This Blog Made Possible by Bupropion

Via TPM Reader DK at Josh Marshall’s place — reporter Chris Rose of the New Orleans Times Picayne describes his descent into clinical depression and how he got his life back with medication.

He starts with an anecdote that perhaps only other depressives can relate to:

I pulled into the Shell station on Magazine Street, my car running on fumes. I turned off the motor. And then I just sat there.

There were other people pumping gas at the island I had pulled into and I didn’t want them to see me, didn’t want to see them, didn’t want to nod hello, didn’t want to interact in any fashion.

Outside the window, they looked like characters in a movie. But not my movie.

I tried to wait them out, but others would follow, get out of their cars and pump and pay and drive off, always followed by more cars, more people. How can they do this, like everything is normal, I wondered. Where do they go? What do they do?

It was early August and two minutes in my car with the windows up and the air conditioner off was insufferable. I was trapped, in my car and in my head.

So I drove off with an empty tank rather than face strangers at a gas station.

Many years ago I went to a DMV office for some reason; I think I had to change my address. After wandering around a bit in the office I found some forms I needed to fill while waiting in line. But there were no pens or pencils handy. I dug around in my purse for a while and found nothing to write with. So I took the form and went home, because I couldn’t bring myself to ask anyone for a pen.

And that’s when I was getting better. At least I got to the DMV office.

Here’s a passage I endorse enthusiastically.

In his book “Darkness Visible: A Memoir of Madness” — the best literary guide to the disease that I have found — the writer William Styron recounted his own descent into and recovery from depression, and one of the biggest obstacles, he said, was the term itself, what he calls “a true wimp of a word.”

He traces the medical use of the word “depression” to a Swiss psychiatrist named Adolf Meyer, who, Styron said, “had a tin ear for the finer rhythms of English and therefore was unaware of the damage he had inflicted by offering ‘depression’ as a descriptive noun for such a dreadful and raging disease.

“Nonetheless, for over 75 years the word has slithered innocuously through the language like a slug, leaving little trace of its intrinsic malevolence and preventing, by its very insipidity, a general awareness of the horrible intensity of the disease when out of control.”

He continued: “As one who has suffered from the malady in extremis yet returned to tell the tale, I would lobby for a truly arresting designation. ‘Brainstorm,’ for instance, has unfortunately been preempted to describe, somewhat jocularly, intellectual inspiration. But something along these lines is needed.

“Told that someone’s mood disorder has evolved into a storm — a veritable howling tempest in the brain, which is indeed what a clinical depression resembles like nothing else — even the uninformed layman might display sympathy rather than the standard reaction that ‘depression’ evokes, something akin to ‘So what?’ or ‘You’ll pull out of it’ or ‘We all have bad days.’ “

Some time before the DMV incident, when I was worse, I abandoned a cart full of food and ran in panic from a grocery store because someone told me to cheer up and smile. (Don’t ever do that to anyone you don’t know.)

Styron is a helluva writer. His words were my life. I was having one serious brainstorm. Hell, it was a brain hurricane, Category 5. But what happens when your own personal despair starts bleeding over into the lives of those around you?

What happens when you can’t get out of your car at the gas station even when you’re out of gas? Man, talk about the perfect metaphor.

Depression don’t get no respect because of the name. The common emotion depression and the disease depression are two entirely different things, but even some doctors and therapists can’t get that.

… here’s my doctor’s take: The amount of cortisol in my brain increased to dangerous levels. The overproduction, in turn, was blocking the transmission of serotonin and norepinephrine.

Some definitions: Cortisol is the hormone produced in response to chronic stress. Serotonin and norepinephrine are neurotransmitters — chemical messengers — that mediate messages between nerves in the brain, and this communication system is the basic source of all mood and behavior.

The chemistry department at the University of Bristol in England has a massive Web database for serotonin, titled, appropriately: “The Molecule of Happiness.”

And I wasn’t getting enough. My brain was literally shorting out. The cells were not properly communicating. Chemical imbalances, likely caused by increased stress hormones — cortisol, to be precise — were dogging the work of my neurotransmitters, my electrical wiring. A real and true physiological deterioration had begun.

