Depression and emotional history

A new study suggests that long-term use of anti-depressants could actually cause chronic depression when you stop taking the drugs.  But it’s yet more talk of “chemical imbalances”, nobody stopping to think hey, maybe depression has a purpose.

Let me start with some positioning.  The study is published in Frontiers in Evolutionary Psychiatry.  (Yeeee-hawww!) Not to put too fine a point on it, you have to be pretty fucking out there before evolutionary psychiatry considers you a cowboy.   Evo psy- is the justificatory structure of choice for people who want truthy explanations of why men rape and whites have higher IQ scores.

This has nothing to do with this particular study — I mainly just wanted to register that I’m not an evo psych fanboy.

But.  In the past two decades, the dominant narrative about depression has been that it’s an illness caused by an imbalance of chemicals in the brain.

Maybe it’s caused by some psychic insult such as a breakup or bereavement, or maybe you’re born with it because your parents are both depressives, too;  in that narrative, actual cause of depression doesn’t matter. You take pills that increase the kind of chemicals you’re low on, and voilà, your mood improves.

I took anti-depressants for a couple of years in my mid-twenties. I was financially under pressure, had some extremely heavy emotional shit to deal with, and one of my parents lived with major league depression all through my teen years.  It was the perfect storm of distress and unhappiness.

During that time, SSRI ‘worked’ only briefly, as an emotional anaesthetic; after a few months of use, they washed all the emotion out of my life, including the good ones.  They didn’t lift my mood, at all, but it was a huge relief to take a break from the heavy stuff.

The one drug that really did lift my mood, I took for a year — a year in which I failed all my subjects at university, because it messed with my sleep patterns, memory formation and concentration span.

During this time, I was going to a really good clinic here in Melbourne; although private, they get a lot closer to the ideal of primary health care than most community health centres.  But I never saw the same GP twice, and I was never referred for counselling, or psychiatric consultation.

As a result of the chemical imbalance narrative, depression is now understood as simple enough for a GP to treat with a prescription, monitoring only for unwelcome side effects which might prompt a change of medication.

So when I failed all my subjects, yet another GP switched me over to Zoloft.

Predictably, I gained weight and lost all my sex drive, but these were a problem because I’d begun a relationship. My partner was strong enough to tell me: “I need you to get your shit together”. I ditched the Zoloft.

This is the part where the Hollywood movie of my life cues up a montage of Daniel getting shit done.  I’m tearing up just thinking about it.

It didn’t happen.

What actually happened was my partner, my friends and colleagues helped me back into the world of paid work and the land of the living, creating peace and quiet in which I could face and address the reasons for my depression.

We all live with an emotional history, not all of it our own.

There’s a growing acknowledgement that depression may be functional: it’s a state of mind in which we can obsess over and analyse our current situation and all the shitty stuff leading up to it.

Joyful emotions that might distract us are ruthlessly muted, and so are the normal processes of discounting and excuse-making that normally serve to protect our ego from rational scrutiny.

It is a deeply unpleasant place to be in, and there’s no question you can get stuck there and sick of it — which is where an SSRI ‘holiday’ can be a lifesaver.

The report in Frontiers in Evo Psych (Andrews et al, 2011) describes an ‘oppositional tolerance’ it claims the brain develops, where it adapts neurochemically to the presence of the anti-depressant, producing less of the neurochemical targeted in order to maintain homeostasis.

This is almost certainly true — it’s the reason why withdrawing from anti-depressants is such a miserable experience — but explaining it in these terms is completely missing the point.

For one thing, it’s just more of the same chemical imbalance talk that led us to see SSRI as a miracle cure in the first place. And secondly, it fails to ask the question evolutionary psychology is meant to ask: does the brain adjust in this way to maintain a function served by depression?

I learnt about this study via a write-up by a journalist in Psychology Today, Robert Whitaker, who’s written one of the many books castigating big pharma for its role in creating an epidemic of depression in the American people.

He knows the PR and marketing origins of the chemical imbalance narrative, yet he still can’t wean himself from it, not even when critiquing it; indeed, that was its point: it’s a story that’s easy enough for journalists to sell tell.

Whitaker and the studies and experts quoted in his article use all the same tactics as the problem they critique: slap a diagnostic label on it, in this case ‘tardive dysphoria’, and offer the chemical imbalance explanation plus homeostasis (which everyone remembers from highschool biology class).

They don’t even have the cultural smarts to listen to their own word choices. They adapt their diagnostic label by analogy from ‘tardive dyskinesia’ — a delayed-onset condition that sometimes results from anti-psychotic medication.

Yet there’s no delay involved in their condition; it simply results from the withdrawal of the medication. The question they failed to ask is: does long-term anti-depressant use delay a reckoning with the reasons for depression?

