03 March 2010

Depression

In one of those moments of synchronicity, there were two fascinating articles about depression within a week in the two publications I read regularly - one, called "Depression's Upside" in the New York Times Magazine, and the other a sort of book review in the New Yorker.

They left me perplexed, for what I came away with was: my 50mg of Zoloft every day is a placebo, and depression is "a sane response to a crazy world".

From The New Yorker:

There is "little agreement about what causes depression and no consensus about what cures it". The "drug companies and the psychiatric establishment...have...invented a disease so that they could sell the cure". "Is psychopharmacology evil, or is it useless?"

From the Times Magazine:
"Depression has a secret purpose and our medical interventions are making a bad situation even worse." "If depression didn't exist - if we didn't react to stress and trauma with endless ruminations - then we would be less likely to solve our predicaments." "Depressed affect made people think better."

It's a paradox, one that I'm not equipped to untangle. But it makes me wonder about that 50mg of Zoloft. I've been on it, on and off, for a long time - maybe 10 years. Persistent weepiness and ineffable sadness landed me in a shrink's office, and on Zoloft. Biology? External stressors? I don't know. It wasn't, isn't, the kind of major depression that Andrew Solomon or William Styron have written well about, but more of a chronic low-level dysthymia - which occasionally seems endemic in my cohort. After all, it sometimes seems like everyone I know is on one SSRI or another.

Feeling better, I've gone off several times, but eventually the friability creeps back and I start taking it again. It's a low dose, I know that, but still, taking it makes me less weepy, less fragile. But is that merely a placebo effect? Would I be better off learning to cope without my little crutch? Would I think more clearly, more easily sort out complexity? I don't know. Do I want to find out? I don't know.

Did you read one or both of those articles? Were you as unsettled as I am?

33 comments:

Imperatrix said...

There was a similar article in Newsweek recently. I take 25 mg of sertraline (Zoloft), and have for the past 10 months. (I describe my emotional liability in my 12 November 2008 post, but at that point I was going to try using the Pill to get things under control. It didn't.) It has been INCREDIBLY life-changing. Does is bother me that it may be a placebo effect? (especially since I'm taking 1/2 the normal dose) Heck no. For $10 a month, I get a little green pill that makes all the difference in the world. I spend more than $10 on coffee drinks with my girlfriends each month, so it isn't much of an outlay compared to other stress relievers, and whether it is physically making a difference or pyschosomatically making a difference, it is making a difference (so I'm OK with my insurance getting me such a good deal [on the generic, no less!]) I don't feel the rushes of anger, the temptation to smack the hell out of my girls, and I don't care whether it's all in my mind.

My question to the researchers is: when one starts on sertraline, one has a few days of fuzzy feeling, wooziness (even on 25 mg). So CLEARLY it is physically affecting something, right?

Pgoodness said...

I heard about the New Yorker article, but not about the Times one. Based on what I heard and what you've written, I have to say that personally, i don't care if it's a placebo...my zoloft keeps me even, calm and happy, which is different from the me not on it. I don't think it's an invented disease - I think it's more "popular" because of a change in the generations; people are less worried about stigmas and WANT to be happy and work to get there, via therapy, meds or both.

Anjali said...

Interesting. What issues were they in? I seemed to have missed both pieces, even though I regularly read both magazines.

Kyddryn said...

I have the major kind of depression. I was on medication for it, but quit when the side effects weren't worth the small benefits I experienced. For me (and only for me, I won't address anyone else's process or needs), Prozac and Zoloft were both failures that cost me more than they benefited me.

I'm glad they work for some folks. I'm all for people finding relief from this pernicious emotional cancer. As for me, I endure, sometimes slogging through interminable days and sometimes actually finding life worth a dang. It never goes away entirely, and it never will. I am alive, though, so I win.

I haven't read or even heard of either article, but I tend to be a little isolated here at Casa de Crazy. Thanks for pointing them out.

