Different drugs are popular during different decades (e.g., tranquilizers in the 1950s and 1960s). So, clearly a lot of diagnosing and prescribing is based on what’s trendy.
What’s wrong with being trendy? Attaching electrodes to a patient’s brain … a treatment that was trendy for a while and then considered, uh, shocking, has become far more sophisticated lately and is now being used again with reasonably good results. Eventually, prescribing meds will not be considered trendy … probably soon. Something else will come along. I can’t wait to try it. But, I won’t be first in line.
Prescription medicines may help one disease, but throw other things off balance.
That’s true of all “interventions,” natural or pharmaceutical. Of course, by the same token, those interventions can bring a lot of other things into balance. The body does seem to try to maintain some kind of homeostasis and will use all the help it can get.
We are overmedicating our children and it’s going to have catastrophic results.
Throughout history, cultures have tried all sorts of ways to “deal with” kids—from potentially catastrophic tribal rituals to potentially catastrophic 16-hour work days to potentially catastrophic medications to potentially catastrophic denial. Children are always pushing the envelope of consciousness. That’s their job! How we encourage and guide that energy is the most critical creative challenge faced by parents, society, and humanity at large. But, most of all, it’s a challenge for every child. And nothing is going to stop a child from pushing his or her personal envelope.
The body has its own wisdom and can, ultimately, heal itself.
In many cases, that’s true. In many cases, it’s a judgment call. In all cases, it depends on the person, the illness or injury, and many other factors.
It’s important to treat the whole person, not just the symptoms.
You mean you’re going to treat all ±trillion of my cells all at once? Cool.
Antidepressants are actually placebos.
Great! Where can I buy more?
Incidences of mental illness have actually increased since antidepressants were invented.
This is an interesting argument popularized by a recent book called Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. And Robert Whitaker, the author, does an excellent job of making his case, based on one way of evaluating clinical-trial and epidemiological data. But who knows whether the relationship between diseases, drugs, environment, and culture is co-dependent, independent, or coincident? My guess would be all three. Certainly, most people would agree that societal and environmental stresses have increased significantly since antidepressants were invented.
Many people have serious objections to the way pharmaceutical companies do business. They refer to them collectively as “Big Pharma,” and say all they care about is making money. But consider this:
Hundreds of thousands of people work for pharmaceutical companies. Undoubtedly, some of them just want to sell as many of their drugs to as many people as possible. They might as well be selling widgets. But most of them would sincerely like to help cure what ails us. Plus, they have bills to pay and kids to put through college. So they hope their drugs prove more effective than other treatments—whether traditional or complementary. They enthusiastically advertise any scientific or anecdotal report that says so. To medical professionals as well as individuals.
By the same token, hundreds of thousands of people work in the egg industry. Undoubtedly, some of them just want to sell as many eggs as possible. They might as well be selling potato chips. But most of them really think eggs should be part of our diet. Plus, they also have bills to pay and kids to put through college. So they hope their eggs prove to be as good a source of protein as any other food. They enthusiastically advertise any scientific or anecdotal report that says so. To professional nutritionists as well as individuals.
Ditto for people at companies who manufacture nutritional supplements, gluten-free products and (shocking as it may seem) even the family growing organic vegetables down the road. Undoubtedly, some of them just want to sell as many pills, and rice cakes, and organic carrots as possible. They might as well be selling, well, prescription drugs! But most of them really want us to feel good. Plus, they also have bills to pay and kids to put through college. So they hope their products make us feel better than the competition’s and even taste better! They enthusiastically advertise any scientific or anecdotal report that says so. To professionals in complementary therapies as well as to individuals.
Ditto for people working at manufacturers of cars, computers, beer, and so on. Some might as well be selling snake oil. But most of them sincerely want you to enjoy life more, and believe their products might help you do that. They advertise to that effect.
Same with books. Undoubtedly, some writers just want to sell as many of their books as possible. They’d say anything as long someone paid them to say it. But, like most authors, I really hope my book helps you understand more, and/or feel better, and/or just pass a few pleasant hours. Plus, while our daughter graduated from college years ago, we still have bills to pay. So I hope this book does as good a job of talking about mental illness as other similar books … if not better. I will enthusiastically put any reviews that say so in the next edition!
There’s a word for this vast conspiracy. It’s called capitalism. Whenever two or more people are gathered in its name, some people feel better, others feel worse. Some make money, others lose money. Some feel manipulated, others feel empowered.
I have no opinion about capitalism. I do know that no one has ever put a gun to my head and made me take a drug; eat an egg; swallow a multivitamin; bite into an organic carrot; or buy a computer, car, or six-pack of beer.
There’s certainly nothing wrong with letting people know your feelings and opinions about the motives and behavior of pharmaceutical companies, egg producers, organic gardeners, computer makers, and authors of books on mental illness. In fact, let’s get as many perspectives on the table as possible.
