Antidepressants in America

Sometimes I stare into space
Tears all over my face
I can’t explain it
Don’t understand it–“(Love Is Like a) Heat Wave,” Holland-Dozier-Holland

I own a Prozac clock, a souvenir of a pharmaceutical company. A friend who never prescribed Prozac (a drug that can cause mania) gave it to me.

Depending on the decade and the literature, taking Prozac (or another antidepressant) can mean: you have major depression or bipolar disorder (modern psychiatry); you are a madman or a madwoman (man on the street or 19th century literature); you have an Oedipal complex or an Electra complex (Freud); you are psychic,  or the only sane person in the room (Laing).

Darkness VisibleDepending on the decade and literature, it can also mean:  Mike Wallace, the great journalist who suffered from major depression; Kaye Gibbons, who is bipolar, the author of Sights Unseen, a novel about a girl coping with a bipolar mother; William Styron, author of Darkness Visible:  A Memoir of Madness, who suffered from major depression; Kay Redfield Jamison, author of An Unquiet Mind:  A Memoir of Moods and Madness, a psychiatrist who suffers from bipolar disorder; and Carrie Fisher, the author of The Best Awful, who suffers from bipolar disorder and used to have addiction problems.

Alex Preston’s recent article in The Guardian, “Does Prozac Help Artists?”, made me think of stories I’ve heard.

I’ve heard about the time you went manic on Prozac and couldn’t stop running around your neighborhood singing “Heat Wave.”  I’ve heard about the time you didn’t take your antidepressants and couldn’t leave your apartment for a month.  I know you never slept before you took antidepressants.  I know you lost your job.  I know you were homeless for a while. I know you finally got back on track (or didn’t).

No one likes to take psychiatric drugs– Zoloft/Seroquel/Prozac/Lexapro/Wellbutrin/Lithium/Depakote–but they can alleviate the symptoms.  There are different levels of  depression and bipolar disorder:  some feel very down for a while but get better on their own, others plunge into such a catatonic darkness they need medication; some spend a few dollars too much if hypomanic, but if manic try to buy a multi-million-dollar Lamborghini Reventon on a spree.  Studies show that psychotherapy and drugs are the best treatment for these biological brain disorders.    But many people do not have these options.

antidepressant_medications_signAccording to the National Institute for Mental Health, depression is the major cause of medical disability in the U.S. and Canada and accounts for 10 percent of all medical disability.  The data indicate that antidepressants are both overprescribed and underprescribed:  The Centers for Disease Control say that 11 percent of Americans aged 12 and older say they take antidepressants, yet 80 percent of antidepressants are prescribed by doctors who are not psychiatrists   (they have only a two-week residency in psychiatry in their training). Only twenty percent are prescribed by psychiatrists, who have the training to diagnose these illnesses.   But  large numbers of people go untreated because they do not want to go to a psychiatrist, or because there are no mental health facilities in their area:  great portions of the prairies and plains have few doctors.

Alex Preston’s rambling article in The Guardian is both good and bad.  Writing about depression is as difficult as it is to write about poststructuralism,  the 1970s, or some other subject with an abstruse lingo.  He is a novelist who took drugs in his teens, and spent his 20s on antidepressants (SSRIs), even though his GP at the unvierity told him to quit.  In London, he managed to find a pharmacy that would sell him antidepressants over the counter. The antidepressants blocked his creativity:   he finally got off the drugs and wrote two books.  Here is my problem with this story:  if the doctor did not recommend  the SSRI drugs, what did he need?  Did he need them at all?

The '90s memoir for the young.

The ’90s memoir for the young.

He summarizes various books and memoirs about depression, including some by Americans.  He writes favorably of the wildly out-of-date Listening to Prozac by psychiatrist Peter Kramer (1993),  and then attacks Elizabeth Wurtzel’s  Prozac Nation (1994), a kind of youth classic of depression, which he says “has not aged well – it is stuck in the 90s, po-faced and narcissistic. It lacks the note of authenticity that characterises the best books about mental illness.” (She also wrote a book on getting addicted to Ritalin, so I think we can see she has authentic difficulties,)

Of David Foster Wallace, he writes that he went off Nardil (which is not an SSRI) but  remained blocked “and, as his friend Jonathan Franzen put it, ‘when his hope for fiction died, after years of struggle with the new novel, there was no other way out but death’.”

