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.