Have Meds Not Moved the Needle Enough?

Researchers believe that prescribed medications play a key role in the treatment of mental illness. They can reduce symptoms and prevent relapses of a psychiatric disorder.

I don’t remember when Prozac hit the market because I was a child in 1987. But from what I’ve read, it was a hallelujah moment; a turning point; a triumph of great magnitude. The prescriptions started flowing like honey. My dad started taking it. And when I turned 16, I did too.

Over the years I’ve been prescribed all the SSRIs (selective serotonin reuptake inhibitors), taking them individually and in various combinations. As a class of drugs, they haven’t done the trick for me, which landed me in the ‘treatment-resistant‘ bucket. But since we can’t measure things that don’t happen, I imagine I’ve benefited, maybe significantly.

Now I’m reading publications that suggest it’s the SSRIs and not me; studies show they just don’t work very well. In his book Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions, Johann Hari dismantles the orthodoxy surrounding anti-depressant medication and even more mind blowingly, the idea that depression stems from a chemical imbalance in the brain. Let’s pause here and let that supposition settle in – I, like many millions of Americans, may have been imbibing strong drugs that the medical profession tells us mitigate the symptoms of an organic brain disease, which may not exist.

I was shattered by this thought because, like many of us who battle mood disorders, I keep hope alive that a yet to be tried, effective cocktail exists that will one day make me feel a whole lot better. Dismissing my strongly felt belief that psychiatric medication plays an essential role in the treatment of depression requires nothing less than a shift in worldview. The implications are far reaching—I would no longer be able to blame my condition on a problem with my brain. If my pain is entirely environmental and a result of experiences I had no control over in early life, I would also feel disempowered in my psychotherapeutic work. Why keep talking endlessly about a past whose mark has been made permanently?

Or maybe not—maybe I have more control. I’ve always known that my depression surfaced and then continued to thrive, like an unruly house plant, because of circumstances in my family. I was also especially vulnerable to clinical sadness because of a lifelong shyness that colored all my interactions with the world, starting at the tender age of 3 or 4. Now in adulthood, I captain my own ship, which doesn’t mean I’ve always steered myself in the right direction, but with experience my navigational instincts are becoming more self assured.

Hari points to the isolated nature of modern society as a primary driver of depression and I echo this sentiment. There are ways we can combat societal alienation but it will take intentional, forceful action. America in the year 2018 is rife with “lost connections”.

When I venture outside of my apartment in New York, it is highly unlikely I’ll enjoy eye contact from my fellow inhabitants, let alone a friendly conversation, so I pull out my smartphone just like everyone else. People in my office text and use messaging apps to communicate while we work in the same room. Single people and families live in apartments quite literally on top of each other but the most meaningful contact I have is with the doorman, who now feels like a friend.

If we accept that loneliness and alienation are the true root causes of depression, how does this fight against a structural enemy take shape? The battlefield changes for one thing; we move from private work done in hushed doctor’s offices to the public square, which these days exists online. so that’s where I started building my community. When I created this website for people struggling with depression to share our stories, I instantly activated a potent source of communal validation. Peer to peer exchanges feed a different stomach than the support I get from a therapist.

Another weapon involves participating in the lives of our communities, which brings to mind that late 90s bestseller Tuesdays with Morrie: “love each other or perish” is Morrie’s favorite line by poet W. H. Auden. I’ve been expressing that love these days by volunteering for a senate campaign. For the first time have met neighbors I knew existed but didn’t dare talk to.

And let’s not forget support groups. Find your local NAMI chapter and link up with other people fighting similar battles. Force yourself to get together with a friend in person, preferably not over alcohol at a loud bar.

The list goes on. Sometimes I’m too depressed to do any of these things. That’s just fine. But knowing the nature of our enemy is vital to healing. If Hari is truly on to something, it is time to reframe the battle against depression as one against isolation and not a sick brain.

I say let’s incorporate the battle against loneliness into the treatment of depression without throwing the baby out with the bath water. As we know more about the brain through further research and innovations in brain scans, our views on mental illness will evolve significantly. And so will we.

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