But do we really have to demonize each other so much in the process?
Many people also have serious objections to relying on alternative medicine to treat depression. And yet again, for each objection there is a balancing point of view:
It’s hard to design reliable clinical trials for supplements—particularly because the purity of nutritional supplements and amino acids can’t be guaranteed.
There are also variances in the molecular structure of generic drugs versus the original brand names. Some patients notice a significant difference in their effectiveness.
If you feel better from taking herbs or supplements, it’s probably just a placebo effect.
Same deal as with prescription drugs: if they work, all I want to know is, “where can I get more of them placebos?”
The idea that we have some kind of “energetic body” around our physical one is downright weird.
I know, but it’s sure a good explanation for all kinds of other “weird” stuff.
The very idea of Craniosacral therapy is preposterous. It’s a biological impossibility.
Ever had one? Maybe you’d be more open!
Homeopathic remedies are so diluted, there’s no there there.
Millions of people—and thousands of doctors—rely on them more than prescription drugs.
You believe in astrology? Are you crazy?
Well, I think we’ve established that fact. But, remember, it was an astrologer who gave me the most accurate timeline of how my breakdown would progress and, eventually, end.
Throughout history, there’s an interesting kind of synergy between humans and their cures. I wouldn’t be surprised if the notion of treating depression by screwing around with neurotransmitters, receptors, and synapses is eventually considered as archaic as black bile and bloodletting. In the meantime, it seems that anything that proves helpful to anyone is worthy of our consideration and respect.
> One clinical trial is a proof. Two clinical trials is half a proof. And three clinical trials are no proof at all. I’m paraphrasing one of the great philosophers of the twentieth century. Well, he was actually the beloved seventh generation Yankee who owned the orchards that surround my home. That’s how he described managing the teenage boys he hired to pick apples: “One boy is a boy. Two boys is half a boy. And three boys is no boy at all.”
There are articles, dissertations, complex research reports, and entire books—all with countless caveats and footnotes—written about whether antidepressants work. We’re not talking your basic incoherent academic dispute. This has turned into one giant medical cluster f—.
Many experts use clinical trials to prove convincingly that mind medications are effective. According to their studies, meds work about 60% the first time around, with the likelihood of success rising for those who can keep it together enough to try another one or two if necessary.
Others use clinical trials—and often the same ones!—to prove equally convincingly that clinical trials have proved beyond a shadow of a doubt that placebos work just as well as antidepressants.
Even more impressive, there’s now some evidence that the exact same experiments, following exactly the same rules of scientific protocol, can yield significantly different results over time. Makes you want to take two aspirin and call Hippocrates in the morning.
Then there’s the quantum issue. Oh yeah, the quantum issue. The one that says you can’t ever really measure anything because the act of measuring changes the thing being measured. Can we just agree not to mention the quantum issue?
One thing everyone does seem to agree on—although some rather begrudgingly—is that the controversy primarily involves people with mild to moderate depression. Once they see you sobbing uncontrollably in the waiting room, they’re usually willing to let you give drugs a try.
I accept that the occasional scientist will fiddle with results—consciously or subconsciously—based on who’s paying for the research. More important, you don’t have to be Einstein (or Heidegger to be imprecise) to realize that researchers’ conclusions are inevitably influenced to some extent by their own assumptions and conventional wisdom.
William Blake, a guy who knew a thing or two about mental illness, wrote, “What is now proved was once only imagined.” I would add that what many now consider imaginary may one day be proved.
Academic disputes aside, there are several questions that every self-respecting gobbler of antidepressants, antipsychotics, and anti-all-kinds-of-other things will eventually wonder: Why are clinical studies such unreliable predictors of which treatment(s) will help me? Why can a drug/remedy that was perfectly effective for me for many years suddenly stop working? Why can it have an entirely different effect when I start taking it again after stopping for a while? Why should I worry about having an erection for four hours when I can barely get up in the morning?
They are excellent questions. And, since the scientific answers are all over the place, I’ll stick with the philosophical and the commonsensical:
Humans evolve. All the time. Individually. And as a species. So does all of nature. So does the entire universe. Every “subject” in those clinical trials is a swirling mass of energies in constant flux, whose individual complexity can make a mockery of any particular data point.
As I’ve said, we admire the determined fight of someone with cancer who insists on breaking down doors to get into the latest clinical trial, even though the treatment could be more fatal than the disease. Why don’t we equally admire people who will try an antidepressant even if it hasn’t been clinically proven and may also prove to be more fatal than the disease? Why don’t we talk about how they, too, fought a courageous battle with their illness, and tried everything they could in an attempt to ward off an inevitability they felt they couldn’t avoid?
Just askin’.
