This is a post about depression. You’ll notice how I highlight this upfront, in the title. This is deliberate; a sort of disclaimer, if you will. It tells you right away that the content of the story that follows is not going to be pretty. It warns off anyone coming here for a nice cup of tea and pictures of daisies. But, if the title has done its job, you’ll realise that this is also not really a post about depression. It’s about the price you pay to live a Life Un-depressed.
There are a lot of really great personal accounts and metaphors about depression out there. I particularly like how Allie Brosh, Andrew Solomon and Matthew Johnstone have managed to capture the experience of it in ways that, hopefully, both depressed and un-depressed people can relate to. What I think many of these narratives don’t quite capture, though, is how impossibly part of your Self depression is. Like a virus, it infiltrates your cells, blackens them and reflects the worst parts of yourself back at you. It becomes impossible to tell the difference between what is real and what is depression. It’s all sorts of awful.
All sorts of awful is where I’ve been these past few months.
The thing about recovering from depression is that there is no one-size-fits-all. Some people have spontaneous remission without treatment. Some go onto a course of medication and / or psychotherapy and get through the ‘episode’, which might be the only one they’ll ever be unlucky enough to have experienced. Some, like me, will cycle in and out, from one episode to the next, emerging eventually with the knowledge that theirs is a chronic condition for which, much like diabetes, they will need to be on medication for the rest of their lives. If, like me, you’re one of the lucky ones, you’ll find an anti-depressant (likely after many hit-and-miss attempts) that takes the depression away. I stumbled upon my particular brand of drug – selective serotonin reputake inhibitors or SSRIs – a decade ago. I got Better. I stayed Better, for over ten years. Until I decided, last year, to come off SSRIs.
Every anti-depressant affects every person differently. SSRIs, in their defense, have a fairly good reputation for being effective for many people. They also have a reputation for a rather significant set of side effects (more on this later). It was because of these side effects that I tried to come off them (resulting in a pretty trippy few months), and was put onto a different class of drugs. Evidently, this new drug did not work. My neurotransmitters wanted their SSRI back. Faced with a severely depressed patient, my doctor put me back onto my trusty SSRI. I protested against this, but at the time I was not in a position to put up much of a fight.
And here, finally, is the point of this story. I am lucky to have found a drug that works for my depression. I am less lucky to be one of the people who is particularly affected by the drug’s side-effects. And so I wonder: when you take anti-depressant medication, does it make you become more of yourself, or less?
A lot of medications have side effects. Headaches, nausea, dry mouth, insomnia, somnolence… an endless list, really. But mine are not physical side effects. Physical side effects, quite frankly, I could live with. There are a number of delightful terms given to this particular melody of effects: emotional blunting, SSRI-induced indifference, frontal lobe syndrome. The offshoots include detachment, apathy, numbness, indifference, boredom, anhedonia, and lack of interest in anything and everything. Unsurprisingly, these are not among the endless physical ‘contraindications’ listed in the box insert. They are seldom spoken about in doctors’ offices. The idea seems to be that if the SSRI makes you un-depressed, the rest you can live with. As if living like that is really living.
Please don’t misunderstand me. Being depressed is intolerable. No one would choose not to get better. But living a robotic, colourless, emotionally void life is, I think, a very high price to pay. I’m willing to bet this is true for a great deal of people. What astonishes me, though perhaps it shouldn’t, is how little has been published about this price. On the web, anecdotal evidence abounds. Message board upon message board has pages of posts and comments about the experience of becoming less alive on SSRIs. But scientific, empirical research (the kind that is taken seriously by the medical community) documenting these effects? A virtual void. If you’re fortunate, you’ll get a doctor who has seen enough of this in his or her patients to pay attention to these complaints. Although, so far, none have been able to tell me exactly why or how these drugs have this effect. I’m guessing this has something to do with the fact that medical science, for all its astounding advances, still can’t quite say exactly how or why anti-depressants work at all – or why one person’s miracle drug is another person’s nightmare. There are theories, of course. But I’ve yet to hear or see conclusive evidence.
How does one make a choice like this? A reverse Sophie’s Choice, if you will, where neither option is desirable. I of course have the option of trying one of the anti-depressants from the vast range of non-SSRI alternatives, and I am now working my way back to being off SSRIs. Trying, once again, something new – a drug that works on different neurotransmitters all together. But because my depression seems to be serotonin-based, there is the risk that this new drug will not work. Then, once again, I will have to choose between depression and the life-altering effects of SSRIs.
It’s an impossible choice. But the risk is worth taking: I want to see how much more of my Self I can become.