I had a disease.

Rose was lucky. His employer realized he was sick and cut him slack, and his wife also recognized he needed help. He got almost immediately relief from a new medication, Cymbalta, instead of going through weeks or months of trial and error — waiting for a new drug to begin working, trying another dosage or another drug if it doesn’t. As Rose’s psychiatrist said, it’s a crapshoot. Many anti-depressants have to be taken for two to four weeks before any effects kick in, and sometimes the effects never kick in.

Do-gooders trying to get anti-depressive meds banned because of anecdotal evidence they cause suicides need to understand that untreated depressives kill themselves at much higher rates than not-depressed people. If someone who just started to take Paxil commits suicide, that doesn’t mean the Paxil made him do it. If the Paxil was a factor at all, more likely the patient became more despondent because it wasn’t working. Or, it’s possible a patient who is too enervated and mentally disorganized to do much but sit and stare into space might get just better enough to carry out a suicide plan.

And don’t forget — people get misdiagnosed. When someone taking an antidepressant becomes violent — Eric Harris of Columbine High School fame, for example — before blaming the drug, ask why he was taking it to begin with. He may not have been depressed; he may have been bipolar, which calls for different drugs, or he may have been psycopathic, a condition that doesn’t respond to medication. Also, the drugs may work differently on juvenile brains than on adult brains.

I hear people who have tried antidepressants say that the drugs suppressed their emotions and made them feel mentally foggy, which suggests to me they didn’t have the disease depression but just the common emotion of depression. If your brain chemistry and neurotransmitters are functioning normally, anti-depressants may make you feel worse. They aren’t “happy pills.” Taking anti-depressants if your brain is healthy is as stupid as taking insulin if you aren’t diabetic. However, if you are depressed, with the right meds your thinking becomes clearer and your emotions are normal. It’s important to understand this, because ignorance may be keeping some people from taking meds who could genuinely benefit from them.

Too many people still have medieval attitudes about psychiatric disorders. Many of them are caused by real physical and chemical changes in the brain, and these should be treated with the same respect as any other disease in any other organ.

16 thoughts on “This Blog Made Possible by Bupropion

  1. Wow, wonderful post. I’m in the habit of recommending Styron’s Darkness Visible to anyone who wants to start learning about depression, because it’s the best description I’ve ever read of what depression feels like.

    I suffered from a couple of lengthy bouts in my early 20s and early 30s, and thank goodness am closing out my 40s with no recurrence. I remember actual, physical pain sometimes, and other times a complete deadness in every molecule of my being. (Wow, that sounds fatuous. Depression can be so hard to describe.)

    I’ve never taken meds for it, as they were only just coming on the market when I was in my mid-30s. It’s always interesting to hear personal accounts, pro and con, of the current treatments. I really do think we’ve come a long way in the last 15 years. (Take that, Tom Cruise!)

  2. Thank you for sharing this information. I think if more people discussed it openly, it would become much better understood. I’ve suffered from depression since I can remember (I’m 44). I did not seek medical treatment for it, however, until after the birth of my second child (I suffered servere post partum depression, not surprisingly). I was prescribed Zoloft, and found great relief. I eventually stopped taking it, as I had hoped to have another child. I was doing pretty well, but eventually, my panic attacks resumed (even worse). That time, however, the Zoloft seemed to make my anxiety even worse, so I stopped and used sedatives when things got really bad. I then found a therapist who specialized in anxiety disorders and in just a few short months, was able to develop skills to cope unmedicated. I can’t say I was normal, but was pretty good. After my third child, my OB, at my request, put me on Zoloft again in the hospital. Within 2 days I was having devastating panic attacks again, so I stopped taking the medication. Only later did I learn that that occasionally happens the first few days/weeks of the medication, but will usually stop. I guess my point is that I have seen the medications work wonderfully, but that people should be more closely supervised when starting or stopping – my medication was always prescribed by my OB/GYN, who has no training in treating mental illness (at one point, she even told me I could just take it for the two weeks before my period each month, when she thought my problem was only bad PMS). Finally, on a sad note, we are mourning the loss of my brother this week. He suffered from alcoholism most of his adult life. I always believed he suffered from depression and was self-medicating with the alcohol (there seems to be a genetic tendency towards the disease in our family). Sadly, however, in my family, depression is very misunderstood, so his illness was never addressed. Hopefully, by discussing this more openly, we can prevent others from suffering needlessly.

