Views on the medicalization of depression

[Little_Sticks]

edit: I'm not going to go off my medication unless I consult my doctor again and she approves, but for anyone answering the hypothetical "would you advise going off the SSRI?", here are a few details. I was severely depressed and had an anxiety disorder from 2006-mid 2012. I've been well since June and am done with therapy. The only reason I'm still on the meds is because my doctor has a policy of keeping patients on them for at least a year.

Why do you allow your doctor to make your decisions for you? ...you value the doctor's guidance and he/she directs you to stay on meds...you stop valuing such guidance and you now have earned the merit to go off meds. Interesting...how that works. Or maybe I'm just an asshole...but that seems pathetic...I'd feel I was worthless if I couldn't make my own decisions. But many people are like this and if I admit that I look down on such things, they'd say I had too much pride and maybe I'm narcissistic. But I say it's just self-respect. Do you have self-respect? I bet you'll say you do and I wonder how you'll rationalize your doctor's role as necessary in making your own decisions about your life. But I don't know, just a guess from another creepy person on the internet.

I'm not sure whether I've brought this up, but while I'm generally doing well, I feel numb a lot of the time. So, even if I'm no less "myself" while on the medication than I am when sleep-deprived, I still don't feel quite like myself. It may just be that I need to switch medications, exercise more or change some other factor(s).

You sound like you expect a sense of normalcy. Do most people even get that? Then again, I'm sure if psychiatrists had their way, they'd medicate most of society. I think I'd rather have my eyelids removed and my skin peeled from body until the loss of blood induces cardiac arrest, than to give a psychiatrist power over my mental states.

 

[ptgatsby]

I'm not sure whether I've brought this up, but while I'm generally doing well, I feel numb a lot of the time. So, even if I'm no less "myself" while on the medication than I am when sleep-deprived, I still don't feel quite like myself. It may just be that I need to switch medications, exercise more or change some other factor(s).

Those are fair issues, especially the numb part. I'd say that it's worth keeping in mind that a lot of people feel this even if they are off medication. One of the biases we have is to judge people only from what we see of them - put often as "the highlight reel". All of us are pretty messy on the inside, and we get the full show.

hm. The thing is, in CBT, you're actively engaging in addressing your depression on a cognitive level. Very different than just letting antidepressants run their course. (Obviously, the peace of mind brought about by successful medication helps to facilitate such reflective behavior, but still. Doesn't seem like a solid analogy.)

It's definitely different. I use it only as an argument against a "normal" self, in that we do change. However, this doesn't really apply for you if when you talk about feeling numb, etc.

What you wrote here does seem true for me, now that I look back. I consider myself an extremely resilient and optimistic person not prone to self-destruction, and this was especially true during the worst phase of my depression...yet no amount of positive thinking or healthy choices made a dent in what I felt. And it was not just dysthymia, it was totally unhinging and hellish and agonizing. I'm not considering that it was a purely biological depression, since I'm able to identify what set the initial depression in motion. But it's plausible that that first phase took such a toll on my mind that it was too exhausted to recover, even when my perspective had.

Depression is definitely a trap and I'm glad you got through it. I imagine that is where the doctor is coming from too. He may understand you better if you say almost exactly what you wrote here - that you used to be more energetic, specific trigger, feel recovered now and less happy (muted) on medication. Most doctors want to work with their patients... most, anyway, are pretty dutiful about improving your quality of life. However, you probably won't get far in persuading it's the best thing for you if it's just about 'getting off meds', especially with what you describe you went through. And I think you would agree with the doctor - you don't want to take the chance of spiraling down like that again, especially if going back on may not be as effective. It's an important conversation!

I'm sorry for implying that medication was to be avoided in all cases. I know that there are those who literally couldn't survive without it, and that black-and-white arguments like that can discourage people from seeking help.

I don't think you implied it really, no worries... it's just that is one of the major concerns with depression. Doctors have the unfortunate job of "trying to convince patients to eat vegetables" more often than they would like. Patients are naturally resistant and not terribly rational. Ultimately it is your choice on the medication thing, but it's also the choice of a lot of people whose life would be improved (or saved)... and all too often, people won't eat their vegetables. (This ignores that sometimes vegetables are over-served, hah).