Meanwhile, based on the excerpts...I believe that depression is both a response to environment and a genetic predisposition, and it's very real (and frankly the idea that it's manufactured is an insult to anyone who's ever had to duke it out with depression)...and I don't think medicating it is a bad idea, nor do I believe medication to be a placebo. For some, it works and is the difference between life and death.

Sigh. I'm blathering. Thanks for spurring some thought on the matter, Mizz Magpie.

Shade and Sweetwater,
K

Florinda said...

I think I read something about at least one of those articles, but haven't gotten to them yet (thanks for the links).

About 5 years ago, after a few months of cognitive behavioral therapy, I was prescribed 50mg of Zoloft to help manage things. My doctor thought I might need to stay on it for about 18 months or so. I'm still taking it. I skip a day here and there, but I really do feel there's a difference if I go more than about three days without taking it.

It's doing SOMETHING for me. I think so, anyway.

Maggie May said...

I have taken zoloft since hospitalized for depression at 18. I have been off it and had to back on twice. Without it I cry daily, feel overwhelmed and scared about everything and cannot change my life.

With it, I still get sad sometimes, and really, really deeply sad others= like with my miscarriage= but it's just not the same as that deep numbing horrible futility.

I do believe that deep sadness creates change. It has for me.

Cold Spaghetti said...

Placebo? Can't be 100% placebo. Even if you're not depressed, anti-depressants will make you feel better.

But I do feel that there is a lot of our world to be sad about. We drone on and on, we have little contact with others outside of work, and few times to really celebrate life.

Libby said...

I read them both. The NYTimes one wasn't about depression, if you ask me--it was about sadness, or contextual depression, maybe, that's a response to a particular event. But not about systemic depression that is always present. And it was way too glib.

I thought the NYer one was more nuanced (Louis Menand is always nuanced) and seemed to acknowledge that, although there are a lot of questions we can't answer, there probably still is something going on. In the end he punts, but that's because--as the comments here show--the meds work for some folks, not for others. I've seen that very thing in my own family. But when they work, whether it's a placebo effect or not, the results are completely worthwhile.

There are certainly times when I think depression is a sane response to an insane world, and I resist the idea of adapting to that world. But I've seen people who w/o the meds can't even make that analysis and change their lives--and with the meds, can.

Julia said...

My take on it is that it's an argument being held by people who aren't suffering from depression.

While it's true that the pill's not the skill, it's also true that sometimes you can't even begin to learn how to cope without the meds. You need mental margin to function and learn.

I daresay that if you've gone off meds thinking you're fine and discover that you're not, that's sufficient evidence that the pill is doing something important.

For anyone suffering from significant and recurring depression, do check out mdsg.org Their newsletter has a regular 'ask the doctor' column with a psychopharmacologist, and you can order recordings of the guest lecturers they've had at their meetings. Many of the members of mdsg have bipolar disorder, but others have unipolar depression. Good people, good support groups, good info.

Kyla said...

I've never suffered from depression, but I do NOT think medications that treat it are simply placebos. There are people with mild depression and those with major depression and people with everything in between. If a low dose of a medication can effectively treat the symptoms of it, why not take it? If you have a headache, wouldn't you take an ibuprofen or acetaminophen tablet? If it made your headache go away every time you took it, would you write it off as a placebo? It is the same...a medical treatment with an effective result.

Marty, a.k.a. canape said...

This makes me just want to meet up with you and everyone who has commented and be able to hug and talk in person.

I agree with so much of it. Imperatrix is right - when you start the Zoloft, there are real physical side effects, so it can't just be a placebo. Pgoodness is right - I don't care if it is a placebo anyway because it has done wonders for me. Julia is right too - I needed the Zoloft to help me learn to cope. Without it, I was stuck, but now I'm level enough to be able to work on myself.

As far as the ruminations are concerned, that part of the article rang very true with me. Without the Zoloft, I will chew on something that has hurt me or bothers me for weeks and weeks. A confrontation that others can just get past and move on from becomes a huge brick wall that I bang my head against forever. What I could have said differently, what I could have done differently, why that other person was wrong, what part of my doing was wrong, and so forth. Obsessed. I like the term ruminations better.