  3. Yes, great post! I suffered from intractable, severe clinical depression from at least the onset of adolescence, through college, and on into my mid-thirties. I wouldn’t have graduated from high school were it not for the indulgence of some of my teachers, who recognized what I was capable of, and cut me some slack. And I franly don’t know how I got through college and grad school, even with some serious time off. And for much of that time, depression was the disease that dared not speak its name, so I couldn’t even admit to people outside my family that I suffered from it.

    Finally, with Prozac and other SSRI’s, I found a class of medications which had an effect on my disease (though not immediate–it took about four weeks before my mood lifted gradually, like a slowly dawning day). Nothing else that was tried previously had any effect, including electroconvulsive therapy (shock therapy, in common parlance).

    To Tom Cruise and other fookin’ eejits who cluelessly condemn all psychiatric medication, I extend both middle fingers with a Bronx cheer. If they had to go through what I did, they wouldn’t be so blithe (and I’m damned sure communing with dead aliens through the medium of a glorified lie detector wouldn’t had done squat for my condition!).

    “Depression” is indeed way to wimpy a term for this soul-crushing disease: how about something like “malignant mood deformation”? (Cancer survivors may object to the appropriation of “malignant”, but in its own hideous way, depression can be every bit as life-threatening and destructive as cancer.)

  4. Good post.

    Sometime ago, I read in the LA Times that some of the “do-gooders” were actually Scientologists who depend on depression to get recruits.

    Insurance companies are also not very tolerant of paying for medication and therapy (both work better together). My former psychriatrist stopped accepting my insurance company because he could not agree to their terms.

  5. Those drugs do somewhat change the way you think about things. A person who has been seriously contemplating suicide for a long time may find that the drugs give him the fortitude and confidence to go ahead and do it. It sounds kind of crazy and ironic but it’s totally believeable (I’ve taken Prozac before, and though it didn’t make me kill myself, it did result in my going to law school, which is almost as bad).

    In such a situation, it would be ridiculous to say that the drugs “caused” the suicide. Notwithstanding, it is not impossible that the drugs can on occasion “trigger” a suicide. This doesn’t mean the drugs shouldn’t be used, but it does mean that people should take the possibility of suicide seriously when someone severely depressed gets on medication — and that person should be closely, closely monitored.

  6. My depression was the worst when I was 20 – 22. It completely disrupted my life (I withdrew from college, moved around three times, worked three jobs one right after the other). I remember most clearly a feeling of impending doom. I thought at first I could manage it, but as it stayed for years and years it started to infect everything. I felt like I couldn’t do anything because it didn’t really matter anyway. Then there was the constant fear of each interaction and every motion in the world. I remember being afraid to do anything because I felt like it would all come crashing down on me in the end. Not a healthy place to be, but I was able to dig myself out of it by taking an anti-depressant (Effexor).

    And perhaps I did not have a disease in the sense that my depression has abated to the point where I have gone off of my anti-depressants and am having a more stable mood. However, I think there comes a point where some people who are medicated make the decision to go off of medication because the scope of the depression seems to have become more manageable. When I quit taking my Effexor I was complaining of the mental fog and dulling of mental capacities that had not been the case just a year previously. Perhaps my brain chemistry shifted, but I knew it was time to come off of Effexor.

    As for claims of links between anti-depressants and suicide, I would like to suggest that if someone is put on potent antidepressants and have to switch between medications, then the withdrawal from one anti-depressant could be enough for any already emotionally turbulent to think suicide is a viable option. When I went off of my Effexor, it was utterly awful. I would get nauseated and feel weak. I kept having this sensation of electric shocks going down my limbs and I had this feeling over and over that my heart was skipping a beat. This was usually accompanied by a brief second of vertigo and a sense of imbalance.

