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

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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.

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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

Study: Poor Lawyers Less Miserable Than Rich Ones

A new study published in Georgetown Law Review finds that lawyers working in relatively low paying public-service fields, like public defense or Legal Aid, are more likely to report being happy (and drink less alcohol) than their partner-track counterparts at white shoe firms.  Read the News

Summer On My Mind

I’m in Ottawa, Canada now. I’m on vacation with my family in this capital of Canada. It’s about a 5-hour drive from Buffalo, my hometown, and I’ve never been here before. It has a European sensibility with historical buildings everywhere. ottawa 2

And it’s been hot; steamy, lava-like hot. But having endured yet another merciless Buffalo winter where the bitter cold felt epoxied to my hands and feet, I can’t complain.

I’m an early riser, and I’m no different on vacation. Whatever town I’m in, the first place I look for is a Starbucks. Many Ottawans, however, seems to pooh-pooh that dark brew from Seattle. “Go organic and go local, man,” says my hotel concierge; a pasty, redheaded young man of maybe twenty-two who looked fifteen named, “Brad.”

So here I am at Bridgehead, a chain that you can only find in Ottawa, that serves “organic, fair-traded and freshly roasted” coffee. The interior of the place is decorated with IKEA furniture with giant windows letting in morning light muted by today’s grey, watercolored clouds.

I’ve been feeling pretty grateful, lately. Maybe it’s the summer sun or the cyclical nature of my moods, but I feel happy. Waking up this morning, my wife and daughter were still asleep. I just celebrated my 18th year anniversary and my daughter is entering her sophomore year in high school. wedding A few weeks ago, I received my 25-year pin from my bar association to commemorate my silver anniversary in the profession. My mom’s been gone four years and I’m 35-five years removed from my high school graduation. Check out the blog I wrote for my 30th high school reunion.

I have a lot less hair, but I think a bit more wisdom. A piece in the New York Times took a stab at what wisdom is:

“They learn from previous negative experiences. They are able to step outside themselves and assess a troubling situation with calm reflection. They recast a crisis as a problem to be addressed, a puzzle to be solved. They take action in situations they can control and accept the inability to do so when matters are outside their control.”

Maybe. But the few people I’ve met in my life that I think wise, are more than that. They have warmth of heart; an appreciation of life despite its troubles and the occasional tragedies that everyone is sure to be struck with if one lives long enough.

Sitting here sipping my coffee in my middle-aged self, I don’t really know how wise I am. But I do know that I’ve had more than my share of blessings and good fortune to be wise enough to smile in appreciation on this summer’s day.

As Mark Twain wrote, “Wrinkles should merely indicate where the smiles have been.”

Here’s to more wrinkles.

Walking in Bigger Shoes

Lawyers are an earnest, disciplined bunch.  They love evidence – the “show me the money” approach to life.  They’re hard-bitten pessimist, yet love the latest self-improvement projects pitched to them by the legal establishment.  You know — graphs, charts and the Oprah-like cattle call to “Change Your Life in Five Easy Steps!”  The goal of all these books and slogans is Happiness, as if it were a commodity for sale.  There was a snappy piece yesterday in the New York Times Review of Books entitled, “The Rap on Happiness.”  It’s a great take on this country’s obsession with finding the veritable Oz of bliss.

“The real problem with happiness is neither its pursuers nor their books; its happiness itself.  Happiness is like beauty:  part of its glory lies in transience.  It is deep but often brief (as the poet Robert Frost would have it), and much great prose and poetry make note of this.  Frank Kermode wrote, ‘It seems there is sort of a calamity built into the texture of life.’  To hold happiness is to hold understanding that the world passes away from us, that the petals fall and the beloved dies.  No amount of mockery, no amount of fashionable scowling will keep any of us from knowing and savoring the pleasure of the sun on our faces or save us from the adult understanding that it cannot last forever.”

Lawyers walk in shoes that are too small for them, living lives that are too confining, unimaginative and which fail to challenge them to be their best.  They need to switch from pinching wing-tips to cushy loafers.  This switch gives a vital bounce to their steps rather than a lugubrious gait. The opposite of depression isn’t happiness; it’s vitality. It’s like a Swordfish bounding out of the ocean’s waves in defiance of gravity or B.B. King playing a blues riff on his guitar.  They have a vibrancy that can’t be contained; they express themselves in a space where great stuff happens.

Part of the equation involves not so much pills or therapy, as the lifting up of our individual imaginations.  Putting aside what’s possible in a concrete sense ( you know, the mortgage or student loans), have you ever looked out your office window and imagined the life you’d like to have?  This is not the same as rumination; a constant churning of negative thoughts in our cranium which a depressive is prone to.

Rather, it’s an exercise in lively engagement with our Self. To engage in this effort, we have to pop our life’s stick shift out of “Neutral”, the frozen state that depression and/or anxiety can keep us stuck again.  Locate the “Drive” on your shift and engage.

In this exercise, it might be helpful to think about the choices we make in a different way.  Not in a self-recriminating way, but in a fashion that moves us in a constructive direction. We need to separate the wheat from the chaff in our lives; to decide what reduces or enlarges our spirits.  Quality questions can help in regard.  Not the common lament of depressives, “What the hell is wrong with me?”  That’s a dreary question that goes nowhere because the answer we give ourselves is – – “Everything!”  James Hollis, Ph.D., in his wonderful book, “What Matters Most: Living a More Considered Life” offers us a keen approach ourselves to view ourselves:

“Ask yourself of every dilemma, every choice, every relationship, every commitment, or every failure to commit, ‘Does this choice diminish me, or enlarge me?’  Do not ask this question if you are afraid of the answer.  You might be afraid of what your soul will require of you, but at least you then know your marching orders.”

Incline your inner ear.  Listen to your response to this challenging question.  Enlargement of one’s self isn’t so much about happiness, as meaning. Deep down, we all want a life of purpose; where we feel our lives have a point, or many points of light for that matter.  You don’t have to look far.  It’s right beneath your bouncing feet.

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