It got me thinking though, that basically the same mental practice is what made me good at my former job. A grant that was due two months from now would take over my thoughts - I would write it in my head over and over again until it was almost complete.

I guess I should stop and just write my own post ;)

niobe said...

I've had two major depressive episodes and a whole bunch of minor ones. When I was really, really depressed, the massive doses of SSRIs I was taking didn't seem to make any difference at all.

Still, I'm willing to do pretty much anything (including taking SSRIs that potentially have only a placebo effect) if it gives me even an incrementally better chance of avoiding the dark, dark place I was in.

Life As I Know It said...

This was Newsweek's cover a few weeks ago.
I don't really know what I think, but I do think a lot about moods and happiness and depression. I'm not on anything, but sometimes in the deep, dark winters, I think it wouldn't be a bad idea. At the same time, some sadness (not depression, but noticeable dips in mood) can lead to necessary contemplation. I'm getting off topic, but there are a lot of interesting articles on expectation of happiness and our society...

In the end, keep doing what works for you, placebo effect or not.

FreshHell said...

I'm on the fence. I haven't read those article but did see one in the WSJ that dovetailed these but was on a slightly different topic. I've been depressed for years. I think it started with post-partum depression after baby #2 and ebbs and flows. I've tried medication but it made me physically ill so I stopped. I think my depression these days is more environmentally-based rather than a brain circuitry problem. Meaning, when my personal circumstances change (if they ever do), my depression may lift. My husband's taken meds for anxiety for years and while it seems to help him cope, I'd noticed a slight flattening of his emotions. He's ever so slightly less "there" to me. I don't know. Perhaps it's my imagination. Either way, I don't have an issue one way or the other about meds - if they work for some people, good.

Mental P Mama said...

I agree that some anxiety and depression makes one a bit wiser and more empathetic, but I don't think I will ever give up my low dose of Lexapro again. I can definitely tell a difference in the quality of my life.

de said...

It's not a placebo. I haven't read the articles, and I will go back and do so today.

My current doctor (OB/GYN) used the analogy of an older house with an insufficient electrical grid to handle all the modern appliances, which indicates to me that he might be in the "sane response to a crazy world" camp.

I heard the same argument against pharmacology you quote from the New Yorker brought up on Brian Lehrer's show (replayed this week from January) regarding medications for kids - ADHD, etc. I agreed with one of the callers that it really comes down to a gap in experience: people can feel sad, so they think they understand depression, but until they've actually been there and been through the gamut of treatments seeking a solution, they don't know.

Several years ago, my emotional life was very bad and stressful. I took 75 mg. zoloft for about 18 months, but it did not solve my problems. Over the course of time, I made career changes, felt better, and stopped the medication.

More recently, I noticed that I had cyclical depression, perhaps fitting the symptoms for PMDD. I would be fine most days, then go into a funk during which I found even routine life difficult to cope with and I cried a lot. This would last a couple of days, then I'd be fine again. I tried taking birth control pills to regulate the hormone levels, but that failed. I now take 25 mg. zoloft and I feel good. I still experience PMS, I still have days of ups and downs, but nothing paralyzing like when I was not on it. I would not say I have to do "work" or gain "skills." This is purely a physical/hormonal issue.

She She said...

I found this article to be interesting, as well:
http://blog.beliefnet.com/beyondblue/2010/02/learning-how-to-be-unhappy-an.html

Bethany said...

Ditto the chronic, low-level dysthymia. I started seeing a cognitive therapist a year or so ago for panic attacks.

I was in therapy weekly for four months. I thought I was learning to cope with panic attacks, but what I realized about two months after leaving therapy is that I no longer had that constant weepiness, sadness, fatigue.

I still have my moments -- now, in fact -- but in general, cognitive therapy made my low-level depression tremendously more manageable. Unlike talk therapy, it doesn't dwell on your past, it's all about changing your thoughts to change your feelings about the present.

