“Plop, Plop, Fizz, Fizz” – Oh, What a Relief it is? Our Relationship with Antidepressants

Alkaseltzer

Most folks with depression have a complicated relationship with their antidepressant medications.

I certainly do.

While these pills saved my life years ago when major depression struck, years later, I often wonder if I still need to take them, or, if they’re still effective.

If I feel tired and flat on a particular afternoon, is it depression, the side effects of my meds or a jumble of both? Or maybe, it’s just my persistently pensive nature?

I think about this a lot these days – and maybe you do as well.

While the one-two punch of Cymbalta and Lamictal have kept me out of the dungeon of major depression for years, its comes with a cost. I have interludes of passivity, numbness, and fatigue. Maybe a low-grade depression at times, as well. If I ditch the drugs, maybe I will feel more “alive,” I think. I fantasize that cutting my ties with meds could lessen the days lost to the deadening grayness of a medically induced sense of normalcy I sometimes go through.

But I also feel anxiety. If I went cold turkey and lived medication-free, would it end, well, in disaster? A return to the swampland of depression? A deadman’s land if ever there was one. Can I take that chance? Should I?

There’s scary research that suggests once you stop antidepressants that work (or sort-of-work) for you and try to go back on the same ones because being off of them caused your depression to return (or you just couldn’t tolerate the horrible side effects that can come with discontinuation), there’s a good chance they won’t be as effective.

So, what’s a depressed person supposed to do? What should I do?

There are two camps that offer some guidance on this issue. Both have persuasive arguments about why those afflicted should or shouldn’t stay on meds.

The Stay on the Meds Camp

If depression is an “illness,” like diabetes or heart disease, I need these meds to balance out my of whacky neurochemistry. Given my risk factors: a family history of depression (genetics), a crazy childhood with a nutty, abusive and alcoholic father, and a high-pressure job with too much stress, I should stay on the pills.

IMG_6260

In his insightful essay in the New York Times, In Defense of Antidepressants, psychiatrist, Peter Kramer, author of the best-selling books, Listening to Prozac and Against Depression, suggest that studies show this: for mild or moderate depression, talk-therapy is as or more effective that medication. But for the Moby Dick sized sucker called Major Depression? Medications are warranted, and, indeed, lifesavers. They help many to function and live productive lives, albeit with a range of mild to more severe side effects.

The Get off the Meds Camp

Some people (including psychiatrists) see meds as the devil’s handiwork: supposed chemical solutions to emotional problems that flat-out don’t work. Many psychiatrists’ (and family doctors who write the overwhelming majority of scripts for these drugs in the U.S.), they maintain, are “pill pushers” who do the bidding of “BigPharma”, a multi-billion dollar industry in this country. Antidepressants aren’t so much a cure as a curse.

Irving Kirsh, Ph.D., author of The Emperor’s New Drugs: Exploding the Antidepressant Myth, writes:

“Putting all [the research] together leads to the conclusion that the relatively small difference between drugs and placebos might not be a real drug effect at all. Instead, it might be an enhanced placebo effect, produced by the fact that some patients have broken [the] blind and have come to realize whether they were given drug or placebo. If this is the case, then there is no real antidepressant drug effect at all. Rather than comparing placebo to drug, we have been comparing ‘regular’ placebos to ‘extra-strength’ placebos.”

The remedy from this group? Psychotherapy. They see depression as the result of off-kiltered, negative thinking patterns. The way out of these ruminative, pessimistic thoughts involves working with a therapist who uses, most often, Cognitive Behavioral Therapy, to challenge and encourage patients to replace such thoughts with more realistic and positive ones.

In his book Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You, Richard O’Connor, Ph.D. argues that both therapy and medication are effective, but limited in certain respects.  He advocates an additional factor often overlooked in depression recovery: our own habits. Unwittingly we get good at depression. We learn how to hide it, how to work around it. We may even achieve great things, but with constant struggle rather than satisfaction. Relying on these methods to make it through each day, we deprive ourselves of true recovery, of deep joy and healthy emotion.

