It's May, and you know what that means — it's Mental Health Awareness Month! Break out the cake, blow up some balloons ... and let's talk about mind-altering drugs. A staggering 11 percent of Americans over the age of 12 take antidepressants, according to a study from 2011 (and since then the numbers may have risen even higher). And that's not even a third of the people demonstrating serious symptoms of depression, according to the Center For Disease Control And Prevention. The widespread nature of antidepressant usage, from Zoloft to Prozac and Lexapro, and the radical increase in their prescription — up 400 percent from 1988 — has led to accusations that America is medicating itself indefinitely rather than dealing with depression's causes. It's also led to some alarming, damaging myths about antidepressants that most users have, at some point or another, probably had to deal with.
I'm lucky: I'm a sufferer of severe depression with a supportive spouse, access to affordable healthcare and therapy, and the ability to buy antidepressants. I'm on 30mg of Citalopram, an SSRI, or selective serotonin re-uptake inhibitor. Simply speaking, it increases the level of serotonin, a neurotransmitter, in my brain. But that's not the only kind of antidepressant around. Others include SNRIs (serotonin-noradrenaline re-uptake inhibitors), a new variant on SSRIs, and older ones like tricyclic antidepressants and monoamine oxidase inhibitors, which tend to be brought in when SSRIs don't work. I'm on the most common kind, and I have heard some serious bull about what that choice means.
So consider this an insider perspective. If you have a friend or family member who's on, or considering going on, antidepressants, here are some incredibly unhelpful things to avoid saying, and why they're a bad idea. Even if it come from a place of love, it's important to get your facts about depression and its treatment right.
1. "You're just hiding from the real problem."
A good way to think about antidepressants, if you don't know much about them, is in terms of relieving symptoms . Yes, many people with depression or anxiety benefit greatly from talking to a therapist, mindfulness, support groups, and other psychological unknottings. But anti-depressants are like a cast on a broken leg; sometimes you can't start the serious, full healing unless there's some structure in place to keep the basic stuff stable.
Anti-depressants work to fix the basic chemistry of a mood disorder, bringing a person out of the darkest points of their disease to somewhere more capable. I can't go to therapy, exercise, or behave in helpful depression-bashing ways unless I've got some kind of chemical life-buoy keeping my head above water. Accusing people of slapping a bandaid on their disorder is not a helpful contribution.
2. "But don't they cut you off from feeling your actual emotions?"
The idea that antidepressants will change your personality or make you a zombie, shut off to normal emotional spectrums, is so widespread that the Depression Health Center devotes an entire page to it. The reality? Antidepressants aren't bludgeons to your brain. A good antidepressant, one which is prescribed in the correct dose and addresses your specific situation, brings you closer to emotional normalcy. Users are not going to go dead inside and drool at the mouth; they're attempting to have genuine emotion, as opposed to the continual gloomy isolation of a depressive state.
If an antidepressant does cause somebody to feel disconnected or "apathetic," chances are that they're simply on the wrong meds, and another dosage or kind of medication will help be more helpful. It's regarded in the profession as a pretty rare and unusual side affect.
3. "Won't you get addicted?"
Antidepressants aren't heroin; they're a mood-booster and often seriously necessary, not a craving. Medical advice for people without severe depression only advises you to be on them for 6 months to a year. The goal isn't to keep people medicated forever, just to get them through the tough parts without a relapse.
And coming off them, while occasionally hard (and bizarre — did you know "brain zaps" are a thing? It feels like you've bitten aluminium foil and your mouth fills with sparks), is perfectly viable. There are a lot of resources about how to come off antidepressants gradually and safely by reducing doses, planning in advance, and taking steps to cope with side affects. Lots of people do it and go on to perfectly unmedicated lives.
4. "You should try to fix it without drugs."
What are you, Tom Cruise? It's a sad misunderstanding of depression that people are "just weak" and "should try harder to conquer the problem on their own." News flash: many people who suffer from depression would much rather be happy than in their miserable hole, and are trying their damnedest to climb out. But not being able to achieve that on their own doesn't make them a failure, weak, or lacking in will. It simply means that they require some aid in solving a difficult and often scary problem. Let them reach for whatever ladder they need.
5. "Don't those make your sex life suck?"
One: this is seriously none of your business. Two: antidepressants have a complex relationship with sexual libido, which is fitting, because libido is a pretty complex subject. The myth that they always kill it dead is absolute nonsense, though. Antidepressants can be an ingredient in a healthy sex life for a depressive person, because they can help them feel pleasure again. And the continued presence of depression may play a role in any lessening desire after going on medication.
Let's not deny that lower libido is a possible side affect of antidepressants — but it's not a universal, and can be something you work through with a good partner and an understanding doctor.
6. "You'd be much better off if you used holistic, natural remedies."
First rule of Depression Fight Club: my body, my rules. The reality is that people seeking treatment for depression have likely been encouraged by their doctors to do all the "natural" stuff they can alongside their antidepressant dosage (omega-3s, good fats, exercise), because it's a standard of today's medical care, and hey, that stuff does have benefits. For some, however, purely natural remedies are not sufficient. And that doesn't mean they hate Earth, bunny rabbits, or want to pour chemicals into their bodies. It means that you should butt out.
7. "But you seem so normal! I'm sure you don't need them."
Thank you. My excellent veneer of coping skills does not, however, invalidate my need for serious medication; in fact, it's probably what makes me capable of having every functional conversation I've had in the past six years. That's how long I've been on them, and my normalcy is the product of experimentation with doses, consultations with healthcare professionals, and a lot of work. Just because people aren't obviously depressed doesn't mean that they're not in need of help and support. It just means they're good actors, having a reasonable mood day, or putting on a brave face.
8. "I read that they're basically only placebos."
A study in the Journal of the American Medical Association got a lot of attention when it claimed that, for people who didn't suffer severe depression, antidepressants were basically just as effective as placebos — that is, they only seemed to be helping. But the study, while it started a lot of good conversations, also seriously concerned medical professionals. Experts from Johns Hopkins, Harvard and UCLA have commented critically on how limited the study's parameters were, and how little it tried to understand what "helping depression" actually meant.
The medical profession in general does acknowledge that sometimes antidepressants simply don't work; there's no such thing as a 100 percent success rate. The human brain is a tricky thing. But antidepressants are not a useless endeavor, and causing a person trying them out to doubt their progress isn't helping anything at all.
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