Tuesday, July 25, 2006

Beating Depression for Good

From breakdown to breakthrough

A number of people have been very upset with me for suggesting a life without antidepressants. I’ve been accused of not being qualified to have an opinion on the subject.

My response is the same response I gave when I was in advertising school and I was accused of having no advertising experience. “I’ve been a consumer my whole life. I’ve been on the receiving end of advertising for more than two decades. I think I’m qualified to have a few ideas of what works and what doesn’t.” In the same way I’ve experienced depression and suicidal people around me for more than two decades.

On Saturday night I went to see someone who used to train with myself and a squad of other swimmers, every day, summer and winter, year after year after year. In the twenty years since we swam together, almost all the swimmers have become doctors. With a gulp I realized that I seem to be the underachiever amongst our group.

She educated herself at Cambridge and is currently living with her German husband in Houston. She’s a doctor of psychopathology, which emphasizes the mental diseases that are associated with depression.

That’s an important distinction. Depression is a common, curable disorder, but mania, bipolar disorder, schizophrenia etc are a lot more troublesome and difficult to treat. They’re associated with genetic triggers she tells me, and may take root irrespective of environmental or behavioral patterns.

I spoke to her about my experiences of depression. I’ve read extensively on the subject, but it’s quite correct to accuse me of not being an educated specialist on the subject. I suggested the following:

In ordinary depression, you don’t just wake up one day with a chemical imbalance. A lot of depressed people seem to think that the imbalance ‘just happens’ and chemicals are needed to reverse it. It’s more realistic, I suggested, that behaviour patterns, the (high sugar content) food we habitually eat, the bad habits we develop over time, negative destructive thinking, just cycle after cycle of negative behaviour, negative responses (when we can choose how to respond to reality) – all these add up to an eventually depressed person suffering from low serotonin levels in the brain. While the depressed person will blame depression (as if it were some exterior illness), there’s no acknowledgement of the behaviour (or lack of) that leads to depression.

I find this lack of accountability disturbing. It’s upsetting, because it’s delusional when you behave your way into a sickness, then blame the sickness for your symptoms. I believe even when we suffer from a common cold, in large part we are responsible for getting sick. Did we allow ourselves to become sleep deprived? Did we maintain a healthy diet, and allow ourselves plenty of rest and relaxation despite work pressures?

The chances are, a lot of the reason we suffer from colds and flu are a result of our not taking adequate care of ourselves. Depression is no different. We’re responsible for mental health too, and failure to control our behaviour can lead to a break down. This includes undisciplined thinking, undisciplined eating and a failure to exercise. In layman’s terms – becoming lazy and excessively self indulgent. So if these behaviours bring us to depression, and all we do is take chemicals to produce pleasurable (happy) reactions in our brains, it’s unlikely that the depression will ever lift because the behaviour that perpetuates depression remains.
Of course, anyone happy to be depressed-and-taking-antidepressants (now there’s a contrast in terms) doesn’t need to change their behaviour, but it’s irrational not to. I asked Dr Sharp: “Wouldn’t a logical course of action be to reverse all those behaviours that lead to depression? In other words, behave yourself happy. Exercise, control your thoughts, develop an affirming attitude and identity, and control your appetites. In short: redeveloping discipline. Recreating good habits.”

Dr Sharp agreed. What was interesting was that all these behaviors were useful in mental diseases like mania, but, she said, someone suffering from a genetically triggered mental disease simply cannot function consistently without medication. I didn’t know that. She said that exercise is one of the best ways to behave your way back to happiness. But exercise alone is not going to be enough for people with advanced mental disease. Ordinary depression yes, schizophrenia or mania, no.

There’s another kind of depression too that is not inherited, and is serious. It’s the sort of depression that occurs as a result of extreme trauma. I asked Dr Sharp if a doctor could prescribe antidepressants as a lifelong sentence for someone young, but suffering from severe trauma. Imagine having survived a car accident but seeing your sister die in your arms. Imagine the pain of the original event being revisited time and again in over 16 surgeries to reconstruct your face. Imagine revisiting the accident over and over again when you realize your body has been too damaged for you to do sport (at school) like everyone else. Unhappily, the list goes on.

In this case, Dr Sharp said, behaviour (including healthy diet and exercise) is essential but incomplete. If the goal is to be weaned away from antidepressants, a person needs extensive psychotherapy, which is expensive, in addition to antidepressants. It’s likely to be a long road, but with perseverance, a whole person can emerge, healed and whole, on the other end.
We live in a culture of short cuts, quick fixes and false appearances. The idea that taking pills will make us happy is an offshoot of another culture, the culture of taking recreational chemicals purely for the purpose of feeling happy. So it’s not such a long walk to wonder why people expect, when they feel depressed, that they can just swallow some chemical laden pills and they’ll get through their days and hours feeling less moody and gloomy.

The good news is that antidepressants are an alternative, a window of release. For those with the will to go the Pinocchio road (wanting to become real, fully fledged, fully functioning human beings again, capable of enjoying the taste of food, able to have and enjoy sex, able to concentrate and listen, able to sleep soundly), the good news is we can behave our way to happiness. And for those of us who are happy, we have an idea now how to stay happy.

Incidentally, everyone we know in that swimming squad of twenty years ago, still swim, including Dr Sharp.

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