The Pharmaceutical Rabbit Hole

Q: How do you know you’re depressed?

A: Someone gives you antidepressants.

Does that sound right? Part of my story is the long term use of psychotropic drugs. I’ve been on SNRI’s, SSRI’s, antipsychotics, methylphenidate, and some others that don’t fit into neat categories. I’ve been on them in combinations and for varying lengths of time and doses. I’ve been on some of them more than once and some in doses that were ridiculously high. I’ve done a lot of reading about these drugs, and I’ve experienced their effects, their “side effects,” and their withdrawal effects. In my journey I’ve run across lots of people who rail against these drugs and accuse the people who develop and sell them of being evil and interested in making money from the pain of others. You have to remember when you read things like that it’s because the drugs didn’t work in their case; if the drugs worked for those people, they’d have the opposite opinion.

The problems I have with psychotropic medicines aren’t that someone tried to create a pill that would fix depression; if you really know what depression is and what it does to people, it is noble to pursue a cure. I don’t mind people making money from the things they produce either. What are they supposed to do? Work for free? People have to pay their bills! The problems I have are different. They are more about my opening Q and A.

The first doctor to prescribe me an antidepressant was my General Practitioner. I was having issues with fatigue, brain fog, and stamina. I was also going through a hard time of transition in career and with my kids leaving home. I’d done a bunch of tests (I will write more about the medical system in another post) and they all came back negative. By the medical yard stick I was “fine.” Only I was not fine. Frustrating. So one day, after reading out the results of all the latest tests, my doc pulls out a pad and writes me a prescription. It was for something I’d never heard of before: Effexor. “Let’s try this,” he says. I feel pretty bad so I don’t ask questions, I just go and fill the prescription and pop the pill. This may sound incredible, but I don’t believe I knew I was taking an antidepressant. I’m an American. When things are broken we fix them. When we feel pain we take a pill and it stops. I wasn’t too curious about how it worked, or why the doc wanted me to take it. He was the expert and I wanted a solution. As I said in a previous post; when the pain is bad enough you’ll try anything to get it to stop.

I don’t know what your first experience with psychotropic medicine was. I hear many different stories. Some of us may have been put on meds before we were old enough to have a say in the decision, others got prescribed like I did by a GP, still others sought out psychological help and this is where they started with the drugs. One thing I do know is this: whoever gave you a psychotropic medicine did not know how it would work. And it stands to reason if they didn’t know how it would work, they didn’t know if it would work. The truth is that when a psychotropic medicine works, it was at best an educated guess; a shot in the dark. I will tell you what my GP said when I went back to him a couple of weeks after I started taking Effexor. By then I knew it was an antidepressant and I was concerned and confused. Maybe you can relate. I took a low “loading dose” to begin (these drugs require titration to get them into your body when you start taking them and out of your body if you stop) and in the first two days I felt an immediate improvement. It was like my brain snapped back to its normal pattern. I had been dizzy and fuzzy and tired, but I had a lifting of the grey cloud. One of the things I distinctly remember was the way my vision changed. There was a literal clearing of my eyesight. I had not even known that my sight was dim. I’ve since come to associate what I call “the lift” – times when I am aware of the release from depression – with clarity in my eyesight. I asked the doc why an antidepressant made me feel better when I wasn’t depressed. He said my body didn’t make the distinction between depression and non-depression, it just responded to a drug that met a need and we didn’t have to worry about what we called it.

That’s my problem with psychotropic drugs, right there. Why do they work? Nobody knows. Why do they get prescribed? People who feel bad want to stop feeling bad and people who want to help them can’t find anything wrong with them. This is hard to imagine in other areas of medicine, but it is the common place story for people like me, who don’t have a problem that has a root detectable with any modern medical tests.

