Penny-Arcade TV on chronic anxiety and antidepressants
penny-arcade.com
penny-arcade.com
I would not recommend this life to one who can avoid it. This was my private hell and I would not return there willingly. It did not eliminate my despair. Just me more dull and numb to it.
But maybe you are not like me.
http://www.alternet.org/health/146659/are_prozac_and_other_p...
I'm not bipolar, and I've had a manic (or, much more likely, hypomanic) reaction to a vitamin (when I stopped using it, I was fine, but had done a few really moronic things up to that point). It happens, and aggressive diagnosis is not the solution.
Also, I think the efficacy of SSRIs is still quite questionable. I'd love for someone who really understands the statistics and medical scales to do the comparison and tell us their opinion about Lexapro vs Placebo for depression or anxiety disorders.
Note that Lexapro is the drug they're advocating, which is an SSRI, but there are plenty of other anxiety drugs (like any benzo) which are clearly effective.
I had a bout of crippling panic attacks in the spring of 2008. I lost my job because of this (I was a trader at a hedge fund). I had about 30 attacks in the first 3 months.
It was obvious from the 3rd or 4th day on Lexapro that the drug was doing something: I had some mildly annoying but harmless side effects in the first week or two-- sweating, "the yawns", tiredness, and weird visuals when going to sleep.
After about a week on the SSRI, I began to have a panic attack while in the park and something weird happened-- the attack just ended after 5 seconds, and I felt no worse than if I'd been startled by a loud sound. The attacks became milder and more manageable. Now I have about one per month-- unpleasant, but not something that'd make me unemployable-- but none at any level of severity approaching what I had before I started taking the drug.
Some of this improvement is due to lifestyle changes and increasing skill at handling the problem, but a large fraction of the improvement is directly attributable to Lexapro.
As laypeople, we readily recognise the social and cognitive basis of much of what is called mental illness. We clearly see that when our friends are overworked and in debt, they become anxious. We see people lose their job and become depressed. Anecdotally, I struggle to recall a single instance of anyone I know experiencing significant distress with no clear social or cognitive reason.
As part of the medicalisation of our thoughts and emotions, we seem to have discarded the notion that we personally can change how we feel, by changing how we think and the way we live our lives. We have no model for how to think about our emotions in the broader context of our lives without involving someone with a certificate and a nice office.
To me it seems absurd that much of the medical establishment would regard the unhappiness a recently bereaved person as a chemical imbalance or a symptom of illness, but there are no shortage of references to the use of anti-depressants to treat "bereavement related depression".
I can't speak for anything beyond my own experience, but I have been diagnosed with a catalogue of mental illnesses by a variety of highly trained professionals. It turned out that my life was just really crappy and I needed to sort myself out. I felt hopeless because I really didn't have any reason to hope. I lacked energy because I had nothing to do. I felt nervous and restless because I was living in a shitty set of circumstances. A few significant but simple changes to my lifestyle and mindset suceeded where endless "treatment" failed.
It occurs to me that it is possible that we are treating symptoms without addressing causes. We rarely treat physical pain with painkillers alone, but usually act to resolve the cause of the pain wherever possible. It seems illogical to me that someone can become depressed as a result of a specific event in their lives, be prescribed antidepressants and continue to take those drugs for many months or years, without anyone thinking to address the issue that precipitated the negative thoughts and feelings in the first place.
I suggest that those advocating SSRIs as a cureall for anxiety and depression take a closer look at the recent metastudies into their efficacy. From the largest and most recent (JAMA. 2010;303:47-53):
""The magnitude of benefit of antidepressant medication compared with placebo ... may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.""
For all but the most severe depression, SSRIs are less effective than sunbathing or jogging. Given the quite substantial risk of side effects, especially amongst the young, I can't help but be dismayed at how widespread SSRI use is.