He interviews some writers, artists, and musicians, including his brother, about the effect of Prozac and other SSRIs on their work,r.  Some say they have been hurt by SSRIs and got off them, others say they have been helped. Will Self, the author of Umbrella , had problems with addiction and was prescribed an SSRI.  He says, “Heroin, cocaine, marijuana and alcohol were really the drugs that ended up fucking my creativity; the Seroxat was just a way station on the escape ramp to abstinence.”

Mike Wallace

Mike Wallace

Whether to take drugs or not for depression can be an individual decision.  It can, however, be a necessity. One of the most articulate persons on the subject of depression and pills was the late Mike Wallace. He wrote for Guideposts:

Like most people, I’d had days when I felt blue and it took more of an effort than usual to get through the things I had to do.

But I always snapped out of it….

So my down times invariably passed. Until the fall of 1984, that is, when I found myself suddenly struck, then overwhelmed, by something—an emptiness, a helplessness, an emotional and physical collapse—I’d never experienced before.

Wallace, who attempted suicide, spent a week in the hospital.  The psychiatrist treated him with antidepressants and therapy.  The medication worked, but when he went off the pills, he fell into another major depression.  The antidepressants were necessary for him.

Let’s hope the National Institute for Mental Health gets money for research for better antidepressants.

5 thoughts on “Antidepressants in America

  1. These are important issues, and it is a sad that so many people go untreated, or are given the wrong pills. Artists have side effects, yes, the rest of us, too.

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  2. I’m dealing with an older sister right now whose bipolar condition went unacknowledged and untreated for most of her life. She started taking meds in her early 60s, after some initial difficulty accepting the diagnosis, but badly, and now, in her late 60s, after two involuntary committments since mid-March and a bunch of other stuff I won’t go into, it turns out the bipolar’s been masking just how advanced a case of Alzheimer’s she’s got going on as well. Plus, the state of North Carolina says she gets too much Social Security to qualify for Medicaid! Whee! And did I mention I’m the only family she has left? And I live 80 miles away? And she hangs up on me when I call?

    It took until late April before I could get power of attorney from her and she turned on me and started trying to get it back within days since she’s so paranoid and delusional. The hospital rep thinks a lot of this may be coming from the Alzheimer’s, not the bipolar, but who knows? I got a social worker added on as having co-power of attorney just yesterday who’s been assessing her and is going to assist in finding a nursing facility for her, but she says her problems are so unique, it’s going to be hard.

    Anyway, there ought to be more books written about mental health issues in late life, I think.

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  3. Antoinette, absolutely! The NIMH needs to do more research.

    Susan, what a sad story. I hadn’t thought about these conditions in late life, and you’re right, someone should write about it. She probably hates the pills, and the Alzheimer’s must be terrible, too. Two hospitalizations! Awful! And how can the state not give her Medicaid? I do feel for you. It is a huge responsibility: bad when you’re so far away, and you have your own family, too. The U.S. does not take good care of people with these illnesses.

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  4. I was just released from a psychiatric ward at a General Hospital. It was a voluntary commitment for depression but mainly for suicidal thoughts. The stay wasn’t too helpful. I have spent many years in psychotherapy and taken many different meds including currently Prozac, lamictal, Seroquel and klonopin. I am also an older woman (75) and it really is discouraging to have this happen after all my efforts and at my age.

    I couldn’t tell by your message whether you wrote about the topic because you had suffered from depression yourself or that mental problems and/medications were of interest to you. In any case, thanks for writing this message as it’s time to bring this problem out of the closet.

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  5. Kay, I am so sorry to hear about your hospitalization. I know these places are awful, and I’m glad it was voluntary. I hope your suicidal thoughts are gone. Too many good people have these illnesses. The medications–well, they have no money to develop new ones–are given to everybody, whether they have depression, bipolar, or even something like leukemia. Sometimes they work, sometimes they don’t.

    Please feel better! I know the 11 percent of people with these illnesses.

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