Misconceptions about Antidepressants

What do you think are the most common misconceptions about antidepressants?

Prozac Monologues: A Voice from the Edge is at the press kit stage with Q&A in development. My publicist wants me to answer questions that interviewers might ask. My responses should be in the three to seven sentence range, she says.

Three to seven sentences are not my forte. I am doing my best and taking comfort that in an interview format, there might be a follow-up when I can say more.

They are good questions and worth a blog series, I think, where I can expand to three to seven paragraphs. Mostly seven. Maybe more. Plus, you know, pictures. So that's what you get for a few weeks.

No, antidepressants are not happy pills

Nor do they change your personality. It's depression that does that. Having depression is like getting cast in concrete. You don't notice it at first, but slowly it sets, locking your thoughts, your emotions, your movement in place.


Okay, so it looks like there's a lot of movement in a hamster wheel. It may feel like your brain doesn't stop. But it doesn't really get anywhere, does it.

People for whom antidepressants work (that's not everybody who takes them, but that's another post...) say, I feel like myself again. Your self may not be happy. In fact, your self might be a jerk. But antidepressants get you off that hamster wheel so you can feel your feelings, the whole range of feelings. My therapist used to call it all eighty-eight keys, referring to the full keyboard of a piano. On antidepressants you can think clearly again, get out of that negativity loop that keeps confirming your hopeless/helplessness. On antidepressants you can make choices again -- you know, therapy might help with that jerk-thing.

No, antidepressants don't "fix a chemical imbalance"

Oh, I know that's what you were told. Zoloft sold a lot of ADs with its cute little cartoon that took an overly-simple idea and turned it into a heartwarming sales pitch.

The chemical imbalance thing was an early hypothesis, trying to figure out how antidepressants work. One problem with the hypothesis is that they take so long to work, four to six weeks usually. If you just need more serotonin in your synapses, (check out Zoloft's video) then why don't you feel better in a couple days, as soon as the "balance" is restored?

Nowadays scientists think the synapses are not where the action is anyway. But it is fixed in the public imagination as the fault-free explanation for depression and why you shouldn't be ashamed for having to take medicine.

Dr. Ronald Pies has written several articles about this controversial phrase, the problems with it, and a better, albeit longer, discussion of the causes of depression. Try Doctor, Is My Mood Disorder Due to a Chemical Imbalance? if you'd like to know more.

Do Antidepressants T(h)reat(en) Depressives?

Well, that issue is complicated. Zolt├ín Rihmer and Hagop Akiskal wrote this cleverly titled article on the subject that gave fits to the design people for my book. (The computer program kept thinking that t(h)reat(en) was more than one word.) But I digress...

The bottom line is, if you truly have unipolar depression, then antidepressants are the thing for you. They save lives of severely depressed people.

On the other hand, if you have a bit of unrecognized bipolarity, and it doesn't have to be the screaming wild recognizable mania of the movies, then antidepressants can create what are called "mixed states," the misery of depression combined with the agitation, insomnia, irritability, increased suicidal ideation and maybe a dash of impulsivity of mania or hypomania. You want to die and you have the energy to do something about it. That's a dangerous, sometimes deadly combination. Most people who attempt suicide do so while experiencing mixed states.

Those terrible side effects that give you pause usually happen to those of us with unrecognized bipolarity. If doctors did a better job of diagnosis, then we wouldn't get what are for us the death pills, the effectiveness rate of antidepressants (which now hovers just a tick above the effectiveness rate of placebo) would rise, and antidepressants would get cleared of the charges against them.

That's my story and I'm sticking to it.

What to do about antidepressants

Before you pop those pills for whatever diagnosis, check out these screening tools: the Mood Disorder Questionnaire and the Bipolar Spectrum Diagnostic Scale. If you are taking antidepressants and it's not going well, check out those screening tools. If they give you an all clear, then happy day! Or, happy day to come... If they raise further questions...

I'm over my seven paragraph limit. Further questions will be next week's post.

photo by author
gif from giphy.com
cartoon from depirrogarrone.com
flair from Facebook.com

Trauma, COVID-19, and Cutting Yourself Some Slack

Are you failing to build your abs while social distancing?
Or learn that new language?
Or clean out that closet (you know which one)?

Are you utterly exhausted while getting nothing done and beating yourself up for it?

STOP. Just stop.
And read on.

You are experiencing trauma, a deeply distressing and disturbing experience. How's that to describe a pandemic, "deeply distressing and disturbing experience"? Your experience does't have to be unique or worse than anybody else's for you to have genuine feelings about all this, nor for you to take care of yourself.

SAMHSA is a federal organization, the Substance Abuse and Mental Health Services Administration. Now those words may have nothing to do with you generally. But they produce materials that are helpful to all of us in this weird universe to which we all have been transported by the deeply distressing and disturbing experience called COVID-19.

The following are excerpts from Trauma-Informed Care in Behavioral Health Services, one of their resources.

