Wednesday, January 19, 2011

Five Things You Need to Know About Your Antidepressant

Following is a chopped-down version of a new article I wrote for my mcmanweb site. Another article delivers strong advisories about taking these meds if you even have the slightest suspicion you may have even "a little" bipolar. So, assuming the bipolar diagnosis has been completely ruled out ...

There are occasions when antidepressants are appropriate, and that occasion is when you're desperate and willing to try anything. Let's get started:

First Thing You Need to Know About Your Antidepressant

You can get more out of your antidepressant if you don't ask too much of it. Antidepressants are not magic bullets. They are certainly not going to get you 100 percent better. They may not get you even 10 percent better. But even a slight improvement is better than no improvement.

A slight improvement may be all that is required in shifting your critical mass to the next phase of recovery: From not being able to get up out of bed to getting up out of bed, from not wanting to get out the door to getting out the door, from not doing things to help yourself to doing things to help yourself.

The Second Thing You Need to Know About Your Antidepressant

Don't expect an antidepressant to make your miserable life bearable. If the underlying cause of your depression is a toxic relationship or abusive working situation or something similar, at best an antidepressant will perk you up enough to help you resolve it. Doing nothing invites depression back in.

No one should have to endure depression one second longer than necessary. But our psychic pain is often part of the healing process - as part of channeling our grief, acknowledging reality, reaching acceptance, and making tough choices.

An antidepressant may prove extremely useful in keeping us from falling apart when we least need it. But it serves no useful purpose in masking the very thoughts and feelings - however unpleasant - that we so desperately need to experience.

The Third Thing You Need to Know About Your Antidepressant

Your antidepressant will work much better if you put in the work. Mental health advocates stress that mental illness, including depression, is biologically based and therefore no-fault. This may be true, but if you interpret this to mean that all you have to do is sit back and wait for your pill to kick in, you will be sorely disappointed.

To use a medical analogy, statins don't work well for people on high-fat diets. Insulin doesn't work well for people on high-sugar diets.

The Fourth Thing You Need to Know About Your Antidepressant

Doctors (including psychiatrists) are not necessarily your best advisers. Far too many have fallen in love with the idea that a pill will solve all of your problems. They often fail to see the whole picture - that you are a person and not just a diagnosis, and that your medication plays but a small role in your recovery. They don't see their job as working with you in devising a strategy to integrate your meds with other important aspects of your recovery.

Virtually all psychiatrists have swallowed Pharma propaganda wholesale. You cannot sit in a waiting room for more than ten minutes without a Pharm rep walking in the door. Pens and coffee mugs and notepads and literature with drug logos are everywhere. The impression is being in the branch office of Eli Lilly or Bristol-Myers Squibb rather than in the clinic of a professional who has taken an oath to do you no harm.

The Fifth Thing You Need to Know About Your Antidepressant

The scientific/medical evidence base for antidepressant treatment is nonexistent, or at best highly suspect. Virtually all treatment studies regard all depressions as the same, with one-size-fits-all remedies, which means there are no studies in support of what works best for you.

Nearly all short term antidepressant trials (about six weeks) are conducted by drug companies to serve their own interests (an FDA indication to market to the widest possible audience) rather than your own interest (namely, what works best to get you well and keep you well).

As for the long-term, it simply doesn't exist. No one does five-year studies. Studies lasting a year or more are extremely rare and are marred by extremely high drop-out rates and methodological glitches too numerous to mention.

Finally, prominent academic researchers have been bought out by Pharma. "Findings" that support drug company marketing objectives rather than dispassionate scientific enquiry are the rule rather than the exception. Clinical trials are replete with various tricks of the trade to improve the performance of the test med, from weeding out beforehand likely nonresponders to cooking data to spinning results.
The one authoritative proposition that comes out of this is the surprising amount of studies that fail, despite every effort made by the drug companies to optimize a good result.

To Wrap It Up

When we use a fork to do a spoon's job, we tend to be unhappy with the results. Just ask anyone who has ever stuck a fork into a bowl of soup.

It is far worse with antidepressants. Not only are we asking a fork to do the job of a spoon, we are asking it to do the job of a knife, a screwdriver, a hammer, a shovel, the tires on your car.
People who use their forks (and antidepressants) wisely, tend to be pleased with the results. Doctors need to exercise far greater selectivity in their prescriptions. Patients need to recognize that antidepressants can only accomplish so much.

Be wise, live well ...


Grace-WorkinProgress said...

I just came out of a three year bout of grief mixed with instant menopause. I think caused by the grief. I have resisted meds because of the points you made in your post. It was the hardest three years of my life but I am glad that I didn't choose meds. I went to the doctor at the beginning for something else and left with free meds for depression. I think it is a can be a way to avoid the real problem and I have seen friends personalities become flat. Nobody wants to feel bad but sometimes if you face life you can come out on the other side a new person. You can be sure my friend wished I had taken something. Oh well.

John McManamy said...

Hey, Grace. These are very tough choices, which reinforces both our points. If antidepressants worked as well as Pharma would have us believe, then taking an antidepressant to get one through a very hard emotional time would be a no-brainer - like taking something for an infection or a digestive upset. The fact that you can look back at what you went through and say that you are glad with your choice speaks volumes.

To readers: I'm interested in all points of view here, as no doubt all of you are. So please feel free to post anything about how an antidepressant got you through a bad patch.

In the final analysis - we the people are the best source of info.

Porcelaine said...

I really love this post. The most frightful thing is the people/patients not knowing the full picture about medication. They don't realise or are forced to believe that they can't be the ones to make the decisions and that is in part legally reflected by law by the way mental health is treated. If taking meds is similar to fixing a stomach ache, we know that it works and it is an informed choice, then the medical and social approach in mental health should better acknowledge that the doctor patient relationship should be a more active one rather than an authoritative/passive one.

Hope that makes sense!

John McManamy said...

Hey, Porcelaine. Very much so. The docs are very much in charge when we're in crisis - same as when we're wheeled into the ER unconscious from an auto accident. Very different story when we get our wits back. We're the boss.