The theory behind treating depression with medications is that happiness is mediated by neurotransmitters and unusually low levels of them cause depression. Serotonin is most the most commonly targeted but dopamine, and epinephrine may also also be targeted. Monoamine oxidase inhibitors are yet another class. The most commonly prescribed drugs are in a class known as SSRIs.
SSRI stands for Selective Serotonin Reuptake Inhibitor. Your brain produces serotonin as a neurotransmitter. Any chemistry your body produces has to be metabolized or it would build up to unhealthy levels and possibly kill you. You have one set of machinery cranking out the product while another is clearing it away. An SSRI slows down the removal of serotonin from your system a bit, hopefully increasing its concentration.
And it works. Many seriously depressed patients report a marked improvement of mood when on them. The catch is that it is a maintenance plan. Depression is not a pharmacologically curable state – yet.
Taper off the antidepressants and unless you and your environment have really changed, you’ll go back to your previous state. Stop them cold turkey and you will crash lower than you have ever been. Long-term use of antidepressants creates dependency. Your body adapts to them and it takes weeks to months to adapt to not having them.
But… the drugs are often prescribed without any kind of therapy (economics, mostly). Not good. Underlying problems can still creep up to overwhelm.
When a depressed person finds the euphoria and emotional anesthesia caused by illegal drugs, it is a very short step to habituation – and addiction if the drug is addictive in nature. It is “Russian roulette” style self-medication for those who are depressed but can’t or won’t access official channels for help.
I won’t say that a lot of my youth wasn’t spent in a haze of pot, speed, mushrooms, LSD, and Ecstasy. It was partly self-medication for depression, partly self-investigation with hallucinogens, and partly pure hedonism.
I will say I got lucky and walked away unharmed. Alcohol caused more nausea than euphoria. I could have become a meth addict but it was never a regular thing. Cocaine did little for me. I didn’t enjoy opiates or downers. Hallucinogens were my drugs of choice. If I’d been on an SSRI at the time, I could have gotten serotonin syndrome from the hallucinogens. Ecstasy can kill by shutting down the natural thermoregulation process of your body. Without even realizing it you can overheat and die from hyperthermia.
If scientists truly had a handle on the problem, they could send exactly what was needed to exactly those cells that need it. They don’t. Any antidepressant regimen is a shotgun approach. Consequently, whatever drug is being administered also ends up affecting neurological centers that don’t need it.
Prozac and other SSRIs have a potential (not a certainty by any means) for zeroing out one’s libido, affecting appetite, interrupting sleep, sometimes causing impotence or even preventing you from being able to orgasm. It can negate legitimate highs and appropriate sadness. Some antidepressants put you to sleep. Others keep you awake and jittery. Some make you absent-minded and careless. (I’m an expert. I took Prozac and other antidepressants for 25 years.)
You may need to go thru several before finding the one right for you. Just like if you go to a therapist, you may need to try out several before you find one that you sync with.
It is not surprising that people would resist them regardless of their benefits. And some people have a psychological block with the use of drugs in general, particularly those for mood disorders. Despite the downsides, I think they can help a great deal. If your psych thinks they’d be useful for you, give them a few months and see what happens.
Some doctors have noted favorable results with a “natural” antidepressant in St. John’s Wort. It doesn’t seem to be as pronounced as that in Prozac but that may be because of the dosages involved. I don’t find “natural” remedies to human maladies to be particularly reassuring. To your body it is just another set of alien chemistries to metabolize.
There’s a deeper philosophical issue to contend with. How much do we want to reduce ourselves to chemical reactions? Psychopharmacology offers us the possibility of optimizing our personality in any direction we want. Or whatever our medical profession wants. This gives rise to the notion of cosmetic psychopharmacology. Or even the medicalization of personality.
To what extent are pain and rejection necessary for the development of a full human being?
In Star Trek, The Final Frontier, The crew of the Enterprise is offered release from the greatest pain in their lives by Spock’s brother. Almost everyone accepts without question except for Spock and Captain Kirk. Spock says he has come to terms with his past and it is no longer painful. Kirk refuses, saying that his pain is what makes him who he is. Who is better off here? Is it just possible that our pain can give us strength if we handle it correctly?
See what I have done here? I have offered up anti-depressants as a long term solution to depression and then followed up with a cautionary screed. That’s how the world works. Every benefit has its risks.
Pain does not need to be rejected nor is sadness always a bad thing.
Do we even want to be strong?
Next up, Part 4