Trauma affects your body, your thinking, your emotions, your sense of self, your soul. Here are some of the consequences of trauma (your results may vary):

Immediate Emotional Reactions:

  • Numbness and detachment
  • Anxiety or severe fear
  • Guilt (including survivor guilt)
  • Exhilaration as a result of surviving
  • Anger
  • Sadness
  • Helplessness
  • Feeling unreal; depersonalization (e.g., feeling as if you are watching yourself)
  • Disorientation
  • Feeling out of control
  • Denial
  • Constriction of feelings
  • Feeling overwhelmed

Immediate Physical Reactions:

  • Nausea and/or gastrointestinal distress
  • Sweating or shivering
  • Faintness
  • Muscle tremors or uncontrollable shaking
  • Elevated heartbeat, respiration, and blood pressure
  • Extreme fatigue or exhaustion
  • Greater startle responses
  • Depersonalization

Immediate Cognitive Reactions:

  • Difficulty concentrating
  • Rumination or racing thoughts (e.g., replaying the traumatic event over and over again)
  • Distortion of time and space (e.g., traumatic event may be perceived as if it was happening in slow motion, or a few seconds can be perceived as minutes)
  • Memory problems (e.g., not being able to recall important aspects of the trauma)
  • Strong identification with victims

Any of these sound familiar? I'm getting hit with anger, sadness, GI distress, faintness, extreme fatigue, difficulty concentrating, rumination. And time, what day is this? What about you?

These are not good circumstances for undertaking ambitious schemes of self improvement. If you can, great. Go for it. You may have a plan that channels any of these reactions into something positive. There's a lot of banana bread being baked right this very minute, so much that they are writing articles about its psychological benefits.

But if you are stuck in a "should" storm, it's time to cut yourself some slack. You are not alone, as this article about 17 Totally Normal Things to Feel Right Now will demonstrate.

Things will get better. Well, I don't know about the universe. Me, I am expecting the whole show to go over a cliff and us with it. But we will get better. We will adapt to whatever this new world will dish up. We really will.

These also are consequences of trauma, what resilient people do eventually:

  • Increased bonding with family and community.
  • Redefined or increased sense of purpose and meaning.
  • Increased commitment to a personal mission.
  • Revised priorities.
  • Increased charitable giving and volunteerism.

So take a deep breath, drink some water, stretch and get whatever exercise you can, once you can, enjoy your banana bread. Move on when you are ready. You'll be okay, even if you have banana bread abs and don't speak French.

logo in the public domain

Frazzled Cafe and Ruby Wax - Yes, I am a Fan

Ruby Wax is the founder of Frazzled Cafe, a peer support group for anyone who is overwhelmed by the stresses of modern life. As Ruby says, our brains just don't have the bandwidth. If that describes you, check it out. But bring your own coffee. The meetings moved online, a Zoom meeting on account of... you know.

Ruby is an American-born long time television personality in Britain and comedienne whose career pivoted when mental illness caught up with her. She went back to school to study the brain and got a masters from Oxford on mindfulness based therapy. Since then she has written books, toured, lectured, using her prodigious brain and her comic chops to entertain and educate about brain health.

So I'm not the only one whose career pivoted to brain nerd in response to the question, What the hell happened here? and then makes that information available to the general public using humor and plain English. Ruby's was one of my most coveted and not-secured blurbs for Prozac Monologues: A Voice from the Edge. I could spend a lot of time ruminating about that. But in the video below, she teaches me how not to.

The following was first published in April 2014. If you want more, here is another post with another video. Can you tell I'm a fan?

How to Tame Your Mind -- Ruby Wax

It's like training a dragon, only harder.

Ruby Wax nails depression: when your personality leaves town, and suddenly you are filled with cement.

She nails the problem: our brains don't have the bandwidth for the 21st century. Nobody's brain does. Yours doesn't, either.

And she nails the solution: learning how to apply the brakes.

photo of coffee cups from frazzledcafe.org/
photo of Ruby Wax used under the creative commons license

The End of Miracles - A Review

What is it like to have depression with psychotic features?

What is a day like inside a psych ward?

What is the psychiatrist thinking?

Sometimes the best way to explore questions like these is in a story. So here is Prozac Monologues' first review of a novel.

Monica Starkman is a psychiatrist at the University of Michigan whose expertise includes psychosomatic disorders, stress, and women's issues around fertility, miscarriage, and obstetrics. In her debut novel, The End of Miracles, she turns her clinical experience to the story of one woman, Margo Kerber, a long-infertile woman who finally conceives, tragically miscarries, and then... unravels.

Covid-19 and Coping - The Humor Version

So, we've all been coping as best we can. My best varies from hour to hour, as I imagine yours does too. And if you have hung around Prozac Monologues for long, you know that humor is one of my go-to tools. It takes a different shape, depending on the topic and the need. This is my Covid-19 version, the gentler one.

Of course, some things have not changed for me. You might say, I am in my zone.

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