July 28, 2017

"When Medication Side Effects Make You Rethink What it Means to Have a ‘Good Life.'"

"Many commonly prescribed antidepressants, in particular, can come with a host of side effects that can paradoxically contribute to depression..." (New York Magazine).

60 comments:

Feste said...
This comment has been removed by the author.
Jim said...

I know people who love it, but Aleve is a downer for me. I'm not saying people shouldn't use it, just be aware of effects of anything.

epador said...

Forms of cognitive behavioral therapy are as effective as oral antidepressants and for most people, a 3-6 month course of counseling is sufficient, though with some life stressors, a "recharge" may be needed. The cost, life-long, is cheaper than 2 years of antidepressants if you are on anything more than a generic drug. There are no known side effects. Limiting factors are finding a competent counsellor, and time commitment, both to counseling sessions and homework. Too many people just want a pill for whatever their problem is.

Feste said...
This comment has been removed by the author.
Henry said...

Part of the weirdness of this article, besides its hazy anecdotalism, is the notion of "normal."

Drugs have side effects, but so do a lot of thing.

For Sertraline and Wellbutrin substitute alcohol and sugar. Which also change one's concept of "normal."

traditionalguy said...

Surprize, surprize. You mean the Pharmakea that holds out false hopes still hurts the people it seduces more than it helps them?



Henry said...

Forms of cognitive behavioral therapy are as effective as oral antidepressants and for most people, a 3-6 month course of counseling is sufficient, though with some life stressors, a "recharge" may be needed.

That may be true. I have found that meditation is helpful as well.

Depressions is episodic and sadness in life is inevitable.

But for people collapsing under acute depression, 3 to 6 months of counseling and practice may be more time and focus than they have.

Fernandinande said...

"Cooperation often begins with Haldol."

Dust Bunny Queen said...

Depressions is episodic and sadness in life is inevitable.

I just don't understand this epidemic of depression. What IS this acute depression that is so awful that you need to take a drug? I know about being sad, discouraged, down in the dumps, bored and even depressed (I guess) for a while when my husband was caught cheating on me and I was a newly divorced single mother. Yeah. That was depressing....but get over it! Life goes on, get back on the path.

I'm not unsympathetic. I just don't understand it being something that you can medicate your way out of. Counseling, support groups, friends to help you get out of your own funk, pets and children that rely on you....sure those help you get back on track. But this obsessive navel gazing is just weird.

Feste said...

Henry – “Depressions is episodic and sadness in life is inevitable”

Morbid depression isn’t. Re sadness: love taught me trust, pain taught me wisdom. As the learning curve goes.

Althouse seems to have a way of generating synesthesia-like posts. In this one case, meds have a priority place. Not final. Necessary. Maybe not sufficient.

We can over-trust medical science. Like over-trusting any other cult of statistical significance. Difficult to know what self-medication masks. Sometimes fatal.

Henry said...

@Dust Bunny Queen -- I would recommend William Styron's Darkness Visible: A Memoir of Madness. A friend of mine who has had a life long fight with depression and anxiety recommended it to me.

I went through a fairly debilitating period of depression about two years ago. It was certainly triggered by some discouraging life events, but the difference between depression and melancholy (my normal state for most of my 52 years) is profound.

Here's Styron: That fall, as the disorder gradually took full possession of my system, I began to conceive that my mind itself was like one of theoutmoded small-town telephone exchanges, being gradually inundated by flood-waters: one by one, the normal circuits began to drown, causing some of the functions of the body and nearly all of those of instinct and intellect to slowly disconnect.

The reason antidepressants work is because depression is a biochemical illness. It is strongly connected to failure in the brain's dopamine system, with major, complex interactions with neurological stress and the way it affects brain development.

CStanley said...

I've posted this here before, I think...a list of non pharmaceutical supplements that have proven efficacy for depression.

SAMe and methylated B vitamins, for unipolar depression and some bipolar people. Get your DNA analyzed to see if you need methylation support (some people can't convert B vitamins to their active, methylated form well, and modern food supplies have made this worse with nonmethylated synthetic folate in all processed breads and cereals.)

Omega 3s (fish oil)

Vitamin D

Zinc

Magnesium

Light therapy

All of these have the advantage of fixing underlying chemical imbalances instead of artificially increasing neurotransmitters. Even leaving aside the issue of side effects of SSRIs and SNRIs, the mechanism of action itself is harmful in the long run. Leaving more serotonin in the synapse to combat the problem of receptors not responding enough just means more downregulation (the receptor becomes less sensitive to the presence of the serotonin over time.)

