In Defense of Antidepressants

Regular readers will know that I have mentioned many times in many prior posts that I have bipolar disorder. Some time ago I reached a conclusion within myself that the best way to counteract the still prominent stigma of mental illness and with it the misinformation based on fear and misunderstanding was to offer myself as a concrete example. I must admit, though, that I never thought I’d need to speak out against anyone or any column that at least concedes that treatment would be necessary, assuming, that is, that it worked. Most resistance I face and most assumptions I refute are mainly a product of people who, as they inevitably put it, don’t wish to be a slave to a pill or who think that anyone who has to rely on medication to solve his or her problems must have some deficiency in inner strength, independence, or both.

Begley’s article in Newsweek entitled “The Depressing News about Antidepressants” contains much truth, but its underlying assumption that antidepressants aren’t worth the risks involved and might be more harm than good only provides more justification for people of such stripes. Fear and unwillingness to seek treatment are the biggest of stumbling blocks to health and the idea that someone whose quality of life is suffering mightily might not reach out and seek a highly available and usually quite effective means of obtaining an otherwise normal life distresses me greatly.

Yes, the drugs are effective, in that they lift depression in most patients. But that benefit is hardly more than what patients get when they, unknowingly and as part of a study, take a dummy pill-a placebo. As more and more scientists who study depression and the drugs that treat it are concluding, that suggests that antidepressants are basically expensive Tic Tacs.

This is an unfair across-the-board characterization of psychotropic medication as a whole. The true problem here is the typically 21st Century liberal sensibility of the back-to-basics, return-to-the earth holistic treatment movement which casts doubts regarding the efficacy of all modern medicine aside from the obviously irrefutable (and sometimes not even then) . A misunderstanding of the basic elements of psychiatry leads many on a series of wild goose chases and frustrating avenues towards health that, in my opinion, could be better resolved through visiting a medical professional. There has been talk of liposomal cbd oil hemp extract being a useful alternative medication to help brain function and mood so that might be helpful to some. To wit, the brain is a very complex organ, one still frequently beholden to mysteries and theories in place of solid data. Though we might have a good grasp on treating certain diseases, in this instance we only can work with the information and biological advances currently available. This goes for schizophrenia, senile dementia, and migraine headaches.

We have observed recently that though many might clamor for change in the abstract, or as long as it doesn’t happen to them personally, the prospect of individual change promises only the unknown. That which we cannot perceive easily is often frightening and distressing, but those who know intuitively that the life they are living is not the one they need while simultaneously recognizing also that they don’t have to feel the way that they do, psychotropic medication is a godsend. Sometimes, but rarely, one finds an instant fit with the first drug prescribed, but trial and error is necessary for those who strive for lasting health and stability. I myself have been on twenty-four different meds over the course of roughly fifteen years, and while I take care to note that I have a very severe and very rare case, I am not completely unusual in some respects. I long ago accepted this as the reality of the situation as to all of us who seek to find a balance between illness and health. Finding the proper medication cocktail is a bit like visiting a psychologist. One rarely finds a good fit the first go round, though not always.

Even Kirsch’s analysis, however, found that antidepressants are a little more effective than dummy pills-those 1.8 points on the depression scale. Maybe Prozac, Zoloft, Paxil, Celexa, and their cousins do have some non-placebo, chemical benefit. But the small edge of real drugs compared with placebos might not mean what it seems, Kirsch explained to me one evening from his home in Hull. Consider how research on drugs works. Patient volunteers are told they will receive either the drug or a placebo, and that neither they nor the scientists will know who is getting what. Most volunteers hope they get the drug, not the dummy pill. After taking the unknown meds for a while, some volunteers experience side effects. Bingo: a clue they’re on the real drug. About 80 percent guess right, and studies show that the worse side effects a patient experiences, the more effective the drug. Patients apparently think, this drug is so strong it’s making me vomit and hate sex, so it must be strong enough to lift my depression. In clinical-trial patients who figure out they’re receiving the drug and not the inert pill, expectations soar.

As for the clinical trials of varying effectiveness mentioned in the article, I had a much different experience. Beginning in late 2008 into last year I spent nearly six months in-patient at the National Institute of Mental Health (NIMH) in Bethesda, Maryland. I can’t say that I ever doubted the antidepressant effect of any or all of the existing trials and protocols that were being performed on-site. My reservations mainly were that the process of research was so minutely calibrated and overcautious that psychiatrists and researchers took huge pools of patient data samples before publishing their studies. Individual results were secondary to examining a whole cloud of results and then proceeding warily from there. Often long-term studies ran not just for months, but for years. The focus of each was equally narrow, examining a relatively small number of variables on a very particular desire effect. This makes for safe science and prevents results from being challenged or questioned, but it doesn’t exactly advance the discipline and the available scholarship at anything more than a snail’s pace.

A particular study I observed as a patient comes to mind. Participants were given the drug ketamine, known to vets as a tranquilizer and anesthetic and a few generations of recreational drug users as Special K. The drug was administered in the form of an IV infusion. The injection was given, mild hallucinatory and/or dissociative side effects subsided after a few minutes, and then almost every patient who underwent the protocol experienced a very pronounced anti-depressant effect thanks to the innovation of ketamine infusion therapy. The effect lasted only four or five days in a row, and each day that passed promised less and less of an impact at counteracting depression. Only a single active injection of ketamine was given during the entire study as a whole. The point of the study was to measure how long one treatment achieved its stated purpose, to what degree, and at what point the patient returned to a state of full depression. After the first and only injection that quite clearly wasn’t placebo wore off, patients naturally went back to being depressed. Those who felt a pronounced lifting of mood and depressive symptoms knew instantly that the next injection was going to be placebo, regardless of what the nurses or doctors informed them to the contrary.