 

[Derpravity]

I found an article that more or less expresses my current opinion on medicating depression, among other things, on the rationality blog Less Wrong: Diseased Thinking: Dissolving Questions About Disease.

I see no reason why people who want effective treatment for a condition should be denied it or stigmatized for seeking it, whether it is traditionally considered "medical" or not.

People commonly debate whether social and mental conditions are real diseases. This masquerades as a medical question, but its implications are mainly social and ethical. We use the concept of disease to decide who gets sympathy, who gets blame, and who gets treatment.

Instead of continuing the fruitless "disease" argument, we should address these questions directly. Taking a determinist consequentialist position allows us to do so more effectively. We should blame and stigmatize people for conditions where blame and stigma are the most useful methods for curing or preventing the condition, and we should allow patients to seek treatment whenever it is available and effective.

I suffer from bouts of depression, and I've been diagnosed as type 1 bipolar. I consider this an ailment because it distracts from the person I feel like I am, and want to be. I'm a rational person, and yet when I'm caught up in an episode I become hysterically emotional and resemble "myself" very little, in terms of goals, processes and my self-concept. I've suffered a prolonged, full-on psychotic episode once in my past, which I view in similar terms -- I became someone delusional, paranoid, and disturbed in all my thinking. That person was almost nothing like me, and I'm glad that antipsychotic medication was able to bring me back to my regular, fully functional personality. I've finished the course of antipsychotics, but I remain on lithium for mood stability and an antidepressant for my continuing and occasionally debilitating depressive swings.

I think that because depression demonstrably makes my life worse, I'm entitled to correct it with medication rather than suffer it because "it's part of me", for the same reasons I wear glasses and get dental treatment and take the pill to ease PMS symptoms.

Like the writer of the article I quoted, I think this argument can also be extended to "alcoholism", addictions in general, and "treatable" personality/psychological disorders that the sufferer wants to treat. I can't justify their suffering because "it's in their head" or "it's part of them". If they can be treated and live a better life, power to them.

 

[Derpravity]

Why do you allow your doctor to make your decisions for you? ...you value the doctor's guidance and he/she directs you to stay on meds...you stop valuing such guidance and you now have earned the merit to go off meds. Interesting...how that works. Or maybe I'm just an asshole...but that seems pathetic...I'd feel I was worthless if I couldn't make my own decisions. But many people are like this and if I admit that I look down on such things, they'd say I had too much pride and maybe I'm narcissistic. But I say it's just self-respect. Do you have self-respect? I bet you'll say you do and I wonder how you'll rationalize your doctor's role as necessary in making your own decisions about your life. But I don't know, just a guess from another creepy person on the internet.

Doctors have policies like keeping patients on their SSRIs for at least a year for good reasons. Many medications for depression will really mess with the head if you stop and start them suddenly; your system needs to be able to adjust. And it's clinically been shown that coming off antidepressants just because you feel better can lead to bad relapses, for the same reason you don't stop medication for other ongoing illnesses just because the medication is doing the trick. Antidepressants are considered to "treat", not "cure". And Doctors, especially psychiatrists, have strong medical grounds for their recommendations when it comes to these things, even if those grounds are often "erring on the side of caution because we're not sure how it works".

I think it's natural to accept a doctor's guidance over your own intuition, with a healthy level of skepticism of course, because there's a good chance a decent doctor would have a better idea of how to go about treatment than the average person. That's not surrendering personal autonomy, that's trying to make the most informed decision possible.

Fair enough if you don't think doctors are equipped at all to treat depression (which I'd argue, obviously), but the way you worded your post made it sound like if you were found to have cancer, you wouldn't even consider doctors' suggestions of the best way to treat it to keep you alive, because accepting their authority is somehow forfeiting your own will rather than, well, exercising it.

 

[tinker683]

As somebody who took two tours through a hospital 12 years ago because I was severely depressed and suicidal, I have two answers for you, the short, blunt, and mean answer and the long nicer answer.