Henry said...

That said, depression and sadness are not the same thing. Sad things happen. That doesn't mean they cause depression.

One of Winston Churchill's recent biographers pointed this out. Objecting to the long-held conclusion that Churchill suffered from depression -- the black dog, as he put it -- the author pointed out that the black dog showed up when Churchill had good reason to be crushingly disappointed. When you suffer a legitimate disaster, grief is normal.

CStanley said...

I'm not unsympathetic. I just don't understand it being something that you can medicate your way out of. Counseling, support groups, friends to help you get out of your own funk, pets and children that rely on you....sure those help you get back on track. But this obsessive navel gazing is just weird.

Henry is right...situational depression and the biochemical kind are two different things although there is some overlap.

Both kinds have become more prevalent in our society, i think, because many people lack the social support networks that you mention that were helpful to you and because our food supply has exacerbated some genetic tendencies toward the biochemical kind of depression.

Where I think I'd agree with you is that navel gazing isn't helpful and that there's been a tendency to overmedicate everybody. It's just also not helpful for people who don't have biochemical depression to tell people who do that it's strictly a matter of willing oneself better.

Dust Bunny Queen said...

Thank you Henry. I will look and see if we have this book in our library or perhaps on line.

As a biochemical thing, I suppose that medication may be a part of the answer for depression. I've had some pretty hard blows in my lifetime but have never been so depressed that I couldn't function and eventually pull myself out of it. I just endure it and find something else to do or think about. Perhaps a different biological system and why I don't get it..../shrug.

Several medical professionals over my life have remarked that I am a "Stoic". Not sure if that is a compliment or not :-|

Henry said...

Sounds like a compliment to me.

I am a fatalist. ;)

William said...

If one out of six people are being prescribed antidepressants, then antidepressants are being overprescribed.......I had an ailment that required a strong painkiller. When I went off the painkiller, I experienced the most profound and crushing depression I had ever known, I think a lot of people are addicted to opioids not to avoid pain but to avoid the depression that comes from giving them up.......I think if you eat right (with occasional BBQ supplements) and exercise regularly the sadness of life can be contained, but that's the insight of someone in good health with adequate finances. As a general rule life sucks, but sometimes it sucks in ways that are beyond imagining.

Dust Bunny Queen said...

This article I just looked up about how to be a stoic in modern life 9 Stoic Principles describes my general philosophy on living (more or less)

“Does what’s happened keep you from acting with justice, generosity, self-control, sanity, prudence, honesty, humility, straightforwardness, and all other qualities that allow a person’s nature to fulfill itself? So remember this principle when something threatens to cause you pain: the thing itself was no misfortune at all; to endure it and prevail is great good fortune.” — Marcus Aurelius, Meditations

and this also resonated.

Challenge yourself to be brutally honest

“‘A consciousness of wrongdoing is the first step to salvation.’ This remark of Epicurus’ is to me a very good one. For a person who is not aware that he is doing anything wrong has no desire to be put right. You have to catch yourself doing it before you can reform. Some people boast about their failings: can you imagine someone who counts his faults as merits ever giving thought to their cure? So—to the best of your ability—demonstrate your own guilt, conduct inquiries of your own into all the evidence against yourself. Play the first part of prosecutor, then of judge and finally of pleader in mitigation. Be harsh with yourself at times.” — Seneca, Letters From a Stoic


For example, during my divorce (28 years ago ancient history) I realized I can't put all the blame in one place, on my ex, and needed to honestly look at my own part in the failure and accept my blame. Otherwise how can I not repeat that disaster if I don't accept my part?

Maybe people who are depressed should learn to be Stoics :-D

Feste said...

'Life Saving' Counseling

Henry said...

Peace. And best wishes to you. Thank you for your personal note. I occasionally forget, and I want to forget, how this feels.

I tested with a battery of tests, including the MMPI, which put me in the mid-90 percentile for “optimism” (the technical name for the scalar may be different). With two other features in that range. At this extreme high-end range, it's perhaps "congenital optimism." We don't really know. A virtue. And a vice.

My works involves recurring episodes of stress reaction - treated best by R&R. I suffer occasional seasons of deeper, prolonged blues. I once self-presented for depression. Deep and dark. Both my physician and counselor said, “no pills.”

