1/12/10
This week's Journal of the American Medical Association has a study sure to rumble the foundation of everyone taking and prescribing antidepressants, at least until we all agree to forget about the study and continue on as usual: drugs were found to have minimal effect on those patients who were slightly depressed. Except the study only focused on one random drug (Paxil) and the weed-out process guaranteed the result before the study even began.
If you're into this SSRI porn like me - or take any antidepressant - Peter D. Kramer (he of "Listening to Prozac") has a great article on doubleX right now about this study, and a much better one done by Northwestern that clarifies what these drugs are actually doing. In essence, they aren't curing depression, they are changing your personality's way of dealing with adversity.
But Kramer buries his lede by waiting until page 3 (an eternity on the web) for the much more important study from the University of Michigan: in layman's terms, we are a excruciatingly sad country walking around with no help. Check it out:
• The average person diagnosed with depression had severe depression. Average equals severe? That is, as they say, BAD.
• 34% of depressed people received medication, and only 11% of those got adequate medication.
• Only 9% of severely-depressed people got adequate medication combined with the right psychotherapy.
My mom once described a woman she truly loathed as being "over-therapied", a kick-ass rebuke that says it all: someone who tries to solve all of their (and your) problems with half-baked drugs and daddy issues, and worst of all, rationalized their worst behavior at light speeds using psychological syndromes they barely understood. I have no doubt I can be one of those people when I set my mind to it.
But the real American tragedy is the opposite. In some ways, it's oddly comforting to know how miserable everyone else is - it makes you feel less crazy knowing half the people you see each day are cloaked in mystifying sadness. But it's not doing any of us any good, that's for motherfucking sure. Hundreds of you reading this, right now, are sedated by melancholy, saddled with chronic, free-floating anxiety, and you're not doing anything about it.
I've always thought the mere act of getting help for being depressed was true bravery - not for the usual canards (only sissies talk about their feelings and only addicts use drugs), but because one's misery becomes the last thing we can count on. It becomes a spell that keeps us from moving too quickly. Seeking help, getting out of the house, disrupts the reverie and allows true pain to pour through. It's temporary, sure, but searingly real.
If there is anything I can say, it's this: you will earn no medals or gain valuable personal experience by being depressed. Not at this stage, anyway. By now, all it's doing is eroding everything your parents, your friends and you have ever built for yourself. This is not a dress rehearsal; this is it. Turn off the computer, there are no answers here. I say this as lovingly as I can.
And if you want a terse, mean-spirited quote, here is one of my favorites:
"Despair is the absolute extreme of self-love. It is reached when a man refuses all help from anyone else in order to taste the rotten luxury of knowing himself to be lost."
-Thomas Merton
Hear, hear. This, so much: "... the mere act of getting help for being depressed was true bravery."
It's hard work having anxiety, panic disorder, depression, social anxiety. I cop to the first three, big-time, and the struggle can be exhausting. (I spent more than 10 years in the prime of my life unable to get onto an interstate highway because of severe panic attacks. Ever try navigating around New England solely on back roads? Oh, and no big bridges, either.)
My mother was "melancholy" for most of the 2nd half of her life. She would no more have sought psychiatric help or psychotherapy than she'd have jumped on a ship to the moon. I feel terrible that she lived that way. Sometimes a negative example is an excellent motivator. Psychotropic medications have given me much of my life back, and I am not shy about giving them (and some great cognitive therapists along the way) credit for my functionality and the fact that most of the time, I greatly enjoy life.
Do you know people in denial about their depression, Ian? Most of my friends and colleagues seem forthright about getting help for mood disorders. But I am admittedly exposed to a smallish sample of the population, and we may be the exceptions.
Amen Ian.
I now work in a psych hospital so of course I see this every day but back when I was in in primary care I would bet the root cause for complaint of more than half the people who came to see me was related to depression or anxiety. I'm not saying their sleep problems, back pain, abdominal pain, etc. weren't real but they were caused or at least greatly exacerbated by their stress levels and mental health issues. It was always hard to bring this up to people but I tried to in the nicest way possible. Some saw the point others dismissed it. Many who agreed it was an issue either had too much inertia to look for help or no resources to do so. Finding a psychologist or psychiatrist, in this area at least, who will take your insurance and is available is really hard. Then, the co pays are outrageous and you may well have the whole visit denied. People are afraid of seeking help because of the stigma and the label and they should be. If I dared to code a visit with a mental health code (depression, anxiety) I liked wouldn't be paid by their insurance and it would label them and make them less likely to get health, disability or life insurance in the future.
Our society needs to admit that mental health is important and then maybe individuals will come forward to seek help.
Also - I have to say it's interesting you quote from Thomas Merton - a well know Christian theologian that I would consider a great representative of the good things Christianity has to offer.
Here is the article's quote saying the study (that I happen to think is pretty crappy by the way) discussed in JAMA about antidepressants:
"they help with acute severe depression. They help with chronic minor depression. And yet they do little for acute, isolated bouts of minor mood disorder. Still, overall, they make patients resilient in a general fashion having to do with personality traits".
I would argue people with acute isolated bouts of minor mood disorders don't need Rx meds in the first place and were never the group recommended to get them. Also, the only SSRI included was paxil - my least favorite to Rx. There are lots and lots and lots of other good studies showing the benefit of SSRIs with significant depression and I've seen miracles using them in practice.
Pardon my cynicism, but that Michigan study sounds like it was funded by GlaxoSmithKline and friends.
Maybe they've got a pill for that.
Is being in denial about one's own depression an additional disorder in the DSM-IV? It sounds like those folks are doubly in need of some assistance. Is it possible to think one is depressed and be wrong about it, or is that, in and of itself a disorder?
I have no doubt that depression is real, profound, and potentially crippling, and that many could be aided by a variety of chemical and theraputic cures. However, the study cited above seems awfully specious and shady.
"You are not a beautiful and unique snowflake. You are the same decaying organic matter as everyone else, and we are all part of the same compost pile." ~Chuck Palahniuk, Fight Club, Chapter 17
...... the best way to get over depression is to suck up this fact and deal with it, to live in the present moment, to realize things are mostly okay, and to refuse to determine your self-worth according to the F-d up mores of consumerist society. Life is beautiful, and our generation, who has no great war or great depression other than our lives, consists of a bunch of fucking whiners (myself included) who are focused on the wrong things. Let's all center ourselves and pause to sit in God's lap, shall we?