Short answer: Drop the attitude you've got, take your medication, and do what your doctor tells you to do and stop thinking you're smarter than her. You'd only be making yourself miserable for a much longer period of time than you need too.

Long answer: I'd had been dealing with depression for a long time before I actually got to the point to where I was suicidial but I remember during my 2nd tour in a mental hospital how I felt when they put me on the drug combo that I would be on: I felt stable, like the ground I was standing on suddenly became solid. It was from that feeling that I was able to start rebuilding myself.

While I am sure that there are doctors out there who issue out medication without much thought, I'm far more inclined to feel that if you're still struggling with depression, and you're on medication, you are either taking the wrong drugs or you're not doing what your therapist is telling you to do.

Recovery from depression (my own experience, mind you) is fought on two fronts: The biochemical front (which medication addresses) and the cognitive front (which therapy addresses). Many people make the mistake of treating their meds like Tylenol: You take the pill and the sadness goes away, and everything is fine, right?

NO. Whether you realize it or not, your cognitive processes are in work 24/7 and you may not realize that a lot of what caused the imbalance in the first place (assuming you're not one of those people that will simply require medication of one form or another to function) is how negative and destructive your cognitive processes are. All the medication in the world isn't going to mean anything if you are constantly telling yourself that you are a useless human being.

All that said: Being on meds can royally suck. I was on Effexor and Seroquel and the Seroquel gave me a bitching hangover every morning that I dealt with for 6 years before I finally got off of them (though on the flip side, I sleep VERY well every night ). The side effects can be harsh, sometimes more so than the depression you're trying to treat, but thats what happens when you start ingesting chemicals that play with your brain chemistry. The trick is to find the combination you can work with, that can help you build yourself a better you.

I apologize for coming off as a bit hostile at times, but this is a topic I've weighed in on many times I have little patience for people who try and tell me all the evils of pharmaceuticals and therapy. These are usually the same people who are STILL battling with their depression whereas my depression was a speed bump in my life I'm OVER it now and I got there by TAKING MY MEDS!!

I'm sorry you are going through depression and anxiety, that really sucks. Major Depression isn't something I wish on anyone, I know what it can do to someone. But hang in there, keep your head up and the positive thoughts flowing and soon you'll build a strong enough being to where you won't need them anymore.

 

[Thalassa]

As somebody who took two tours through a hospital 12 years ago because I was severely depressed and suicidal, I have two answers for you, the short, blunt, and mean answer and the long nicer answer.

Short answer: Drop the attitude you've got, take your medication, and do what your doctor tells you to do and stop thinking you're smarter than her. You'd only be making yourself miserable for a much longer period of time than you need too.

Long answer: I'd had been dealing with depression for a long time before I actually got to the point to where I was suicidial but I remember during my 2nd tour in a mental hospital how I felt when they put me on the drug combo that I would be on: I felt stable, like the ground I was standing on suddenly became solid. It was from that feeling that I was able to start rebuilding myself.

While I am sure that there are doctors out there who issue out medication without much thought, I'm far more inclined to feel that if you're still struggling with depression, and you're on medication, you are either taking the wrong drugs or you're not doing what your therapist is telling you to do.

Recovery from depression (my own experience, mind you) is fought on two fronts: The biochemical front (which medication addresses) and the cognitive front (which therapy addresses). Many people make the mistake of treating their meds like Tylenol: You take the pill and the sadness goes away, and everything is fine, right?

NO. Whether you realize it or not, your cognitive processes are in work 24/7 and you may not realize that a lot of what caused the imbalance in the first place (assuming you're not one of those people that will simply require medication of one form or another to function) is how negative and destructive your cognitive processes are. All the medication in the world isn't going to mean anything if you are constantly telling yourself that you are a useless human being.

All that said: Being on meds can royally suck. I was on Effexor and Seroquel and the Seroquel gave me a bitching hangover every morning that I dealt with for 6 years before I finally got off of them (though on the flip side, I sleep VERY well every night ). The side effects can be harsh, sometimes more so than the depression you're trying to treat, but thats what happens when you start ingesting chemicals that play with your brain chemistry. The trick is to find the combination you can work with, that can help you build yourself a better you.

