Barbelith Underground > Conversation > Barbeloids on medication

Always meant to return to this thread. Apologies for what may seem like a rather disparate and disjointed summary of points I'd like to address/explore:

One of the problems inherent in an entity like depression (for which objective diagnostic 'lab' investigations are essentially non-existent) is the fact that many individuals not only make the diagnosis themselves ("no, doctor, I'm definitely depressed") but have very specific views on what has caused their current bout of 'illness'. They're often quite correct, of course, particularly where immediate situational stressors are concerned, but nonetheless it's notable that most people are much more ready to accept a neutral pseudoscientific explanation (faulty "brain chemistry") than a need to review certain aspects of their lives (job, relationship, alcohol/recreational drug consumption, etc., etc.) The tentative suggestion that more distant personal events/background might have relevance to current mood is almost always rejected outright. Johnny O said:

Therapy, or at least talking to a psychiatrist, didn't help much, because I knew what the problem was, but I couldn't make my brain produce the chemicals I wanted.

More often than not, past experiences do play a part in depression: not as crudely as 'self-harming means childhood abuse' (although this is often the case; it's an understandable link to make) but in subtly shaping the ways we handle stress and the familiar situations we recreate. There's an implicit belief - among doctors and the population in general - that the simple realisation of something's likely cause (eg. I unconsciously fall into abusive relationships because my father was abusive) is enough to dispel the problem. This is not the case, and Fridge is quite right to emphasise the need to proceed with a view to changing the offending behaviour, not merely understanding its genesis.

Iszabelle described antidepressants as "heavy artillery" and I'm not sure exactly how true this is. I've harboured the creeping suspicion, over the last few years, that the 'biochemically antidepressant' aspect of antidepressants is much slighter than we generally think, compared to the sedative, anxiolytic and placebo elements. I certainly wouldn't describe them as Big Guns, and tend rarely to sell their benefits as anything more than 'this should help with your sleep and appetite and will hopefully lift your mood to the point where you're more able to address problems X and Y'. As Fridge says, they really need to be viewed as an adjunct to a more general approach - either a specifically problem-solving therapy (such as CBT) or, at the very least, an undertaking to look at possible environmental and/or personality stressors.

Down in the Head Shop's 'Christianity' thread, Zadok writes:

You're so numbed out on your medication that you don't feel your soul anymore. You can at least feel pain when you're depressed. Depression is a very strong emotion. When the valleys are low the peaks are often higher. When you're on drugs you're just so fucking content and mediocre that you can't feel strong pleasure and pain anymore.

I'd argue that someone who's clinically depressed has no 'peaks' and cannot feel pleasure at all. This aside, the existential view of depression (that some degree of suffering is essential to provide life's 'shading') is interesting in its seeming antithesis to the 'suffering = depression = 'illness' = must be cured' standpoint...

Fridge (who I seem to be quoting endlessly here) advances the view that the advent of supposedly all-curative psychotropic drugs encourages a culture of remaining in psychologically stressful situations longer because one has 'pharmaceutical support'. This is certainly one of my potential concerns when I'm called upon to prescribe an antidepressant for some who appears to be unhappy as a result of their immediate environment (shitty job, relationship, etc.): in supplying a pharmacological 'solution' (and a quite possibly not-that-effective pharmacological solution) I worry that I'm helping that person procrastinate in terms of actually addressing their problems. They focus instead on "brain chemistry" and whether or not the drug's effective - when their energies might be better directed into finding another job/partner/whatever. Sometimes the addition of an antidepressant 'medicalises' the situation to a degree that is counterproductive for all concerned...

Bleh.

Anyway, I'd be interested in your thoughts on the above, people.