The real problem is that there’s no quantifiable way to measure depression. Which makes life kind of difficult for traditional data-driven researchers. A psychiatrist can make his own before-and-after observations. And he can ask you the same questions before and after you start or stop a medication. Scientists are also beginning to be able to measure the amount of certain chemicals in your brain that may indicate neurotransmitter level and functioning.
It’s just not the same as with other drugs.
We know what will probably happen if we take an aspirin, smoke tobacco or marijuana, have a glass of wine, or a cup of double espresso. However, we don’t know with anywhere near 100% certainty whether a specific prescription mind med will alleviate our symptoms; fix what ails us; have significant side effects (including death); or work for a day, month, year, or lifetime. There’s an overload of facts, figures, and anecdotal evidence out there.
You can measure whether a blood pressure medication is lowering your blood pressure. You can measure whether a cholesterol medication is lowering your cholesterol levels. You can even measure whether a cancer treatment is reducing a tumor or the number of cancer cells in your blood.
Even with other immeasurable or “subjective” medications there are at least some reasonably reliable indicators. Inhalers do or don’t help you breathe better. Sleep medications either put you to sleep or they don’t. Pain medications either relieve the pain or they don’t. There may be questions about the placebo effect even with these drugs. But, tell that to anyone who’s gasping for breath until they take a shot of their inhaler.
Whatever you decide to do, it is really helpful to have one or more professionals go along for the ride. Maybe if your depression is situational, your psychological immune system can manage to remain intact—the exposed inner “skin” slowly scarring over while your neurons and/or esoteric energetic patterns find other ways to get the job done. As your life improves or at least evens out over time, your moods may improve or even out accordingly.
In cases of clinical mental illness, however, the neural patterns are usually so out of kilter that changes in external circumstances have minimal effect. That’s when it’s probably time to call a professional.
By professional, I mean anyone who has a lot of experience working closely with people suffering from big-time depression or mania. It could be a psychiatrist, psychologist, chiropractor, homeopath … even a psychic or priest. Or any combination of the above. As long as they are open to discussing any possible treatment you’re curious about without making you feel like an idiot; as long as they answer your phone calls when you’re desperate, or at least call you the next morning; and as long as you feel that they are truly committed to your healing … partners, I daresay, in the process.
Fortunately, everyone’s become a little more open-minded. Nobody ever told me that prescription meds were the devil’s work. A few people suggested that natural remedies were better, but even my most rabid vegan, natural-remedy-adherent therapists and friends acknowledged that sometimes medications might be necessary … at least temporarily. By the same token, no conventional medical professional ever gave me a hard time about having some needles stuck in me from time to time.
Still, it can feel weird to tell your psychiatrist that you’re also taking mega B vitamins, SAM-e, tryptophan, and doing full-spectrum light therapy. It can make you squirm to tell your homeopath that you’ve decided to go back on your meds, just when she or he is convinced they finally figured out the right remedy for you.
I’m a big fan of putting your cards on the table. Their opinions and prejudices aren’t your problem. By the same token, they don’t have to agree with what you’re doing. They just need to do their best to understand where you’re coming from and explain the potential risks and rewards as best they can. And you owe it to them to provide as much information as you can before they prescribe anything, natural or otherwise.
I don’t know, for example, if combining acupuncture, herbs, deep tissue massage, and prescription drugs helped trigger my breakdown. For all I know, the combination kept it from being
more severe. I have no regrets. But I know that, at times, by not coming clean, I missed an opportunity to work more openly and closely with my psychiatrist, in a way that might have been helpful to both of us.
The important point is that most professionals—conventional or alternative—don’t have a whole lot of experience in how other therapies might interact with theirs. An herb or pressure point over here is likely to affect a gland or neurotransmitter over there. And vice versa. Same is true for massage, meditation, prayer, illegal drugs, and SSRIs. We’re still in uncharted waters here … and it’s best if we admit it.
Bottom line: It’s a miracle that any one treatment can help more than one person. We’re dealing with more synapses in our brains than we can imagine. Our thoughts, feelings, words, actions, and biology emerge from our distinctly individual history, physiology, genetics, environment, culture, race, color, and creed, as well as our astrological sign, karma, past lives, energetic body, and a host of other factors that aren’t quite so apparent to the naked eye. (You may not believe in those last few. That’s fine. I think that means you’re an empiricist.)
That’s why so many different people are convinced there are so many different “best” ways to treat major depression.
Some people insist natural remedies are better. Others say only pharmaceuticals have been proven effective.
Some people think alternative treatments are weird. Others think that electrical stimulation of deep areas in your brain is weird.
Some people think you’ll get fired if your boss finds out. Others figure your boss will get sued if she or he fires you.
Some people think seeing a psychiatrist is a sign of weakness. Others think it takes courage.
Some people think medications are too expensive. Others think it’s worth begging and borrowing if you have to.
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