I apologize for coming off as a bit hostile at times, but this is a topic I've weighed in on many times I have little patience for people who try and tell me all the evils of pharmaceuticals and therapy. These are usually the same people who are STILL battling with their depression whereas my depression was a speed bump in my life I'm OVER it now and I got there by TAKING MY MEDS!!

I'm sorry you are going through depression and anxiety, that really sucks. Major Depression isn't something I wish on anyone, I know what it can do to someone. But hang in there, keep your head up and the positive thoughts flowing and soon you'll build a strong enough being to where you won't need them anymore.

I completely and utterly agree with this, for the most part. You should take your meds, but also be aware of what works for you and what doesn't. For example, the doctor once prescribed a sleeping pill for me (she said it was optional) that I realized I absolutely DID NOT NEED. She was okay with that, because it was optional anyway, and it just kind of took away my motivation, and I was much better off without it, and my doctor agreed that taking something like melatonin was better for me, as long as I took my other meds.

People who are VERY sick (schizophrenia, severe bipolar disorder, some cases of BPD) will just get worse over time if they don't take their meds. The brain has plasticity, but if your brain keeps running in dysfunctional patterns over and over again, day after day, without you getting treatment, guess what? There's more likely you'll "stay that way" or be harder to treat in the long run. This is especially crucial in cases of people who actually lose touch with reality, or who are a harm to themselves and/or others, but even in clinical depression, it still applies.

On the other hand, is a pill going to solve all your problems? Fuck no. Eat right, get enough sleep, stop taking street drugs or drinking excessive amounts of alcohol, get at least moderate exercise several times a week (taking walks outside, riding a bike, doing yoga or an exercise video SOMETHING) and try to avoid negative or trigger situations (such as isolating yourself or repeating patterns that you know upset you).

I knew this one guy who used to drive me batshit because he expected to sit in front of his computer for twelve hours a day (he was in grad school), he didn't work, he didn't exercise regularly, et al...and he wondered why meds weren't helping his depression.

It's because meds are necessary, but a lot of what they do is help to stabilize you while you go through therapy, improve your lifestyle choices, develop healthier habits, and make other therapeutic changes to your life.

I take a very balanced view on this topic. Meds aren't the answer to all of life's problems and they don't replace other forms of therapy, but if you don't take your meds...dude, just look at what happened to Sylvia Plath. Back when these meds didn't exist, people killed themselves all of the time, or ended up living in institutions. Take advantage of modern medicine in an intelligent and balanced way.

 

[mintleaf]

Short answer: Drop the attitude you've got, take your medication, and do what your doctor tells you to do and stop thinking you're smarter than her. You'd only be making yourself miserable for a much longer period of time than you need too.

I saw my doctor this week, and as soon as I mentioned the numbness that my medication seems to have brought on, she suggested lowering my dosage by 25mg a month.

I'm still struggling to form a solid opinion on the issue in general, but I want to see how this pans out. Anyway, I had very minimal side effects when I began the medication - I don't know, but wouldn't that suggest minimally difficult withdrawal?

"Drop the attitude"? It's a legitimate uneasiness I have regarding my own mental health treatment. It's bringing about more anxiety and unhealthy introspection, and ignoring it isn't that simple. As much as I appreciate them, the personal experiences others have shared here haven't been able to convince me of anything. Everyone is different.

I'm entitled to correct it with medication rather than suffer it because "it's part of me", for the same reasons I wear glasses and get dental treatment and take the pill to ease PMS symptoms.

I realize that medication works for some, but I'm wondering whether I might be better off without them now. I don't intend to suffer with my depression; I'm fine now, and it doesn't seem that it will come back to any serious extent. If it does, of course I'll consider restarting my medication.

and in response to any potential "how do you know that you're not just fine now because of the medication?" questions: I started recovering about a week before I was supposed to start. So I don't know the answer to that, and I might as well find out.