That matters, because delay (along with confusion, sleep deprivation, reduced memory formation and concentration span) will affect your ability to dig up and process the emotional history that depression evolved to help you address.

The hardest kind of history to address is the one you can’t remember.

In one side of my family there is an emotional history of helpless rage. From what I can tell, it spans three generations. I could say it started with my maternal grandfather, a violent and abusive alcoholic, but that would be 100% artefactual, a conclusion from convenience rather than evidence, because I don’t know his own story.

It is incredibly difficult to deal with, because I learned it deeply and I can recognise its appearances in my life,  yet have no memory of how it came to be and thus no way of fitting it within a story and making sense of it.  When I first took the law subject, Trauma and Psychoanalysis, I would walk out of class crippled by grief that sprang from no ‘traumatic’ event (in my own life at least).

That was the year that I failed all my subjects.  I couldn’t write about what I was realising, and I couldn’t write about anything else, either.

I don’t know what filled my grandfather with rage against his family.  I don’t know why my mother laid her own emotional history on my shoulders when I was too young to bear it, but at least that grief has an explanation behind it. And in recognising my own rage, I am learning to forgive it in her, and reconnect.

Six years have passed, and depression is now an occasional thing in my life, rather than a constant reality. That boyfriend eventually dragged me, kicking and screaming, into couples counselling, which led to family counselling with my mother. Our relationship ended for good reasons, and I moved on to a new job, and eventually a new relationship, and began making long-term plans again (notwithstanding the smoking wreckage of my academic transcript). 😉

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17 thoughts on “Depression and emotional history

  1. Thanks for the considered, and pain-evoking, post.

    IIRC some wit said depression is anger without enthusiasm.

    Which doesn’t help much when you’re in ‘it’ cos where do you find the energy to direct at the target of the anger, or the knowledge to know what the target is anyway?

    But the anger aspect directs attention to your question of purpose, or at least ‘point’.

    And in a sense there is no point other than recognition and acceptance.

    That’s not an easy call at all.

    It challenges our sense of agency. We may feel it diminishes us (at least I’ve felt that, and I’ve been in and out of ‘it’ for some time and my resort to anaesthetics has provided short-term relief at the expense of the kinds of costs you’ve listed).

    • I think this is dead right. Oftentimes to feel better what I needed to do was just name and acknowledge what I was feeling, and endlessly rehearsing and analysing the anger was just a massive distraction from that.

  2. There being the doctors (minority) whom try tell the patient that
    drugs given for depression in main totally worthless / in making
    matters worse they can leave the individual ( via side effects of
    the drugs ) with a variety of physical problems/ some so serious
    they are life threatning. // Thus says the (GOOD) doctor. I don’t
    wish to prescibe drugs that will only cause you harm / drugs that
    in truth worthless in treating depression /having bad side effects.

    Unfortunatly many patients don’t hear the (GOOD) doctor / they
    are one minded in getting relief from their state of mind..All they
    hear is the doctor is refusing them drugs / drugs which could be
    their cure ( they totally believing cure in a pill) thus they give the
    doctor a hard time // till the doctor seeing the situation pointless
    the patient will not listen to sense /thus the doctor /// little choice
    writes out an prescription for drugs/ he /she / knows is worthless.

    Drug companies having a yearly turnover of $billions gained in
    selling mind drugs/ where knowing / as in their having no worth.

    It similar with religions // many organizations having a turnover
    yearly of $billions / promising a heavenly paradise beyond the
    clouds // the sad truth /// in reality they are but lying fraudsters.

    I will write an further comment on such the cause of depression
    as how best deal with it. At moment needs attend other matters.

  3. Looking at the research on treatment options, it seems mild to moderate depression is best dealt with via the ‘talking cure’.

    Deep depression can benefit from a window provided by meds but that’s just an opportunity, not a cure.

    Yes, if you go and see your local GP, s/he will typically resort to either of the two std options in biomedicine, drugs or the knife.

    Which might be fine if ‘mental illness’ were an organ defect, but clearly it’s not (pace Szasz).

    btw, in my post above I said ‘point’; better would be ‘meaning’.

    • Thanks! Yes, I quite liked Kirsch’s argument that side effects from active drugs are part of their therapeutic benefit; I am much less interested in the resulting “are the effects real or fake” debate. There’s a discussion of this issue bubbling away on Twitter and various people are getting outraged about being “misled” — which in his roundabout way is what WWallace’s comment above is questioning.

  4. Thanks Daniel! Always interesting reading your posts. I’ve tried quitting my SSRI several times (usually by letting the prescription lapse and being too lazy to get it re-filled), and even though I don’t think its doing much for me any more, stopping is so dreadful I don’t want to face it. An unpleasant bind that I’ve so far been unwilling to search for a way out of. Your story is inspiring.

