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
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). 😉