The differential distance between congenital optimism and the baseline where others live, like yourself, is a distance so great for me that it feels like clinical depression. To move from congenital optimism to mid-level normality is painful. Life does this. My work. Not medical.

In my case, pills could lock me into morbid depression.

And pills would mask what otherwise reports only and exclusively on a metric psychological scale, the MMPI.

Good workouts, rest, good friends, diet, sleep, sunshine. Basics.

The psychological tests saved my life. My psych said he might have medicated me without the tests.

And on my life, I swear, I don’t know how people who suffer the real thing can cope.

Best to you. And others here in the learning curve.


Feste is an Aspiration. Colombo is a phase ... love taught me trust, pain taught me wisdom.

Henry said...

Good sleep is a lifesaver.

Bob Ellison said...

Kids are anti-depressants. So are dogs.

Drago said...

Great, so NOW they tell Hillary....

Jim said...

CStanley @8:59 +1

Ignorance is Bliss said...

Bob Ellison said...

Kids are anti-depressants.

My kids are. Other people's spawn, not so much...

Howard said...

I wonder how much of the side effects people experience are because they read the side effects section of the drug flimflam which induces an inverse placebo effect? Also, I recognize that people suffer from real depression and mental illness that are helped by medication. I also suspect that a great many people seek and are prescribed medication when they really just need to exercise more, cut out sugar, cannibis and/or alcohol, get a hobby, join a club, use a push mower, etc.

LilyBart said...

Kids are anti-depressants. So are dogs.

Being outside works. Also Vitamin D supplements.



Fernandinande said...

antidepressants...can paradoxically contribute to depression.

Chemotherapy may help cancer spread, new study shows

Dust Bunny Queen said...

Kids are anti-depressants. So are dogs.

The reality that other people, your work colleagues, your children, your helpless pets who sense that something is wrong and want to help but don't know how....are all depending on you is a help. If not to eliminate depression, or the blues, but at least to make you keep busy and focus on OTHER'S need and not so much your own.

IMHO.

Richard said...

This is a good opportunity for Crayola to come out with a new set of crayons. It will consist of multiple shades of red with names such as Hitler, Mao, Stalin, Pol Pot, Kin Jong Un, etc.

dustbunny said...

I second Henry's recommendation for 'Darkness Visible'. Depression is a totally different animal than mere sadness. You sink into a black hole that seems impossible to escape, without help many commit suicide. Also Kay Jamison Redfield's books on manic-depressive illness.

Fernandinande said...

Someone else posted this a while back -
A neural link between generosity and happiness
"Generous behaviour is known to increase happiness, which could thereby motivate generosity."

+

"If I ever get rich I hope I'm not really mean to poor people, like I am now." -- J.H.

The Cracker Emcee Activist said...

Styron's book was an eye-opener for me as well. Being a melancholy baby by nature and an optimist by will, I never really understood what these sad, lazy bastards were whining about. After Darkness, Visible I was glad I didn't understand.

traditionalguy said...

The Scientists and Big Pharma are hard at work to develop and sell more powerful Drugs, but the depression beats the drugs. Assuming we are made out of chemicals, then drug medications and alcohol should be beating the depression.

That makes me suspect that Depression is really another auto-immune Disease. And as usual the scientists never find cures for those, but only create Experimental Treatments for the symptoms.

CStanley said...

@DBQ-
The problem is that all of the fixes require one to have the brainpower to choose to make those fixes.

It's sort of like a car with a bum transmission...you might recognize that you need to switch gears but lack the apparatus which would enable you to do so.

Bob Loblaw said...

If one out of six people are being prescribed antidepressants, then antidepressants are being overprescribed...

Or people are more depressed than their ancestors. Or they're not, and their ancestors could have used antidepressants.

Personally, I think there are social analogs to junk food, and a lot of people develop habits that leave them without any close family or friends. Society isn't structured such that you have to interact with people much any more.

Bad Lieutenant said...

Dust Bunny Queen said...
Depressions is episodic and sadness in life is inevitable.

I just don't understand this epidemic of depression. ...That was depressing....but get over it! Life goes on, get back on the path.

I'm not unsympathetic. I just don't understand it being something that you can medicate your way out of. Counseling, support groups, friends to help you get out of your own funk, pets and children that rely on you....sure those help you get back on track. But this obsessive navel gazing is just weird.

7/28/17, 8:36 AM



DBQ,


What you describe is called "normal depression." Treatable by getting over it, etc., just as you say.