The book teaches us how to replace depressive patterns with a new and more effective set of skills. We already know how to “do” depression-and we can learn how to undo it.

Some Recent News on the Meds and Therapy Conundum

The New York Times reports that a large, multicenter study by Dr. Charles Nemeroff, then a professor of psychiatry at Emory and now at the University of Miami, found that for depressed adults without a history of abuse, there was a clear ranking order of treatment efficacy: Combined psychotherapy (using a form of cognitive behavior therapy) and an antidepressant (in this case, Serzone) was superior to either treatment alone. But for those who had a history of childhood trauma, the results were strikingly different: 48 percent of these patients achieved remission with psychotherapy alone, but only 33 percent of these patients responded to an antidepressant alone. The combination of psychotherapy and a drug was not significantly better than psychotherapy alone.

So what’s a depressed person supposed to do?

I don’t know, really.

We’re in a pickle, aren’t we?

Maybe there’ll be a soon-to-be discovered test that can guide us on precisely what to do. But for now, many of us will stay-the-course and, for better or worse, stick to the “plop, plop, fizz, fix”.

I see myself somewhere in the middle of all this. I’ve never been hospitalized or tried to commit suicide. But I have known depression’s scorching winds, gales that have torn the flesh from my body. I will never forget this pain. It’s scarred me. And I never want to return to it.

If you’re thinking of discontinuing your meds, here’s a great article on how to do it safely.

I welcome your comments about your depression journey with or without medicaton.

Copyright, 2017

by Daniel T. Lukasik

12 Signs of Depression in Men

“While the symptoms used to diagnose depression are the same regardless of gender, often the chief complaint can be different among men and women,” says Ian A. Cook, M.D.  Read the Blog

A Simple Solution to Depression? It Doesn’t Exist

Depression blogger, Therese Borchard writes about her recent visit to a holistic health fair and concludes that while holistic doctors and naturopaths offer valuable advice and treatment, it’s only part of a very complicated puzzle of what works for each individual.  Read the Blog

Law Students, Depression & Suicide

In January 2014, CNN reported that lawyers are among the top five occupations associated with suicide. In the summer of 2014, just before the start of the law school academic year, a law professor from the University of Vermont died by suicide. Since then, in a period of eight months, the United States law school community has seen seven law student deaths from suicide. Approximately one suicide per month, and the actual number may be greater than what has been reported by the media and the law schools.

law classroom

In the painful days, weeks, and months after a suicide, family members and loved ones often are left with unanswered questions. Many times one of those questions or comments is some version of “I don’t understand why (s)/he did not just ask for help.”

A study published in the American Journal of Psychiatry, it was found that of people aged 35 and younger who died by suicide, only 15% had received mental health treatment within one month of their death by suicide and just 24% had received mental health treatment within one year of their suicide. The study also found that 23% of those who died by suicide who were under 35 visited a primary care doctor within one month of their death and 62% visited a primary care doctor within one year of their death.

While interpretation of statistics should be done with caution, the data suggests that young people at risk for suicide present more often to primary care physicians than mental health professionals. And while this perhaps speaks to the need to better train primary care physicians to recognize warning signs of suicide, it also begs the question just posed: why don’t people who are feeling suicidal reach out for help?

stressedstudents1

Based on feedback from law students who attended one of the Dave Nee Foundation’s Uncommon Counsel programs at 35 different schools in the 2013-2014 academic year, 64% agree or strongly agree with the statement that law students do not seek help when needed for fear of the professional consequences. One of our 2L attendees suggested: “…lobby the ABA and character and fitness people to recognize treatment for depression is a good thing, and that legal professionals are people too.” Another 1L attendee noted, “I think it is worthwhile to discuss the stigma associated with seeking mental health services, i.e. perception that s/he ‘can’t hack it’ is weak, thin-skinned, that you’re ‘unstable’ or ‘crazy’. Professional consequences of people knowing this about you, etc.”

