More on feeling low…

I decided to follow up this morning’s post on depression with a few more thoughts.

In the past couple of decades, certainly since the 70s when I was starting out as an intern in a backward mental hospital, we have learned a lot about the biochemistry of depression. There is now a much clearer understanding of the specific chemistry- your serotonin level- that gets out of whack. We know what kinds of things impact serotonin levels and they run the gamut from non-prescription drug use, alcohol, severe emotional or physical stress, even blood sugar levels and normal developmental hormone changes.Zoloft1

The problem with treating depression is that we don’t do it with the same equilibrium we do other chemical upsets. I had a growth on my thyroid and had my thyroid removed. For the rest of my life I will take Synthroid. No shame. My siblings and I have familial hyperlipidemia and we take statin drugs to control that and prolong our lives. No shame. Maybe you have problems with diabetes and take Glucophage. No shame.

No one expects us to up and fix these chemical imbalances. But even though we now understand the chemistry of depression somehow we still expect that we should be able to fix it. Pull ourselves up by the bootstraps and get over it. But when it comes to taking anti-depressants we feel embarrassed and as though we need to defend ourselves. Do I feel badly about taking Synthroid? I do not. Would I hesitate to take or disclose that I take an SSRI or other anti-depressant for depression? Yes, I would. And this is coming from a therapist. Shame on me. There should be no shame. There IS no shame.

Lots of times, rather than go through the process of getting depression properly diagnosed people self-medicate it. I do sometimes. If my day starts at 7AM and has the usual stress of 7 or 8 clients, helping adult children try to figure out first time jury duty or how to book an online airline ticket, FG taking off on another business trip and watching the Detroit Edison crew mutilate my trees to clean up the power line- well, by 630 PM, I’m done. And probably, since I didn’t have time to eat properly during the day my blood sugar is low. So before I address the question of “what’s for dinner” I bump up my serotonin and blood sugar level with a glass of wine. Harmless or no, that’s what I’m doing- giving myself a little bump up, a little self-medication.

Some people can do it without medication, some people can’t. I have a very close friend who recently lost her husband to cancer way too soon; she is choosing to live through that without the help of medication. We’re both hardcore mid-Westerners and sometimes view life as an endurance contest. Should it be?  I don’t really think so.  I respect her decision to take the time to sort out whether she is grieving- a process she believes she needs to live through- or whether she is becoming depressed.  For me, that’s a model that I admire and I think, at one time, had broader application in our society.

Someone else who is very dear to me struggles with bouts of true biochemical depression.
They have chosen the struggle over medication, despite several serious attempts on my part to talk them down the other path. After a brief trial once, my dear one decided the alteration in mood was not worth it; they “were losing a part of who they are." on medication. Daily hard exercise, a good diet, regulated sleep and a constant conscious effort to fight the mood helps enormously. But it’s very hard work and I often think to myself, “this shouldn’t have to be so hard."

Depression medications are better- so much better- than they were 15 years ago and they are being refined every day. When I had 2 major bouts of depression- one post partum and one facing divorce- they were not good options. Way too many side effects and people had difficulty even functioning on them. Plus you couldn’t nurse on those medications. So I toughed it out- and it was way too tough while it lasted. Now the side effects for most people are more tolerable and go away after a week or so. Now when I see someone suffering the way I did I say to her, “There is no reason for you to suffer like this.” Even knowing that, in all likelihood, they will get better on their own after a certain amount of time passes, I still think why should they suffer? Why should they miss one happy day of their newborn’s life? They shouldn’t.

The medications also have their drawbacks. We’re finding that the main drawback is that people become dependent on them. In the same way that Synthroid has taken over the function of my thyroid, SSRIs (Selective Serotonin Re-uptake Inhibitors- Prozac, Zoloft, Luvox, Celexa, etc.) seem to take over your brain’s ability to regulate serotonin production and this is the hormone that controls your mood, your appetites, your sleep. Weaning off is difficult. Another problem with them is paradoxical: because they are safe drugs in the sense that they have fairly uniform dosing and the toxic level is distant from the effective level, family doctors and internists are prescribing them routinely. In my opinion they should prescribe them where needed and people shouldn’t have to jump through hoops and see psychiatrists anymore than I should have to see an endocrinologist to get my Synthroid prescription. My regular doctor can do it. Provided she knows what she’s doing. I find that often internists and family doctors haven’t completely educated themselves about anti-depressants nor do they do appropriate follow-up so they too often hand out what the drug reps sell them on. I think, at the very least, physicians have an obligation to forewarn their patients about the difficulties they will encounter when they try to discontinue their use.

