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Why we’re afraid of antidepressants – even when we take them

Steven Hughes For The Globe And

In the wake of Robin Williams's death, we have seen an incredible outpouring of compassion for those who suffer from depression. Suicide, so often met with accusations of selfishness, has instead been met with empathy – with an understanding that it's the result of unthinkable pain.

I want to feel hopeful that this new ethos of tolerance will last, and will encourage those afflicted to get the help they need and deserve. But deep down I fear it won't.

We are still suspicious of both mental illness and how it's treated. We might accept the idea of depression in celebrities, in our social circles, even in our friends – but surely we ourselves are stronger than that. Talk therapy, maybe. But aren't antidepressants for the weak or unstable, the truly sick?

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I understand these biases because I suffer from depression and I hold them too.

I wasn't 'that' depressed

My first real experience with depression was in my early 20s, a typical age for onset. I had an old-school psychotherapist who did not believe in medication. Depression, he said, is a sign that unconscious material is attempting to break free. It is a good sign that we are ready to heal. To medicate away your symptoms would be a kind of cruelty.

And he was right. I learned more about myself in those two years of therapy than I had in my entire life until then. I learned – I hadn't known! – about the way in which the unacknowledged within us has a way of running the show. I learned that to experience a feeling fully was the only way to release it.

I still believe these things. I know them to be true, because my depression passed. I experienced a long period of peace and ease – I published books, I enjoyed my life. Then the next dark spell hit. I hoped it was just plain old sadness. It was not. This pattern repeated several more times. Was each episode worse? It is so hard to be objective. To be depressed is to be swallowed by a fog. I can say with certainty that each episode made it very painful to be alive.

Still I resisted medication. I didn't want to banish my darkness at the expense of the rest of my personality – my insight, my authenticity, my sense of myself as an artist. And the fact that I was depressed did not line up with how I perceived myself, with how my life was supposed to be.

My fear is not only personal, but cultural. There's been a backlash against antidepressants since Prozac Nation came out in 1994. Part of our skepticism is about whether Big Pharma has our health at stake or just their profit. Part of our skepticism is about whether antidepressants actually work. These are valid concerns: According to a report in 2012, 42.6 million prescriptions for antidepressants were filled in Canada that year (our population is not quite 35 million).

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But there's a deeper fear, too, that pills are a kind of cheating, a lazy way to deal with a problem, and that they will muffle our true or "essential" selves.

I spoke with Dr. David Goldbloom, senior medical adviser and staff psychiatrist at the Centre for Addiction and Mental Health, who called this the "Frankenstein fear" of antidepressants. "This is the fear that medication will change me into something I am not, never was and don't want to be," he told me. "In my experience, most people who benefit from antidepressants feel more connected to, or more able to express and enjoy, their essential selves."

That would be nice.

But still I doubted. I wanted others who suffered to get treatment – of course! – but was I really a good candidate? For me, the episodic nature of the illness means that when I am in the darkness it is hard to remember anything else exists, but when I am well I wonder if I'm making the whole thing up. I have such a good life. I have a family who loves me, financial stability, success in my career.

But depression, as Dr. Goldbloom told me, is not a logical reaction to external circumstances. My new memoir Between Gods is about the ways in which it can be inherited, like a family heirloom passed down the generations. Trauma, and its legacy, are very real. But so is brain chemistry, and despite the new research about the incredible plasticity of our brains, to a certain extent you get what you get.

Is this cheating?

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Last fall, amidst a confluence of difficult personal events, I went to see my doctor. "Is there anything else I can try?" I asked.

"You're in therapy?"

I nodded.

"Exercise works. But for it to have a statistically significant impact you have to exercise every single day."

Scratch that.

So I took a prescription and went to the pharmacy. After years of hesitation, the weight of my suffering all at once seemed heavier than the weight of all my doubts combined. Even so, I confess I thought of it as a kind of caving in, and my body's reaction to the drugs seemed like some bizarre punishment. For three days, I didn't move from bed. I had every side effect – intense nausea, no appetite, dry mouth, dizziness – but the real sensation was of being buried alive.

In this way it was not so different from what I was trying to cure.

I was, as it turned out, having an "abnormal constellation of side effects." My doctor wanted to switch me to a different drug.

Was that wise? Maybe it was a sign I should not be on any drugs at all.

She looked at me with the kindest eyes. "I'm just worried about how you felt before," she said.

The second drug muffled things in a way both pleasing and worrying. I was used to my feelings being like a chainsaw inside me. The jagged teeth tearing through my organs. Now I had some distance. I thought of the pain in my life. A sensation began in my body. But where a wave of grief and tears would normally have overtaken me, now it was thwarted. It rose in my chest and shivered along my shoulders, like goose bumps. Then it subsided. A wave that did not crest.

I was grateful, for I knew the cresting would hurt. I was terrified, for the cresting would bring me relief.

Was this how normal people experienced emotion? It was so different from what I was used to. It was so good. It was so disconcerting.

I thought about a whole society on these medications, a nation of citizens lulled into permanent remove.

I talked to Andrew Solomon, the author of The Noonday Demon: An Atlas of Depression. Mr. Solomon is on antidepressants himself, which he speaks about in his hugely popular and moving TED Talks.

Isn't there something lost in taking drugs? I asked him.

"A great deal would be lost if we had medication that eliminated sadness," he said. "We need sadness to have our basic human experiences of love and connectedness. I would not want to lose that. Antidepressants deal with a lack of vitality: the shift for me was that I stopped being depressed and overwhelmed by having to take a shower. Now I am sad about Gaza, about planes being shot down in the Ukraine. One can hold onto those things even when taking the medication."

Mr. Solomon suggests that we are constantly altering ourselves – with sleep, exercise, our eating habits – and that taking antidepressants isn't somehow bizarrely different from all these other things we do.

But wasn't depression natural? I asked him.

Tooth decay is natural, he said, but nobody advocates against fluoride.

Zing!

Exactly who you are

The drugs worked for me. They took a while to kick in, but once they did I passed several months in the winter – usually my worst time – without the same degree of existential dread. I still felt sad, but that matched up with my life's circumstances, and I was able to function, to be a good parent, to work. I felt so much better that I thought the episode had run its course. Spring arrived. I had been on the drugs for six months. I didn't want to be on them any longer than necessary.

I lowered the dose and then went off the antidepressants entirely. But it turned out I had underestimated the degree to which the medication was shielding me from myself. By which I mean to say, the drugs had succeeded in replicating the feeling of an "authentic self" so even I believed it.

Four days later, I started to cry. The tears leaked out of me like some noxious substance my body was expelling. It was a cry without contents, a chemical cry, but that did not remove the potency. On the contrary.

I told my small daughter that tears were good, tears clean you out.

"Stop it Mama," she said, swiping at my cheeks. "Stop it."

Andrew Solomon told me, "People somehow think taking antidepressants is like losing your virginity; you'll never be able to be your old self again. But my experience is if you don't like the way you've changed, then you can stop taking them and go back to exactly as you were."

Indeed.

Buddhism says every moment is new; we do not know what will happen tomorrow. But the past has a way of predicting the future. I find myself caught between these poles, leaving room for a different story, trying to not become entrenched in the idea of being depressed, while also being realistic about that eventuality.

I still don't know whether I will go back on the medication. Despite how well it worked, my niggle about it remains. Depression is not logical. It is animal, and vicious. It is like being held down by your throat in two feet of water – you can see the surface, the air, but you cannot get there. I know it will pass. I know, each time, that if I can make it through the month, or six months, or year, I will feel better.

On the other hand, that's still a year I will have lost.

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