February 28, 2008
Even If Prozac Doesn't Work for Everyone, I Still Think It Helped Us All
Continued from my post yesterday.
With the clarity of educated hindsight, I can look back at my life and see that I suffered my first serious bout of depression as a young teenager--serious enough that I ended up in the hospital, though not for depression. No, I was hospitalized because of the effects depression and sadness had on my body: I lost six pints of blood--half the blood in my body--through intestinal hemorrhaging, which the doctors, after conducting a slew of tests and subjecting me to unnecessary exploratory surgery, attributed to "stress."
This being 1978, I was told I had made myself ill, and that I better make myself well, or else next time, I'd probably die. No one offered me any counseling or therapy; and so I dealt with the whole thing the only way I could, which was to become anorexic and even more obsessive and weird about religion than I'd previously been.
Somehow or another, I did get better, mostly because the hospital scared the shit out of me: I didn't want to go back there, EVER, if I could help it. If staying out of the hospital required arriving at a sounder state of mind, well, then I damn well was going to do it.
Flash-forward to my mission, where I developed what a doctor would call a case of severe depression but which I prefer to call "religious despair" or plain old heartbreak, and which, when I came home and tried to discuss, pretty much everyone dismissed.
I got my first prescription for anti-depressants on my mission, and I had to be dragged kicking and screaming to get it. (Metaphorically speaking, that is. No one dragged me to the hospital; I took the train, quite decorously. I just was coerced and cajoled into doing it even though I really didn't want to.) I didn't want medication for SO MANY REASONS, one being that I really didn't trust doctors. Another was that I felt very strongly the spiritual aspect of my despair and heartbreak; I didn't see how medication could treat the pain in my soul--and truth be told, it never did; the one drug that worked only made it able for me to sleep and stop crying long enough that *I* could do something about the pain in my soul. But at least as important as all that was that in 1986, when I got that prescription, the Prozac revolution had not occurred and depression was seen not as an illness but as a sign of moral weakness.
So there's a way in which, even if Prozac doesn't work, I feel it has been a beneficial medication for the entire planet, in that the stigma of depression and of seeking help for depression has been so profoundly lessened.
Speaking personally, and in language I know is religiously loaded, for me Prozac was a godsend and I think it may have very well saved my life. By the time I finally went on it in 1990, I'd tried about half a dozen anti-depressants, not because I wanted them but because my therapist kept insisting I needed them. They were, invariably, AWFUL--most of them exacerbated rather than mitigated the effects of depression. Good lord.... I remember one made me feel all giddy and drunk during the day but gave me the most garish, horrible nightmares.... Another gave me cotton-mouth so terrible I could scarcely teach a 50-minute class unless I drank so much liquid during it I nearly wet my pants before it ended. And the ones that helped me sleep--because insomnia is a life-long affliction of mine that is always worse when I'm depressed--made me not only drowsy, but almost unable to get out of bed, which really upset me, because one of the ways I kept even a shred of self-esteem during the whole business was to make sure I got up every morning and did what I needed to do, every single day, no matter how miserable I was.
So anyway, I'd try these anti-depressants for six weeks or so, realize I'd rather be plain old miserable than miserable AND suffering the side effects of these medications, and quit them. Until one day, my therapist told me that if I didn't go on Prozac, she'd have me hospitalized whether I liked it or not. I couldn't afford to spend a week doing nothing in the hospital, either in terms of my schedule or my wallet--I was a grad student, for christsake--so I went on Prozac.
And my god, did it help me. I can't believe there was a placebo effect, because if there were, I would have seen it with the other drugs. But it restored my sleep, almost by magic.... and it just gave me this small island of physical calm barely big enough that I could feel ever so slightly protected from some of the turmoil of my life, but oh, that was enough.
But the thing was, I didn't want to be on it. First of all, it was FREAKIN' EXPENSIVE: in 1990, it cost $2 a pill, and it WAS NOT COVERED BY MY LOUSY GRAD STUDENT INSURANCE. Sixty bucks a month or $720 a year is a hell of a lot to spend on medication when you earn only $9,000 a year. Secondly, I knew the drug was new enough that no one knew its long-term side effects, and I didn't want to find out the hard way that they blew. And finally, I didn't want a crutch. The point of all my searching and work, including all the therapy I had, all the painful decisions I arrived at and the drastic changes I made in my life (like leaving the church), was never merely to stop being depressed; it was to get as close as I could to enlightenment, to seeing the world and myself as cleared-eyed and accurately as possible, and to make my way through the world as effectively as I could.
Throughout the 1990s I'd go on it when I got desperate (for whatever reason: grad school, love gone awry, brain chemical whatever), then go off it when things got better. But I got tired of the cycle and decided I'd pursue any alternative treatment I could, including things like yoga and acupuncture and massage, all of which worked wonders for me, and seeing psychics and astrologers, which didn't always produce such great results. I was also lucky enough to find a terrific therapist who worked every bit as hard with me as I wanted to work, who supported my agenda for self exploration--she was great. I also read every last self-help book I thought would help me; some really did. After about five years of all that, I really did feel better.
So long about 1998 I swore anti-depressants off for good. And one thing that surprised me after that was how readily a doctor--a general practitioner, not even a psychiatrist, who specializes in mental health--would throw a prescription for Prozac at me anyway when I went to be treated for something other than depression. In 2000 I started having all these weird food sensitivities and allergies; one particularly bumbling fellow suggested I go back on Prozac, just in case it might help, but I said, "I'm not depressed; I'm allergic to something. Do you really think ingesting something else is going to help that?" Long about 2001 I saw a doctor who didn't want to give me a prescription for sleeping pills; he said he'd rather give me Prozac. I protested that I wasn't depressed; I was just having trouble sleeping. Finally he convinced me; I took the prescription and filled it--but it had lost its efficacy. It not only didn't work; it made me anxious and weird. At that point, I knew I'd never take it again.
So I feel simultaneously that Prozac is seriously over-prescribed, that it shouldn't be dispensed like aspirin, that it can only do so much, but that one of the things it can do is save lives--as I said, I think it saved mine. These studies I mentioned yesterday all stress that anti-depressants often work quite well for people who are profoundly depressed, and I don't want to forget that, or deprive those people (having been one myself) of what is potentially a very real source of very real relief. And I really do think the world is a better place since the invention of Prozac--as I say, it has revolutionized the way we see depression. But I think like anything it can be abused. And if studies like these are correctives to that abuse, well, it's a good thing they're being conducted.
Posted by holly at February 28, 2008 9:03 AM