Imagine telling a cardiologist your heart hurts all the time. Their response is doing all the tests they can do, and, finding nothing, offering you a drug they don’t understand and only guess might make your heart stop hurting. Now add the fact the drug they give you has potentially serious and permanent side effects, will take, on average, a minimum of 6-8 weeks to show any benefit, has significant withdrawal issues, and may damage your heart. Now imagine going back to the cardiologist in two months and telling them you don’t feel any better and maybe a little worse. They advise you to take a higher dose of the drug that’s not working and come back in another two months. When you do that and it isn’t getting better, they tell you to quit that drug and start a second drug which is also a substance that they don’t understand and are only guessing if it will work. You start over again, hopeful that your aching heart will feel better. Good news! This time after 6 weeks you notice a slight improvement, but…your sex drive is in neutral and you’ve gained ten pounds. No worries, the doc says, we will start you on a second drug that should knock down the weight gain and possibly a third drug to get your sex drive out of neutral. You had a painful heart to begin with, now you have sexual issues and weight issues to go with the heart issue. Congratulations, you’ve fallen down the pharmaceutical rabbit hole.

Do you know the side effect most often reported for psychotropic medicines? Depression. In the speed reader portion of commercials for the latest and greatest pill, just listen. You’ll hear it. May cause depression. Having fallen down the pharmaceutical rabbit hole myself I want to give you some advice. This is for you if you have treatment resistant depression or long term “treatable” depression, and for those of you who love someone who is dealing with this problem. For the purposes of this advice I’m going to assume you’ve been on (or you currently take) meds that don’t work or meds that give questionable improvements.

1. Be willing to imagine yourself healed without meds. This sounds pretty simple, but if you’re down the rabbit hole, especially if, like me, you’ve had a period of relief with one of these drugs but now nothing works, it gets hard to believe there is another way. The nature of the pharmaceutical rabbit hole is to trap us in a one dimensional way of thinking. Meds worked, therefore I am depressed/anxious, therefore I need meds. There is an almost endless progression of “new” psychotropic meds with claims to effectiveness. Each cycle of trying a new drug with a slightly different operating mechanism eats up time (=life) and money (=life) and keeps us from looking at other paths to healing. If you can’t imagine yourself without meds, ask someone to help you believe it; to believe it for you until you can. I will believe it for you. I have believed it and I’m living it. I’m no different from you.

2. Don’t accept marginal improvement as a reason to keep taking meds. The way most of these meds effect us is, generally speaking, a dulling of our personality. We become less ourselves. We lose a lot of what makes us unique people. We also lose motivation. The rabbit hole becomes the pain we know and we are timid about the pain we don’t know. We can become convinced we can’t be better. We can be better. Give yourself permission to be better; to feel better than just “not horrible.” You are worth it. Your full self is valuable and needed. Hard to believe? It can be. If I can help you to know this it will be a great point gained.

3. Make a plan to get off meds. I am not telling you to get off meds if they work for you. But if they did, you probably wouldn’t be reading this. Some psychotropic meds are very difficult to leave behind. All require us to make a plan. There are lots of horror stories of people doing very bad things when they stop taking psychotropic meds too quickly or take them irregularly. The trouble with mood altering meds is that they are mind altering meds. We may not be good judges of how we are doing when we take them or stop taking them. It isn’t helpful that some drug manufacturers distort or minimize the truly harsh effects of withdrawal from their drugs. And we don’t have to be on a drug for very long to experience significant withdrawal problems. The first time I got off of Effexor it was horrible. I was told the drug would be fully out of my system in about a month. I set out to grind through the withdrawals and get to that mark. But it didn’t get better a one month, then two. All the “experts” said this couldn’t be withdrawals because the half life of the drug was short enough that it was all gone. I felt the way I felt and that’s all I know. It was bad, and there were lots of testimonies from others about the same thing. I gave up and went back to the drug not because it helped my depression, but because it had created a dependency I couldn’t ignore. Not all the meds are like this, but many are, and none should be dropped casually. Make a plan. Get help. Make it into your work; your job. It’s a hard job. Give yourself a break. If you are walking through it with someone help them make space to rest a lot. Tell people what you are doing and ask them to support you. If you fail to get off the meds the first time, don’t think you can never try again. You will learn things by the first attempt that you can apply to the next try. Go easy on yourself. Those voices in our head that call us failures are not us and they are not our friends.

4. Make your own decisions and be your own advocate. People are risk averse and mental health professionals are not an exception. They all have caseloads and pressures of their own. They try to help their clients but they usually have too many to be fully engaged with one.

5. Give up on the speed solution.