    It was pretty horrific, I have to say. I wonder if there have been any studies on the effects of multiple withdrawal periods while clinically depressed individuals are trying to find a medicine that works and how the sensations of withdrawal affect suicidal tendency.

  7. I hear people who have tried antidepressants say that the drugs suppressed their emotions and made them feel mentally foggy, which suggests to me they didn’t have the disease depression but just the common emotion of depression. If your brain chemistry and neurotransmitters are functioning normally, anti-depressants may make you feel worse.

    Even if someone is depressed, the wrong drug can be harmful. Paxil made me a *lot* worse; Wellbutrin, however, has been a lifesaver.

    Also, on SSRIs, I tended to hit a “living but numb” space. I wasn’t crushingly depressed, and I could live with it, the way a person can live with a chronic pain disorder, but I was very flat. It was very like depression, without the soul-crushing despair.

    I should note, I have ADHD/inattentive, and that is tied to my depression. I have no idea where one drops off and the other starts. So, for “pure depression” you might be right. I don’t know. But a good or bad reaction to antidepressants isn’t diagnostic in either direction. (Of course, if an 8 month course of (fill in the blank AD) cures the complaint, then the patient will be deemed to have had depression… but a wise doctor understands that it could have been something else, as well.)

  8. This comment is made possible by tetrahydrocannabinol.

    Whatever it takes to keep your wheels on. Realizing that there are varying degrees and different causes for different types depression, I think one of the biggest aids generally in combating depression is openness. There are those who have no understanding and who are quick to say..get over it, get out of yourself, or just get washed in the blood of Jesus and burdens of your mind will roll away. I’ve had a few battles with depression, so I do understand it. Years ago the Veterans Administration hooked me up on Paxil… for me, the side effects outweighed the benefit. First was the stigmatizing by others of not being of sound mind and the second was the physical effect on my mind. I would experience what I called “electrical storms” in my brain where there would be a fluttering sensation lasting for several seconds that would scare the hell out of me. I also would experience an audible sensation that was the equivalent of having an F-4 Phanton jet fly over your head at a low altitute and high speed. Scarry stuff!.. Now I self medicate.. and it works.

    Oh yeah, another draw back to Paxil for me was the inability to experience an orgasm while using that drug..all systems would be up and running 110% except for the little something the occurs in the brain. Talk about frustration?

  9. I have way too many thoughts on this subject; so will spare you. However, off topic, I found this quote that I thought was interesting and could use some good “Maha” analysis–not only by her but the thoughtful people who comment here. The quote is as follows:

    The technology we need most badly is the technology of community – the knowledge about how to cooperate to get things done. Our sense of community is in disrepair at least in part because the prosperity that flowed from cheap fossil fuel has allowed us all to become extremely individualized, even hyperindividualized, in ways that, as we only now begin to understand, represent a truly Faustian bargain. We Americans haven’t needed our neighbors for anything important, and hence neighborliness – local solidarity – has disappeared. Our problem now is that there is no way forward, at least if we’re serious about preventing the worst ecological nightmares, that doesn’t involve working together politically to make changes deep enough and rapid enough to matter. A carbon tax would be a very good place to start.
    Bill McKibben is scholar in residence at Middlebury College and the author of The End of Nature and Deep Economy: The Wealth of Communities and the Durable Future.

    How Close to Catastrophe?
    By Bill McKibben

  10. Bonnie: What you raised is off-topic, but is important. McKibben is spot on. There’s much that could be said about it, I’ll try to be brief, and share my own 2 cents:

    1) Western culture, led by the American experiment, has been the forerunner in emphasizing individualism over community. There is always this tension between the two in any society, but in America, the rights of the individual are paramount. Not so in Confucian cultures, or in third world (poor) countries, which have much to teach us in this regard. I recommend TR Reid’s “Confucius Lives Next Door” for the Asian example. He speaks specifically to this point.

    2) Mother Teresa was once asked where she saw the greatest poverty. She said it was in the loneliness in the eyes of people here in America.