But take my word for it since you haven't felt it - biochemical depression is a real, powerful thing. The effects of the medications are unmistakable, there is no question of snake oil or placebo effect. In fact some are too powerful, too dangerous, and can provoke bad feelings in their own right.

But just as you can have an ear infection and get no relief from aspirin, nor topical hot compresses/olive oil/marijuana oil/drops of (your own!) urine, or any other folk cures, but take the right antibiotic pills or eardrops and the pain vanishes -

You can have a thousand-mile fog of depression, that you do not even understand to discuss and resolve, lifted off you by gentle application of lithium or fluoxetine or sertraline.

It's not a made up story. Be glad you don't know.

Bad Lieutenant said...

Blogger William said...
If one out of six people are being prescribed antidepressants, then antidepressants are being overprescribed



Antibiotics and opiates are overprescribed, but that has nothing to do with whether or not they are efficacious!

Anthony said...

Yeeeeeeeup.

I've gained weight but it's all been muscle.

MikeR said...

This is why I get upset when people (like President Obama) talk about "knock-off" drugs. It seems the pharmaceutical companies are making unfair money by producing new drugs that basically do the same thing as the old drugs.
But not quite. I have a close relative who went through more than a decade of hell because she could not find a mood stabilizer for bipolar that didn't have side effects profound enough that she couldn't take them for long. When she eventually found the right drug, similar to the others but without serious side effects for her, her life was turned back right-side-up, and her whole family was literally saved.
I have another close relative who has not found the right drug yet, who has been so harmed by side effects that he refuses to try again, and who is having a hard time living his life.
These things are a big deal.

exhelodrvr1 said...

My wife went through approx six years of depression. On medication for most of that time, and going through counselling. Eventually she got through it. Some of the counselors she saw made things worse by having pre-determined diagnoses.

There is a lot that can be done in advance to avoid/limit depression (i.e. diet, sleep, exercise, keeping busy). The problem is that, for a variety of reasons, a lot of people who suffer from significant depression at times don't want to take those steps when they aren't significantly depressed.

Ray said...

Antidepressants do have side effects. One I have noticed is it acts like a happy pill, and it eliminates common sense. Another one it can increase anxiety.

And then when you stop, anxiety / paranoia increases.

And your body adjusts / compensates.

There is no free lunch, unfortunately.

What I have seen that works:

1. Exercise
2. Stoicism - Way of thinking that helps to "Power Thru".
3. Meditation / Mindfulness. There are different types of meditation. I see this as building a mental muscle, so your in control of your emotions more, and can see what your doing.
4. Vitamin D or getting enough sun light.
5. Getting 8 hours sleep with a consistent sleep schedule.
6. Talk Therapy, but it's hard to find a good therapist. Think 80/20. Or more like 95/5%. If used as a tool to help you develop habits / grit, great.
7. Work on building grit.
8. Emotional Support animals. Of course the wrong one can make it worse...
9. Face time with with friends and family.
10. Reduce possible anxiety causing issues, such as cooking dinner.
11. Writing therapy.
12. Positive Journal
13. Cut projects into bit size pieces.
14. Use a timer to work on projects for X minutes.
15. Use the tiny habbits approach. Just set the goal of flossing 1 tooth for example. Neat website with reminders on this.
16. Read the poster, remember your ABC's by Wanda Carter at the start of your day. Full of positive thoughts. http://crayne.com/abc.html


I have a family member that is going through anxiety / depression, and it's a challenge to be around.

Vittorio Jano IV said...

Some years ago, late comedian David Brenner observed the irony of dealing with Zoloft side-effects to treat depression (beginning about 0.40):
https://youtu.be/orZvQMZV_z8

Khesanh 0802 said...

Being the medical expert that I am, I think that Doctors are to quick to prescribe and then continue prescribing without really getting to the heart of the problem. Clinical depression is an insidious disease and I suspect that it affects different people in different ways. My response to the minimal medication I got was some weight gain. Of course, eliminating periodic spells of panic attacks and deep dark depression probably had more to do with the weight gain than the pills. I stopped eating so much and that seemed to help!

Khesanh 0802 said...

Once the pills got my brain unscrewed talk therapy was a great benefit as well.

Laslo Spatula said...

Bad Lieutenant said...
"You can have a thousand-mile fog of depression, that you do not even understand to discuss and resolve, lifted off you by gentle application of lithium or fluoxetine or sertraline."