    • I’ve done that and it’s not pleasant! I think the official strategy involves ‘stepping down’ the dosage. Dan Ariely’s research into pain suggests smaller levels over a longer time period is optimal, but there’s some added unpleasantness with SSRI withdrawal – an existential dimension that ripping off a bandage just doesn’t have.

  5. Thanks so much for your post.
    I was on antidepressants (Dothep) for a short time in my twenties, and I am on them again now (Aropax) in my mid-thirties, and have been using them for over a year. Last year I was so anxious I thought my heart was going to shatter. There were some very concrete, real world factors contributing to this state, but I couldn’t find resolutions for them because I was so depressed.

    What I really like about SSRIs is that I just feel publicly confident and can get my shit done without angsting over anything. I feel clear-headed about my ideas and decisions. What I don’t like is that the drug makes me act like a robot when I’m confronted with other people’s emotions (especially my partner’s). I’ve also gained about 15 kilos…and that makes me feel depressed in spite of the drugs because I can only fit into relax-o-pants and I am waking up with muscular pain every day.

    When I was little my parents referred to me as ‘the sensitive one’. Since my teens I have lived with depression and I’ve managed it fine, more-or-less, with dancing and occasional bouts of therapy. I considered my depression, anxiety, self-criticism and tendencies towards perfectionism to be just part of who I am. With Aropax, it feels exactly like I’ve taken a holiday from my emotions/true self and now I don’t want the anxiety to come flooding back. That is the thing that is really terrifying me now as I contemplate coming off them.

    • That’s what it felt for me, too. When I stopped taking Zoloft, I had about three months of counselling. It helped reduce my anxiety by knowing I had an appointment this week or next. I saw a social work-trained counsellor, so it was about helping me sort out what wasn’t working in my life. The other thing that helped was the ANU Moodgym website, which helps users to identify some particular habits of thinking that can lead to low mood and anxiety. It’s not an easy path you’re walking but I hope you’ll find a way through it.

  6. A t-shirt that I saw at a gig over 20 years ago remains burnt into my memory. It said, “I’d rather feel bad than feel nothing at all.”

    For as long as I’ve been aware of it, I’ve been trying to work out if the depression and anxiety I feel are a natural response and/or defence to the world around me, or some kind of condition. I’m hesitant to see a doctor about it because I don’t want to seem like I’m just chasing some feelgood pills.

    I’ve seen people on weird doses of anti-depressants and it prompted to to tell my dearest, “Whatever happens, please don’t let them do that to me.” I keep coming back to that t-shirt.

    • If you’re in Australia, under the Better Access program there’s now an option for your GP to refer you to a psychologist (or social worker–I think) for up to 8 sessions of counselling per year. Some people are really paralysed by depression and that’s when medication is definitely needed, but it’s not like a miracle cure; it’s more the alternative is worse than the side-effects. If you’re doing okay at living with it but you’d like to know if you can do better, I’d probably suggest trying something like MoodGYM (web-based CBT) or counselling first.

  7. Thank you for this piece. It was very interesting, informative and moving. Having tried anti depressants a few years ago, it made me feel like a ‘zombie’..like I had no feelings about anything. I hated it. When I slowly came off them I remember laughing for the first time in 6 months, so hard I couldn’t breath. THAT is what makes me never want to take medication for my feelings ever again.
    Now I have been going to counselling and have in the past 12 months learnt so much about why I am an ‘anxious personality’ and what helped me become depressed. I was functioning but down on myself and trying to be something I wasn’t ( ie perfect) in all my relationships.
    The first hurdle was getting rid of my mother in law from my life. I was given ‘permission’ (after 39 years) to have no further contact with this toxic person who has a personality disorder but who was making me ‘sick’.
    The second hurdle was to learn to ‘forgive’ myself for the feelings of ‘mistakes’ I made as a mother with my three children.
    The third helpful thing was the validation my phsyc gave me that my life was ‘shit’ and that I have done pretty damn good considering.

    I suggest that that ‘break’ from the depression that meds can give is indeed helpful and is even more efficacious if combined ( as you slowly come down off them) with psychological counselling.

    Pity that the Govt has decided the 16-18 sessions was too many a year and has now cut back to 10 the number you can get with a referral from your GP.
    Like others, when I know I am going to my psych I feel a sense of relief that I will have ‘work’ to do.
    Last week I said; I have been so depressed for two weeks but became angry. She said; Anger can mean you are finally realising what it is that has caused you to become depressed this time. Kind of like it ‘unblocked’ something so I could work on it.

    Thank you all for your comments as well. So helpful.

    • Good stuff Abbie. Bye bye MiL! (it’s said that depression can be catching). Feeling anger can as you say unblock some things. And there are ways of using that energy.

      I think the new MBS rebate is for 2 sets of 5 sessions with a psychologist. At a guess the 2nd set would have to be authorised by the GP on advice from the psych.

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