Finally I want to go back to something I touched on in my first post about this subject- something I would REALLY like to have a discussion about. I think, in general, our tolerance for distress and our internal ability to handle it has decreased dramatically over the past generation or so. I do believe that we feel entitled to feel good. All the time. We act as though immediate gratification is our due. I am worried that we can’t distinguish quality or quantity of negative emotions; we’re either pissed off or depressed. And any amount of it is almost too much. You’re unhappy in your marriage? Jump ship. Rough day at work? Have a drink. Don’t like your sofa? Pitch to the curb (even though your payments on it don’t start for another two years) and buy another one.

If you doubt this, look at your children. How long can they wait for a need to be met? How invested are they in a problem solving process rather than a ready solution? It’s getting altogether too easy to be unhappy, i.e., depressed, i.e., time for an external fix. Any thoughts? S, C & A?  Mamacita? Bring it on.
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Question: What’s the difference between an enzyme and a hormone?
Answer: You can’t hear an enzyme. Zoloft3

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13 responses to “More on feeling low…

  1. THere is a tendency for internists to want to impress patients with their knowledge and rather than set a referral to a mental health professional, prescribe medication. Unfortunately, that’s usually all that gets done; no referral for follow up. The patient is set adrift with only part of the map to follow.

    Depression requires both a medical solution and the solution available on through therapy. A patient hasn’t been adequately served if they’re addressing the organic aspect of the disorder but not the cognitive-behavioral aspects of the disorder. Therapy gets at the roots of the irrational thoughts and self-defeating behaviors that define depression; anti-depressants only make us feel better about those thoughts and behaviors.

    Having worked in a mental health triage unit, I’ve had the dubious honor of observing broken clients who have been prescribed cocktails of mood-stabilizers and anti-anxiolitics because someone just threw pills at the problem but didn’t bother to look at the human. 100% of the time, the results were tragic – and avoidable.

  2. You are SO right! I am going to keep this so I can email it to everyone I know who suffers from depression!

    Thanks for your comment today, too. It is so nice to be supported by internet friends.

  3. Thanks for your comments today. I am currently experiencing some health issues that cause severe pain and this constant pain is my source of depression. I have been prescribed a mild anti-depressant to help me sleep at night and its nice to hear someone say “it’s nothing to be ashamed of!” Thanks again for sharing!!

  4. I do not hesitate to report that I take the anti-depressant (obviously), and actually, your post made me feel better about continuing to take it. Ironically, I went through my entire divorce (and marriage) without it. But it was when I was severely depressed four months after the divorce trial was over that it became clear that I needed something. I had already had the therapy.

    And I know myself well enough to know that I am taking it for the right reasons. I realize after your post that it is addictive and that might contribute to why I have had difficulty with staying off it– I have weaned carefully. My dr. warned about the onset of depression if you don’t, and actually, I have to call in every three months or so and check with him before he’ll refill my scrip, even though he has said that usually if you have unsuccessful attempts to wean more than twice, you are probably what he calls a “lifer.” I am more suspicious of that now that I have read your post.

    However, for $10 a month, (and I will wait for your email, which may encourage me in another direction), I am pretty happy to continue to take it.

    I have to go and see my doctor for an annual check up before he can prescribe any more for me, so I am interested in what you have to say.

  5. Well, I’ve had a little experience there and I agree with you. Wonderful thoughts. Thanks 🙂

  6. I gave up my Zoloft almost four years ago, because I felt that I was doing okay. For the past few months, I have been thinking, well, maybe, it is time for a little help. It is taking me some time to get used to it again–I think my body is starting to adjust. I really trust my doctor, and when I asked to be put back on meds, we had a rational discussion about side effects, etc. Thanks again, Vicki, this is more help than you know.

  7. I used to be on the side of the fence as your “dear one” (highlighting, ear-marking page after page, scribbling in the margins of TOUCHED WITH FIRE: Manic Depressive Illness and the Artistic Temperament by K.R. Jamison to support our argument that living a more emotionally healthy life would sacrifice his art) until I was able to see first hand what hell that struggle really is.

