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.
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.