bummed-out because you’ve just been diagnosed (as Vincent was) with multiple sclerosis. It doesn’t matter; if you’re inadequately cheerful for whatever reason, someone wants to write you a prescription.
I’m not inclined to depression. However in the last few years Prozac has been recommended to me on the occasions of my being unhappy over a messy divorce, a spell of unemployment, and the discovery that my mother had been covering up for my ex’s adultery. The idea seemed to be that wanting (respectively) some transitional time, a job, or an apology, or any sort of real-life solution is so unseemly; surely taking some “happy pills” would be nicer?
It’s not just me. Prozac has been prescribed for every freaking thing. Run “Fluoxetine” and “case report” together on MedLine and see what pops up. Are you obese? Maybe a bit overweight? Think you might become overweight? How about anorexic? Do you engage in any sort of sexual activity that someone else might find objectionable? (Since Fluoxetine is a notorious anti-aphrodisiac, it’s been prescribed for every sexual behavior you can think of, including being gay.) Are you a hypochondriac? A thief? A rapist? Autistic? Excessively religious? Did Sept. 11 make you sad? Here, take these.
It’s hard to overdose on SSRIs, they don’t interact with many other drugs, and their users usually like them, so there’s no penalty for prescribing them inappropriately. And honestly, I’m not sure how you’d impose one without stepping on a zillion toes, messing with patient privacy, etc. But SSRIs aren’t benign. They’re a class of strong psychotropic drugs generally taken daily for years at a clip.
As an analogy: Marijuana could be similarly described -- a strong psychotropic drug, not toxic or interactive and well liked by its users. If pot were legal and you had a condition treatable by being mildly stoned on marijuana 24/7, the effects on your personality (and the possible long-term effect of such a treatment), would be subtle (as with Prozac) but not negligible; it’s not something a sensible person would do without good reason.
Ironically, the trade-off for not having unattractive feelings is, as Vincent describes, displaying unattractive behavior. It seems (and I’m speculating here but Vincent makes the same observation) as if the depression-causing intellectual mechanism that these drugs interfere with also mediates some useful inhibitions. So I see these folks -- who, it must be admitted, are usually quite satisfied with their medication -- passing wind as if guiding fog-bound ships, regaling all present with the details of, including . . . [their] arrest record or spouse’s sexual proclivities, chattering noisily after the theatre lights dim, etc.
I know for some people a drug that makes you occasionally act like a bit of a jackass is a small price to pay for not being immobilized by abnormally despondent feelings. However, someone who falls into this category might not be aware of how casually these drugs are pushed on people whose despondency is a normal and fleeting reaction to the occasional [harsh realities] of this life.
M. B.
New York
Jim Capozzola of The Rittenhouse Review responds:
Although I believe M. B. has offered some valuable observations in this letter, given my familiarity with SSRIs and many other classes of anti-depressants and psychotropic medications arising from personal experience and considerable research, there are many arguments and suppositions that, as in Vincent’s Los Angeles Times column, I believe are misguided, erroneous, and completely false.
This truly is a topic that I would prefer to address in-depth at the Review at a later date.
For now, allow me to say that “depression” is the most poorly chosen word in the field of mental illness, perhaps in the entire realm of human health. I think the number of people who truly understand the magnitude of this disease is quite few -- and all too many of them are already dead by their own hands. I have yet to read a memoir of depression that comes close to relaying the hell that I have experienced for most of my life.
Psychopharmacologists will admit there is much they do not understand about how SSRIs work. And psychiatry has a history of using drugs to make diagnoses -- to which drug the patient responds determines what his problem actually is. I believe this is the reason researchers and physicians are trying SSRIs on so many conditions. Also not known is why different SSRIs work differently on different patients, considering the drugs’ chemical similarities.
My hope is that no one suffering from genuine clinical depression (something far more serious and debilitating than a general state of sadness, disappointment, or “the blues”) will refrain for even a single moment from seeking the help of a physician -- and a physician who understands this disease is a malfunction of the brain as an organ of the human body and not the mind as a figment of the novelist’s, or Sigmund Freud’s, imagination -- before waiting for his condition to improve on its own or wasting hundreds, or even thousands, of dollars on worthless “talk” therapy.