    3) It’s my belief (and that of others) that spiritual communities are the future. American hyper-individualism, based on cheap energy, isn’t going to be a viable strategy, nor is the endless surfeit of consumer goods at the expense of the planet’s health and the health of its people satisfying anyway. Many in the first world have moved up past materialism in Maslow’s hierarchy of needs.

    The next few decades are going to see the unfortunately painful transition to this kind of future, IMO. I’ve read that Paramahansa Yogananda, an Indian sage from the early 20th century, said that America will become twice as poor but twice as spiritual.

    Swami: Better living through chemistry, no? I self-medicated in this same way for a long time, and actually used our friend THC to find myself – I could write a book about that journey. I previously learned how to work with subtle energy, and THC enhanced my ability to see negative and stuck energy in my own field, which helped me get rid of it, which changed my life. A clairvoyant named Barbara Martin wrote “Change Your Aura, Change Your Life” along these lines, albeit without the THC boost.

    Psychedelics, even mere THC, are powerful, sacramental, and can be very dangerous over time. It’s only through my knowledge of subtle energy that I knew how to repair the damage they cause to my own energy field, that I was able to stay out of a mental ward. I’m grateful for what I learned and for how I grew, but it was a very dangerous and risky voyage that I’m glad is over.

  11. Maha, I’m sure you know about my own battles. Flunked out of two colleges because of anxiety/depression, saved in the end by Prozac combined with a very good therapist.

    Is there a good way of finding out everybody who has linked to that Chris Rose piece? I’d like to see what people are saying…


  12. Interesting how “A-list” conservative pundits don’t seem to be showing any depressive symptoms or are admitting to being medicated. You’d think with all the expanding horrors of the Iraq which they helped cause, or with the phenomenal discrepancy between hopeful expectations for the Bush administration and with the actual results that this would be a major issue.

    Is there something about the way their brains work that’s not “normal.”

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  14. Oh, what a good post. As I read the text and the comments, my heart just kept expanding to the point where I wished I could bear-hug everybody.
    When I was in my late twenties and my world fell apart because my marriage failed, I went through what I ever after labeled my hell week. [I cannot imagine living in that for more than a week. Geez.]
    I just dropped into something that I guess was a brain fizz disfunction and didn’t even realize something was profoundly wrong…. until I was driving the car and drew blankness: I suddenly couldn’t remember how to turn the car or stop the car, I was in acute anxiety knowing I had to get that car stopped, which somehow I did do, shaking like a leaf. The acuteness passed enough for me to drive home to our farm house.
    For some days, I was alternately weeping and walking around like I was dead. I had the most profound conflict inside. The conflict went like this: I needed attention and help, but if I spoke of what I needed, then somebody would give me what I needed ONLY because I asked for it, which meant [to my ego] that it was no good anyway…..and besides, I realized I was so bad that I deserved nothing from anyone, and I should impose no more on anyone, but even my silence could be an imposition. If I spoke, somebody would feel like they were to listen, but if I didn’t speak, that also might put pressure on another. This conflict was unbearable and stalled me into agonizing muteness if I was in the presence of a possibly helpful person.
    Much of that week is still a blur, but I remember lying on the ground in the rain one night, weeping and flailing my arms onto the earth. The hell week ended when I went to the basement of the farm house and broke my self-image ‘adult goody-two-shoes’ pattern by methodically throwing every last canning jar [dozens] against a concrete wall…..I suppose I safely shattered that glass instead of myself.
    The calmness that followed allowed a most healing logic to replace my despair. I realized that all of my attempts to make myself loveable [slim down the hips, cook better meals, etc, etc] would never bring love to the actual ‘me’, which was, well…. imperfect. What a relief to give up all that wasted energy of trying to be something I wasn’t.
    Like I said, I cannot imagine living in that kind of place for any length of time, which is why my heart so responded to this post. As the Aussies say, good on you all.

  15. Been There – Done That. I used Wellbutrin. Kudos to Maha for a daring post, and my sincere well wishes to all who recovered & are recovering. Anyone who may be suffering and reads this should know from the venerable list of commenters – they are not alone. And there is hope and help.

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