Tuesday, June 15, 2010

Prozac Nation - Not a Movie Review... just so we're clear..

Today, a friend/co-worker of mine posted quite an interesting article outlining one man's struggle to get off anti-depressant medication after a number of years.

Read The Full Article

The article raises some interesting questions regarding the use of SSRI's for treating clinical depression, the main ones being (based on my interpretation of the article):
  • If someone is medicated for depression is it necessary to be medicated for life?
  • Does the use of anti-depressants actually inhibit the body's ability to deal with stress?
I had many intelligent and well thought out ideas to share on the subject, but it's late and I have to take my child for dental surgery tomorrow, so I'll likely keep this shorter than planned.

I am neither pro- or anti- medication. I have heard the argument that taking medication for depression is like a diabetic taking insulin.. you have a condition, you have to take care of it. Now, I think this is a fantastic argument for removing the stigma involved in being on anti-depressants. However, as far as an argument for whether or not to medicate someone who suffers from depression, it is faulty because it runs on the argument that all depression is biological in nature. I would argue that although it can be based on chemical imbalances in the brain, in many cases there are environmental influences that can only be treated through personal awareneness, psychoanalysis and cognitive therapy.

An example from my own life: Around the time my marriage ended, I sought counselling as, understandably, being not only on my own for the first time in six years, but pregnant and raising a toddler as well, I was understandably not in a good place. Stemming from a life-long tendency towards being hyper-sensitive and quick to upset, it had been suggested by a few loved ones that perhaps I was clinically depressed. From the counsellor I was referred to a psychiatrist for an assessment. Some unknown force smiled on me that day, because the psychiatrist, having done his appraisal, basically looked me in the eye and (in slightly more professional wording) said "I don't think you need medication. Your life sucks right now. Of course you're depressed. Who wouldn't be? If life improves and you still feel like this, then come back and we'll talk about medication."

Guess what? Life improved (with hard work) and so did I. The question of medication hasn't come up since then.

The problem is what is called 'diagnosis based on response to medication'. This is when a doctor (as mentioned in the article, many anti-depressants are prescribed by physicians, not psychiatrists) prescribes an anti-depressant to a patient, and if the patient responds positively to the medication he/she can then say 'well, then I guess it was depression'. But my question is, if an anti-depressant is supposed to even out a chemical imbalance in the brain then what happens if the anti-depressant is prescribed to someone who is not actually clinically depressed, but is simply depressed because they've been dealt a shite hand as of late? Would that not, theoretically, cause an imbalance in an otherwise healthy brain? This also is a situation that I've seen with a friend who was down, and was prescribed meds and shortly after seemed to go a little batshit crazy.

The litany of side-effects that I have heard through literature, as well as through personal anectdotes from friends and family who have experienced going through anti-depressant withdrawal, is all the more reason that diagnosis based on response to medication is such a problematic issue. By playing guessing-games with medication-based therapy, doctors and psychiatrists put patients at risk of a worse situation than they arrived in, especially if the case is where no actual chemical imbalance was present previous to the introduction of medication.

There are definitely people out there who require full-time medication in order to function, and this I do not deny. There are also a subclass who may require medicating in the short-term, if only to bring them to an emotional level that will allow them to deal with their issues through counselling and therapy. I should mention, that I think it's rare that any case of depression can be solved through medication alone. There should generally always, in my humble, non-psychiatrist opinion, be some type of cognitive therapy involved, if at all possible.

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