I've never taken an SSRI, so I can't compare the two, but that's my story.

Allison said...

Interesting. I've had a post brewing about this but I don't know if I have the emotional energy to do it yet. I haven't read the articles, but I've read Listening to Prozac. I think a sane response to the craziness of this world might be impossible. I think there is something in the way we live that alters our brain chemistry (everyone I know is on some type of SSRI too). I don't think it's a placebo effect. When I try to go off my meds, I don't muse contemplatively on deep philosophical issues -- I huddle in the corner and wonder if being dead would be better than being this ugly, useless, leaden piece of biology.

Furrow said...

I haven't read the articles you mention, but for me, depression was about more than sadness. I can be sad and not depressed. I can be depressed and not sad. Or maybe depression is not exactly what led me to SSRIs. I don't know. For me it was mental stuckness. In my mind I heard that sound you hear when you've stopped the radio between stations. And it was at times nearly debillitating. I couldn't seem to get anything done, and I couldn't change my negative thought patterns. Pills did help me with that. A lot. Everytime I would go off of them during that 7-10 year period, the stuckness would come back. I've been off for about 5 years now (starting when trying to conceive my first child), and so far, it's ok. Maybe my biology was reset by pregnancy and childbirth. Maybe my pace of life is too busy to allow my brain to get stuck. I don't know. But I do know that SSRIs had a real, neurophysical impact on me.

The Library Lady said...

Didn't they used to say that menstrual cramps were all in our head?

I have never taken depression medication, but I have been on anxiety drugs at several times in my adult life. In fact, there is a seven day supply of a medication sitting in my house right now, and knowing that it is there is a tremendous comfort to me.

I don't think it matters if it's "real" or not. If you feel it, and it is effecting your ability to live your life to the fullest than it is real enough! And if the medication helps you to function, to enjoy all the good things in your life then it's a good thing

Jennifer (ponderosa) said...

Wow. This is so interesting. I would have said I don't know anyone on zoloft, but given these comments I bet I do -- they just don't talk about it.

mayberry said...

I only read the NYT piece, but I also found it unsettling in a way I can't quite articulate. I take a low-dose SSRI to prevent headaches and it works OK for that. I also think it might be helping me with the sadness (not depression) that resulted from my pregnancy loss. It's a pretty tiny dose to be therapeutic for depression, but I had NO issues with depression/sadness/whatever before that loss.

Gwen said...

Maybe depression is the sane response of a brain that's in the midst of an evolutionary leap to a world that seems crazy because it's moved past the current human ability to deal with it. Perhaps, then, the SSRIs are bridging the gap until our brains catch up with the new demands.

I think any time you attempt to cover the many complexities of a population with one blanket of explanation, you're sure to get it wrong.

Bee said...

I've just skimmed these comments, so I apologize if I repeat something that someone else said . . . but surely depression has a hormonal/chemical component. For example, I feel more "depressed" (weepy, low, despondent) when the weather is really gray or when I'm about to get my period. That kind of thing. In these cases, drugs are not a placebo, but surely more of a chemical re-calibrater?

As for mental/psychological depression: well. There are just SO MANY reasons.

ozma said...

Sorry but evolutionary psychology is such bullshit. Pardon my French. Also, my lack of argument. But go back and read the argument. PURE speculation. That shit infuriates me.

(Not all evolutionary psych is bullshit. But a surprising amount. If you can tell a story about why there is some trait, you have an article. But such stories are so easy to tell and impossible to verify.

Plausibility is not a good test because things seem plausible within one's social context and so those evolutionary psychologists are often just reaffirming certain social assumptions. They are the same guys who blather about how insects sexually harass each other and that there is some gene for men to like young girls with big lips. Or whatever fad of the day is.

Note: These are my personal feelings only, and my personal choice. I have some serious trouble. What I have is worse than dysthemia. And after years of observation of myself and many others (except for one exception) I have concluded that these drugs are of extremely dubious value. And I'm being Jenny McCarthy here--this is just anecdotal. But it's my freaking body so anecdotal evidence about myself is a good guide for what to put in it!