    As always, your insight is greatly respected and appreciated.

    Oh, and heehee…I love the Q & A. : )

  8. As always, your post was thought-provoking, intelligent, and just plain good. In some areas I am of the “brave it out” opinion, but in others I’ve changed my ways and am now a “for heaven’s sake, let science help you a little” opinion.

    So many of us take medication that keeps us alive, whereas a few years ago our diagnosis would be a death sentence. Science and magic work hand in hand, in my quirky opinion. Each is the other.

    Sure, some people abuse it. Some people abuse everything. A quick fix. Instant gratification. Yes, and no. For some of us, a pill is a scientific miracle that makes us what we ought to be, and for longer. For others, a pill is a crutch, used instead of patience and self-control.

    I must confess that I tend to be judgmental sometimes. (big surprise!!) But I also know that often, to allow yourself to be helped is far more courageous than to try and go it alone.

    No two people are alike. Each case must be evaluated individually. What works for one might be disastrous to another.

    I am no help at all, am I.

  9. I appreciate the comments, especially the moderate thoughtful tone of them. I agree with Jim that way too many people, esp. those that fall into Community Mental Health centers for help, end up grossly overmedicated without any proper psychotherapeutic treatment or follow-up. I like that the comments reflect that, at least in this circle, the pendulum is not swinging as wildly as it has over the past few years. I still say we need to address the need for immediate, external gratification in ourselves and our children- but what else is new? Thanks much for the feedback.

  10. as long as it’s OK with you, i’m going to copy and paste this post so i can share it with people who need to see it. i’m doing effexor and wellbutrin and know that this is a balanced approach for me, not to mention MOUNTAINS better than the alternative. excellent post! many thanks!

  11. Wow… I’ve had so many friends who’ve had to deal with this disease and everysingle one of them used medication to help them out of their hole. Some still need them for balance and other’s have learned to cope, deal, manage, survive, insert appropriate adjective here, without them. I’m thankful that they have all found excellent therapists who have ensured proper usage of these possibly dependent pills, and that they’ve all “seen the light” if you will. So many don’t. There will always be a ying and yang me thinks to this issue, as with anything else. I guess you need to do what’s right for you and hope that there is someone knowledgeable in your life to guide you there if you can’t make it on your own. Thought provoking post Vicki, thanks.

  12. Wow… I’ve had so many friends who’ve had to deal with this disease and everysingle one of them used medication to help them out of their hole. Some still need them for balance and other’s have learned to cope, deal, manage, survive, insert appropriate adjective here, without them. I’m thankful that they have all found excellent therapists who have ensured proper usage of these possibly dependent pills, and that they’ve all “seen the light” if you will. So many don’t. There will always be a ying and yang me thinks to this issue, as with anything else. I guess you need to do what’s right for you and hope that there is someone knowledgeable in your life to guide you there if you can’t make it on your own. Thought provoking post Vicki, thanks.

  13. Thank you so much for all that information. It is comforting just knowing I am not alone in this battle. And a very hard battle it is.

    My thoughts on therapy: Depression that is brought on by stressful situations may benefit from therapy, but when you are born with “something off”, therapy only forces you to come up with things to explain why you are the way you are, when in reality, there isnt any “thing” because it is a chemical imbalance. My brain works differently than others and it has a hard time with acting “normal”. Talking about my life is not going to fix it.

    My thoughts on drugs: In my particular situation (and this has nothing to do with other people’s situations), I feel confident standing by my “I’m stronger than this thing and I’m better off without drugs” view. I feel drugs would only complicate the situation and add to my stress. If I take them, I am giving in and it wins.

    On a good day, my brain runs a zillion miles a minute on empty fums and it drives me nuts. Its always been that way. I find myself talking out loud all time because it will pour out my ears if I dont 🙂 On a bad day, it runs a zillion miles on black, irrational fums, and it tears me up inside. I dont use medication. I use meditation. Meditation (through my yoga practice) has taught me how to quiet my brain, and it has made all the difference. The Eternal OM, The Mother Of All Sound, has been my life saver.

    But to each his own. What works for one doesnt always work for another. No one functions the same way and everybody’s situation is different. This is how I deal with it and I believe I become stronger because of it. This is something that is part of me and one way or another, I do have to live with it.

    Its a matter of what you feel is best for you, because no one, no doctor in any field, knows your body better than you do.

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