Those who wish to vent at the pharmaceutical industry for its role in nixing health care reform have a worthy target, but I find more deplorable the means by which it artificially inflates cost of medication, meaning that without insurance, the price of a month’s worth of prescription drugs start at the hundreds of dollars and sometimes are priced in the thousands. I myself would have to pay $1000 a month minimum if I didn’t have basic coverage and in prior posts I have noted the needless complexities I encountered achieving even that. Certainly it sets prohibitive cost and pushes product, regardless of quality, effectiveness, or grounding in solid research to make money. This is a travesty of the highest order, but I have never in my own life encountered more than a bare minimum of people with mental illness who were not substantially improved by medication, once they found the optimum possible cocktail.

What I have found much more prominently among those with mental illness who have gone off their meds altogether or have only given them a cursory trial is that they couldn’t handle the initial side effects or felt discouraged that a single medication either didn’t work well, or worked up to a point and then petered out. I am always suspicious of people who push diet regulation or therapy or some combination thereof in place of pills because I can count on one hand the number of people that have adopted that routine and found it wholly sufficient. I have known scores of people who have mental illness over the years because I have been hospitalized at least thirteen times myself, have participated in support groups, and have ended up being curiously inclined to seek company with people who also have mental illness, whether I knew it up front or not. I am a big proponent of therapy in addition to medication because it has helped me out tremendously over the years, but I know that I can never stop taking my meds, ever, for any reason. It is for this reason that when I encounter any article like Ms. Begley’s that I feel a compulsion to tell the whole story as I understand it to be.

So, having seen for myself the tedious and sometimes unnecessary safeguards employed, I recognize that much of this delay and frustratingly incremental progress is unavoidable. The existent understanding of brain function and its impact upon mental illness is measured in inches, rather than miles. It is accepted that certain chemicals and neural pathways associated with them determine emotional well-being and mental health, but aside from that, medications have often been developed that use existing treatment regimens to treat disorders, but aim to lessen side effects than try new chemical structures or neurotransmitters. I suppose one could obsess about the unforeseen consequences that daily medication use promises, negative impacts upon the body as a whole that we might not recognize for decades to come, but I’m much more interested in being able to go about my daily tasks unhampered by my disease. Three hundred years ago, after all, the conventional treatment to address physical ailments was bleeding the patient white to release toxins. We laugh now at how primitive and even barbaric a practice that was, but for those who lived in those times, that was all they knew. We can only go with that which we know, and returning to the past or refusing to embrace the newest solutions promises nothing any more or less solid. All of our choices are half-chance, the same as everything else.


  1. I am always suspicious of people who push diet regulation or therapy or some combination thereof in place of pills because I can count on one hand the number of people that have adopted that routine and found it wholly sufficient.

    Assuming you are sincere, I would suggest that you read this:

    Gluten Free Pricejacking….

    And follow the links in that diary.

    Also this, there are multiple pages but I show just one, read the entire article:

    Scientific American    Celiac Insights Clues to Solving Auto immunity, by Alessio Fasano    http://www.scientificamerican….

    Read this too:


    And this:

    It is not uncommon for celiac disease to present itself with symptoms that are far more vague. Such symptoms can include: dental and bone disorders (such as osteoporosis), depression, irritability, joint pain, mouth sores, muscle cramps, skin rash, stomach discomfort, and even tingling in the legs and feet (neuropathy).

    This too:

    Try this:


    And if you don’t trust Scott Adam’s wonderful site, you can always go to the National Institute of Health Medline dot gov website and start browsing there

    The incidence of celiac and gluten intolerance, an auto immune disease caused by a reaction to wheat family proteins, which affects how the body absorbs nutrients, and therefore how the body functions, including mental function, is rising.  It was previously thought that one in 133 people had it, now it is thought that 1 in 100 people could have it.  Most people who have it are never diagnosed, many are never diagnosed until they develop other associated diseases and symptoms.  About a third of the population carries genes pre disposing them to develop it, if they are somehow triggered by certain stresses.  Some techno clowns keep adding more and more stuff to the wiki article on HLA- DQ2, so it’s getting harder and harder for a layperson to make any sense out of it, but here it is anyway

    While I am not suggesting that all depression comes from an inappropriate diet, I can, based on science, suggest that undiagnosed celiac and gluten intolerance, which can be successfully treated by diet, is being ignored or the subject of much hostility by the pharmaceutical industry.

    I also know that the artificial progesterone in birth control pills causes depression, and many in the medical community is loathe to acknowledge this, also, over the counter and prescription non steroidal anti inflammatories (NSAIDS) such as ibuprofen, when taken daily in large quantities, can act as a depressant.  So can steroids, another drug used to treat inflammation.  

    I would never tell a person on prescription mood altering drugs to stop taking them (without the supervision of their doctor) nor would I even ever suggest that they don’t need them.  I merely point out that what caused their depression in the first place might have a cause that is auto immune, and that some people do respond to a change in diet, the diet is not a fad, but a medically recognized auto immune disease triggered by a reaction to proteins.

    I do also know that the pharmaceutical industry can be bastards on this topic, and would prefer we didn’t talk about it in polite company.

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