It's *very* hard to stay off psychopharm. I've got troubles and the mere hint of some relief calls to me like the sirens called Odysseus. But I have discovered my own method for alleviating my problems which is far from foolproof, a pain in the ass and yet works better. So I just go for that and spare myself the potential health problems and the side effects.

Jenn @ Juggling Life said...

I read the NYTimes article. I don't take anything myself, but I've seen it make such a difference for so many people. Placebo effect or not, it does something.

n said...

To those about to cry I salute you!

I think the truth is, they have no fricken idea. Some things work for some people and not for others, right? It's common sense to me. Not every 'body' is the same. So I think when we take meds, it affects us all to 'some' degree. I'm glad we here all agree on that.

I think and I'm not sure cause I'm no genius, that this NYTimes article is excluding a lot of current thoughts on mental illness and creativity? hmmm..

nonlineargirl said...

I need to dig back through our unread NYers to read the article. My sense is that the drug can take the edge off the blues, which can give people the (mental) space to find better coping mechanisms. At least, that is what several friends have expressed about their experience with depression meds. I have considered taking something several times when my coping skills have not been enough, but for various reasons never started. I can't say whether that is "better" or not, just what happened.

Aurelia said...

Every psychiatrist I know wants to punch the shit out of that stupid writer and both those stupid articles.

There are the media representations and then there is reality.

SSRIs are now prescribed for many things that are not depression but are physical ailments, and we just have a lot of lazy docs who don't bother to diagnose thyroid problems and vitamin deficiencies and a 100 other things. And if those were treated, then yes, lots of people would not need ADs.

But those are not clinically depressed people! Actual clinically depressed people benefit greatly from ADs and lots of other psychiatric meds.

They are lifesaving and have prevented thousands of suicides and terrible consequences. They are a miracle and we should all be grateful they exist.

But the key to all of this is to get a really good diagnosis, with a good physical exam and thoroughly treating those issues, then getting a good neuropsych exam and finding out if someone has depression, or bipolar, or ADHD, or anxiety, or any other problem. And then--hand out the meds.

Who gives a shit if it's a crutch? As long as you can walk, why the hell not?

Stimey said...

I've been on Lexapro for a loooong time. My psychiatrist and I have been on this long journey of "let's wean Jean off of this," but every time I get down to 5mg, I start feeling really low again. I don't think it's placebo, but if it is, I don't care. It helps. And there are people for whom antidepressants have helped even more than me.

abby said...

I didn't read either article.

but reading your post reminded me of the 3 years I took antidepressants. sure, I felt better - they flood your brain with serotonin. but I felt even better when I tossed them and started living a life that I wanted, not that I felt I had to live.

I know some people need the pills, and not always at a high dose. it's definitely for each individual to determine.

but I also feel that we have a hard time doing what makes us happy in "today's" world. I decided to do just that and have been pill-free for 8 years with no hankering to go back.

Clare said...

I haven't read either article, but I have been on zoloft for four years, since my daughter was a couple of months old. Being 'diagnosed' with PPD made me realize that I've been in a fog of depression for my entire life. I go through phases where I will decide to wean myself off the pharma crutch, as I've read about it being all a placebo effect etc, but after a while I will crash into a pit where the tiniest action seems utterly beyond my capabilities.

Maybe the placebo effect needs to be seen as part of medicine and therapy. A person's state of mind, they way they process the world around them, has a huge impact on their emotions and physical health. Maybe believing that something will help you produces better results? I've read about studies that show cancer patients who believe they will recover have a significantly higher recovery rate than those who don't.

Depression seems to be mostly described in terms of being happy/unhappy, but I see it more in terms of coping well or not with the challenges and stresses of everyday life. I can be sad and not depressed, and vice versa.

Sorry for the long comment....very interested to read everyone's thoughts on the subject!