While it is easy to point to the ABA and to other systems that may contribute to stigma, it is harder to see systemic change. It is easier to begin with individual change.  Here are some things that you can do beginning right now to help reduce the stigma associated with mental health treatment.

Talk non-judgmentally with anyone you are concerned about:

  • It is OK to ask someone if they need help.
  • It is OK to ask someone if they are thinking about suicide, it will NOT give them the idea.
  • It is NOT OK to say “You are not thinking about suicide are you?” or “What do you have to be depressed about?”
  • It is OK to say, “I have noticed some changes in your behavior, is everything OK?”
  • It is OK to say “It sounds like you are experiencing depression, often times people with depression have suicidal thoughts, are you thinking about suicide?”

Be mindful of language:

  • The term “died by suicide” is preferable to “committed suicide” as the term “commit” has negative connotations.
  • Avoid talking about suicide attempts as “successful or unsuccessful”; there are more suicide attempts in a year than completed suicides.
  • When describing individuals with a mental health diagnosis, try not to define them by that diagnosis. Put the person first, “s/he is a person with bipolar disorder” not “s/he’s bipolar.”

Promote mental health care services:

  • We are encouraged regularly to get a physical exam annually; we are regularly tested for blood pressure, glucose, and BMI.  Why not promote a mental health check up?
  • Visit Screening for Mental Health to find out how to bring an online screening service to your place of employment.

For more tips on how to help someone or for ways you can be involved in reducing stigma please visit the Dave Nee Foundation’s website.

Memories_Dave

June of 2015 will be the 10th anniversary of Dave Nee’s suicide. Dave was a beloved and brilliant brother, friend, son, and student. The suicide of Dave Nee prompted his loved ones, friends, and family to honor Dave’s life and prevent deaths like his from happening again by establishing the Dave Nee Foundation. Ten years later, there is much that the Foundation has done to promote wellness, raises awareness about depression & anxiety, and to prevent suicide in the legal field via law school and state bar association presentations. We know that 97% of our Uncommon Counsel attendees agree or strongly agree that the information learned will help them to recognize the symptoms of depression. We know that 95% of our Uncommon Counsel attendees agree or strongly agree that as a result of the presentation they can identify three warning signs of suicide. Perhaps most importantly, we know that 97% of Uncommon Counsel attendees agree or strongly agree that they know what steps to take if they felt a law student was at risk for suicide. (All data based on 2013-2014 Uncommon Counsel program feedback.)

As much progress and impact we hope we have had, until there are NO news stories of lawyer and law student suicides, we will not be satisfied. We hope that our passion and commitment might inspire other stakeholders, perhaps more powerful ones, like the ABA, the NCBE, law school administrators, and Big Law firms, to take steps towards creating cultural change and help us to destigmatize getting help and treatment for mental health concerns in the legal profession.

By Katherine Bender

Upon graduating from Georgetown University as an English and Theology major, Katherine Bender began teaching at an independent Catholic secondary school for girls in Philadelphia. During this time, she became increasingly interested in the social concerns of young women and decided to pursue a degree in community counseling with a focus on women’s issues at the University of Scranton. After completing an internship providing individual counseling to undergraduate students at a residential college, as part of her Master’s degree in counseling, she began working as a full time mental health counselor for college students in Daytona Beach, Florida.

Recognizing that advocating for students with mental health issues in higher education would likely require a Ph.D., Kate began her doctoral work at Old Dominion University in January of 2011, focused her dissertation on research regarding college student suicide prevention, and in the summer of 2013, successfully completed her doctoral program. She now has a PhD in Counseling, Counselor Education & Supervision.

She joined the team at the Dave Nee Foundation as Programming Consultant in September of 2012 and became Programming Director in September 2013. In this role, she leads the Uncommon Counsel program and LawLifeline. She sees her role with the Dave Nee Foundation as an excellent way to continue to provide outreach services and to raise awareness about depression, anxiety, and suicide prevention for higher education students.

You can reach Kate by email at Kbender@daveneefoundation.org

 

 

Built by Staple Creative