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A small portion of the population can benefit from anti-depressants


I’m disappointed that your column today seems to advocate long term use of anti-depressants. I am of the opinion that the multibillion dollar drug industry is chemically lobotomizing people. Ten years ago, I decided I must have depression and went to a psychiatrist who I ended up considering a glorified pill pusher. Over the course of a year and a half, I tried four or five of the leading anti-depressants. I hated them. They flattened out my emotional response to a point where I didn’t feel depressed or anxious — in fact, I felt nothing very deeply at all. I was not drinking or smoking, by the way. While I had short periods of “lift” from these drugs, I hate the feeling of being “not me.” While severely suicidal depressed individuals may benefit from short-term use of these chemicals, I was taken aback by your comparison of depression to diabetes and your call for people to accept it as a life sentence requiring drugs. Big Pharma is not our friend, Steven.

— K.L., Las Vegas

I’ll be nominating you, K.L., for the 2013 Human Matters Emily Litella Award.

No, seriously, you’re disappointed in what my column “seems” to be doing. But, come with me and give me a chance to say again what my column is actually doing. Then, if you’re still disappointed, I’ll concede.

The first thing my column does is stand incredulous before the sheer number of people reporting/experiencing symptoms of depression. I say again, I don’t believe our ancestors experienced the same proportion of depressive symptoms. Pure speculation on my part, but still.

Then the column wonders aloud about possible explanations for this phenomenon. Crisis of meaning, for example. An increasingly vacuous culture, with significant evidence of devolution. Or, perhaps depression/depressive episodes is in part provoked by the emotional self-absorption of moderns – the observable, inexplicable delay of real emotional conversance and maturity in modern people.

Then I listed the diagnostic symptoms of depression. We OK so far?

Then I begin to describe the distinctions between populations experiencing these symptoms. For example, depression is not the same as sadness, though people in the first weeks of acute bereavement exhibit symptoms virtually identical to people accurately diagnosed as depressed. If it helps you to know, I am often frustrated by the way the mental health industry moves too often too quickly to “lobotomize” grief.

The first population of depressed patients I described is Jane or John Anybody. Meaning, even ordinarily mentally healthy people can, given sufficient trauma, meaningless, loss and futility, experience depressive episodes. Twice in my own life I have taken anti-depressants. Once for a year. Once for eight months. Life came crashing down, and I just couldn’t pull myself out of the hole. I was so glad the medicine was there. It helped.

I spoke of addicts. Addicts seeking sobriety/recovery are regularly helped by six to 24 months or so of anti-depressants. A significant part of most addiction is an attempt to soothe unhappy brains.

And then I spoke of one, very specific population of depressed patients. These people are, we believe, BORN with brains that chronically underperforming when it comes to stabilizing healthy brain chemistry … the same way that some people are BORN with underperforming pancreases (diabetes!)

K.L., I did not advocate for long-term use of anti-depressants … except for that particular population of patients that NEEDS long-term use of anti-depressants!

You didn’t ask, but my opinion is this paradox: I think the depression is, at once, under-diagnosed (in part because of negative social stigma) AND misdiagnosed. And, when diagnosed, I think depression is often treated … sloppily. One size fits all. We are, indeed, an overly medicated society.

When a patient describes the experience you describe, I wince. Finding the right medicine at the right dose is a true art. I keep a short list of those artists in my professional pocket. In the hands of a competent doctor (someone with the extended training to know what medicine and what dose), you hardly know you’re taking it. What you do know is that now there is a blessed “space” between thinking and feeling. You still have all your feelings, but now you have regained the ability to THINK about what you are feeling.

For the record, I share your deep ambivalence about “Big Pharma.” Have you read “Listening to Prosac,” by Peter D. Kramer? It’s a terrific examination of how psycho-pharmaceuticals have changed culture – for good and for ill.

So: still disappointed?

Thanks for reading, K.L., and for taking the time to write.Steven Kalas is a behavioral health consultant and counselor at Las Vegas Psychiatry and the author of “Human Matters: Wise and Witty Counsel on Relationships, Parenting, Grief and Doing the Right Thing” (Stephens Press). His columns also appear on Sundays in the Las Vegas Review-Journal. Contact him at 702-227-4165 or skalas@reviewjournal.com.