Looking at the healthcare debate in the US, the elephant in the room is that USians consume vastly more medicine than anyone else in the world but see no real improvement in their health as a consequence. From my perspective as a cynical Brit, USians seem to have an almost mystical faith in the power of medicine and seem to have medicalised a dizzying array of things which most of the rest of the world does not consider disease. British dentistry is often the butt of jokes amongst USians and considered substandard, but in fact it is of a very high quality. The difference is that British dental standards are based on function rather than aesthetics. We tend to perceive American dentistry as being vain and neurotic, the maxillofacial equivalent of spinning rims. What we would consider artificially straight and white, many USians would consider the lower bound of normal.
USians are literally bankrupting themselves on healthcare spending, but live shorter lives than Cubans, who spend 1/25th what USians do but lead healthier lifestyles. The United States has the world's highest rate of incapacity due to mental illness and the fastest growth in the rate of mental illness, despite prescribing more psychiatric medications than anywhere else in the world. I invite the reader to draw their own conclusions.
It doesn't seem so absurd when you realize that they make a lot of money that way.
I agree with your post though. The marketing agencies for drug companies want you to feel as though being uncomfortable for any amount of time means something is wrong with you. It doesn't help that (in the United States at least) there is a very large consumer culture which is based around an intellectually-unhealthy ideal, which, I think, makes people deeply unhappy. Thus, when people realize what is wrong with the world around them, they feel extremely uncomfortable and are quickly herded into the category of "mentally ill" rather than being allowed to face what is troubling them. Depression is very much a fad disorder, like ADHD and Asperger's syndrome (much to the dismay of people who suffer from them legitimately, no doubt).
Reminds me of a quote, "The serotonin theory of depression is comparable to the masturbatory theory of insanity." -David Healy
There is a difference between clinical depression (pathology) and misery, which is often a result of bad circumstances, and even in a bad situation there's no benefit or justification being depressed per se, but that distinction is mainly clinical. A lot of people are miserable for circumstantial reasons, and no amount of medication can fix that (without damaging the person's mind). If you give an appropriate dose of an antidepressant to a person who is in the sort of horrible circumstances that are common for the US poor, you might stop the panic attacks and crippling depressions, but you still have a person who's likely to be miserable.
We do, of course, overdiagnose mental illness in the US. I know an eccentric but essentially normal person who was committed as a prank (Manhattan rich kids are the sort of sick fucks who would find this funny) and ended up in a mental hospital for 3 weeks (which is illegal, because you can only be held for 72 hours, and that only if you're in a state that represents direct danger to yourself or others). He was placed on all sorts of inappropriate medications, lost his job, and had more mental problems after the ordeal than before it. This sort of thing has more to do with our culture than with the drugs themselves.
I also want to mention while on the topic of drugs that exercise another potent drug. Someone in a previous thread was downmodded (probably due to his tone) when they brought it up, and I just want to voice that while it's not a fix all solution, it can be used to help too.
Citations:
Exercise is an Effective Antidepressant http://mentalhealth.about.com/cs/mindandbody/a/exercisedep.h...
Sunlight / Vitamin D and depression http://newfoundlandnews.blogspot.com/2008/01/sadness-seasona...
The drugs work for a lot of people, although it's essential to make lifestyle changes (exercise, sun, healthy diet) in addition to using them... but the people who are in the worst shape can't muster the energy to get out of depression until they start taking the drugs.
Anti-depressants are pretty amazing-- far from a panacea, but pretty effective.
Last summer I had my first panic attack.
Saying that, I wonder how many people who say "I had a panic attack" have ever experienced a full on, face on the floor, depersonalizing / derealizing panic attack.
It felt like I was losing my mind.
$250,000 in debt, followed by the disillusion of an 8 year relationship, loss of a job, and a move across the country in a three month period. Chase that with years of outright poverty (earning less than $10,000 [net] over the course of two years.)
7 days of Xanax and the wounds inflicted by three years of prolonged anxiety began to heal.