Amen.

I'm including Trilafon to the list, though.

I am Laslo.

Henry said...

Or people are more depressed than their ancestors.

People used to drink more. A lot lot lot more.*

*Depends on the era and region of course.

FullMoon said...
This comment has been removed by the author.
Feste said...

Happy Girls

Returned recently from taking my adopted grandfather to clinic. Chemo. Ongoing. Ninety-five years old. Bomber pilot WWII.

He voted Trump. Gave money. “This new thing with Trump, what do we do?”

He knows I didn’t vote Trump. Or Clinton. I said, “Twelve O’Clock High! PULL him out! MANHANDLE him out of that cockpit.

He said, “you go get him, I’m too old.” I said, “I’m enjoying the show too much. But it will get old.”

He said, “well, at least I got the happy girls today in the clinic. They always make me feel better. Can we drive by the airport and see who is flying?”

To happy girls everywhere.

Feste is an Aspiration. Colombo, a phase. Love taught me trust. Pain taught me wisdom.

Earnest Prole said...

I can tell you fancy, I can tell you plain:
You give something up for everything you gain

Feste said...

... every pleasure's got an edge of pain ...

Dust Bunny Queen said...

@ Bad Lieutenant

It's not a made up story. Be glad you don't know.

Yes. I am glad that I don't have those experiences (deep depression) and that I can just work my way through the down times.

I'm not negating or denying that other people DO suffer. I just have no understanding of it. Just as a person, who hasn't experienced childbirth, can emphasize, but they cannot really understand. Plus each experience is unique so even if you HAVE given birth, you still don't know.

When I have a friend or family member who is grieving because they have lost a loved one, or a beloved pet, the very last thing I would say or should say is: "I know how you are feeling"....because how could I possibly know THAT. How can I 'know' what someone else is really feeling? Can't.

Dust Bunny Queen said...

lifted off you by gentle application of lithium or fluoxetine or sertraline

On of the key indredients in the soft drink 7-Up.....was lithium. Too bad they removed it.

Don't try adding it yourself though. Ooops Plus your hair might look like that guy's.

Be said...

Unfortunately, nowadays, it seems that folks with gunshot wounds are being treated with the pharma equivalents of randomly placed bandaids. I've been prescribed high blood pressure medication, antidepressants, threatened with statins for the side effects of the hormonal treatment I got kicked up to after the normal steroidal one didn't work.

Don't get me wrong: I've seen the miracles worked on severely depressed folks / folks with OCD issues / Tourette's and the Like thanks to modern medicine. The wholesale dispensing of things like Citalopram (large doses, too; have plenty to say on that subject) on ordinary folks who tick the box "yes, I'm Sad" on medical intake forms is a Problem, though.

Be said...

Super appreciating Dust Bunny Queen's comments here. A favorite poem is one of Emily Dickinson's "I Measure Every Grief I Meet."

https://www.poets.org/poetsorg/poem/i-measure-every-grief-i-meet-561

No, am not doing quantitative analysis on every situation; just trying to figure out how hard someone is hurting, how much Honest Help I can Honestly give and how to communicate that.

mockturtle said...

Feste asserts: ... every pleasure's got an edge of pain ...

But the inverse is not true. At least for most.

Michael said...

Clinical depression is not going to be cured w/ talk therapy. A chemical imbalance, it needs to be treated with medicine. The very big trick is to find the right one and one that will work for an extended period. Grieving over your dead cat is not clinical depression.

Feste said...

mockturtle,

Yep. Fair reminder. I don’t want to go inverse there. Too dark. The Dylan quote warmed me. Because Earnest set it up (intent does not matter). And because Dylan is singing a quasi-end-of-life-blues there. Life’s pleasures tapering into pain. But not overcome by it. Reminded me of taking my adopted grandpa today – age 95 - to the clinic for chemo where he felt pleasure and hope in the simple happiness of the 'happy girls' who work there. Simple pleasures. Per above.

I Have Misplaced My Pants said...

"But trying to use willpower to overcome the apathetic sort of sadness that accompanies depression is like a person with no arms trying to punch themselves until their hands grow back. A fundamental component of the plan is missing and it isn't going to work."

Allie Brosch, Hyperbole and a Half

Earnest Prole said...

I intended to warm you, and yet you say intent doesn't matter, even though you were indeed warmed? Your adopted grandpa may be happy, but I am sad sad sad.

Mountain Maven said...


All the interviewees we're women.