I probably would have killed myself if it weren't for the seven tiny pills that let me keep coding.
My company launches in about two months.
[not my real account]
The worst part was the month during which I thought it was a physical medical condition, and the absolutely rotten quality of treatment I got in many cases. One example was (during the worst attack I ever had) a 7-hour ER wait, including 6 hours locked up in the psych ER, without being told why this was happening. Once I was able to see a doctor (1 doctor on staff for the whole psych ER) he was able to explain what was happening and why, but even then, all he could prescribe was Buspar, which doesn't do anything for panic.
My experience is that the attacks don't go away entirely, but they become rarer and much more manageable. The depersonalizing attacks that feel like bad drug trips don't happen anymore for me (and stopped happening once I got appropriate medicine) because once I get to a 4 or 5 (heart racing, painful muscle tension, inability to concentrate) on the panic scale I can get it under control, taking a benzo if necessary.
Luckily, I have my anxiety in check now that it has a name, but, I've seen too many discarded people laying on hospitals floors with sheets over their faces.
My current girlfriend is a third year in med school, I've begged her to ask the other med students to be especially kind to the patients during their psych rotations.
To compound the badness of the situation, I went to the nearest ER, and I was living in Brooklyn at the time-- in a nice neighborhood, but 1 mile from serious ghetto territory. So the hospital was in the ghetto. Bad idea.
The waiting room was about 10 by 10, with six chairs and twice as many patients. Even if you were self-admitted, like me-- actually, I didn't even want to go, but a girl I was dating thought I should-- you couldn't leave. It was 6:00 pm on a Monday and there was one doctor on staff. By the way, Monday afternoons in the spring are the busiest time in the busiest season for psychiatric ERs, so there's literally no excuse for there having only been one doctor on staff.
The TV was extremely loud-- probably 90 decibels-- and some of the shows that played were rather violent. Since 2/3 of the patients were obviously there for anxiety-related problems, this was clearly a bad choice.
You had to ask the nurses to use the bathroom, and if you pissed them off, they'd threaten to bump you to the bottom of the list. Since I was "compliant" and got out in 7 hours, I can't imagine how long the waits are for the people who were uncontrollable.
Be careful not to line yourself up for another fall. It sounds like you take your trials too much to heart and need to learn to make a bit of distance between what is genuinely important and 'worldly' successes.
I mean, just take care and don't get sucked into thinking your new venture is everything.
That doesn't imply drugs are the wrong treatment. Maybe circumstances like the ones you experience are like accidents that break things. If some treatment can help the healing, why not. It just seems dangerous to assume that one can not live without the drugs forever after.
Anxious people tend to be more prone to panic attacks. A panic attack usually begins with a benign biological malfunction (misfiring of adrenal gland, slight breathing irregularity set off by allergies) that would otherwise be mild and possibly ignored, but if it launches a feedback loop of negative and anxious thoughts, it can become panic.
So the cause is, in part, biological. That doesn't mean that cognitive-behavior therapy in addition to drugs isn't usually a good idea.
Not saying that there can not be biological causes (malfunctioning nerves/brain/whatever), but it doesn't exclude the possibility of "logical" causes.
That doesn't mean you should barf a "Vit D good" information packet on every story about depression, though. Without taking the time to add context, it looks rude and dismissive.
Americans put such a high value on privacy to the point of isolation. I believe that that isolation allows psychological problems to come to the surface when they would otherwise not. Part of that is loneliness, part is the built in need to conform to a group's social dynamic which includes not acting crazy. Your behavior has a strong influence on your psychological state, so acting normal and happy can help regulate your moods.
Not to imply that this is a cure either. Including meds, these are all just treatments and they may work better for some than for others.
I've noticed this too. In addition to increasing cognitive load, stuff also tends to accumulate emotional baggage over time. (E.g., when your towels remind you of your ex-gf or whatever.) Just going through the house and throwing stuff out every couple years is profoundly therapeutic.