My personal economist on SSRIs and at least one thing Adbusters has wrong

As I told Ben, I've taken SSRIs before and surely will again sometime, and I'm (I think, give me a minute, yes, okay) completely down with this analysis:

[T]he folks at Adbusters... believe that depression, panic disorders, and even PMS are "inventions" of drug companies to sell us more drugs. The conclusion follows the same puritanical streak as the Congressmen who pass laws blocking access: if you don't need a drug, then you shouldn't take it---and in the case of anxiety or depression, you never need drugs, because these states are inventions of the drug companies.

I am sorry to say that my emotional state is not a product of advertising.

I actually generally follow a life the Adbusters would approve of: I have no TV, don't let my browser load ads, and generally just don't see advertising, and yet the drug companies still got through to me that I have the ailment they invented. When I briefly lived in Venezuela, a short walk to the stream we drank from and bathed in but a long walk to the nearest town, subsisting on the mangos that fell from the trees in the yard, I was still depressed, and I knew it.

Yes, drug companies are evil multinational corporations. They also manufacture stuff that makes us better. Further, I have to give the evil multinationals a big YAY! for advertising aggressively that depression shouldn't be stigmatized, and that we shouldn't feel ashamed for our brain chemistry, and that it's OK to come forward and seek constructive treatment when just getting more sun doesn't work. The adbusters would point out that they're destigmatizing it to sell us more drugs, and so write articles that re-stigmatize depression.

I think that's all I'm entitled to quote under fair use, but don't miss his earlier, withering analogy involving high school students. Ouch.

Comments

[Rob Lightner]

Given that I have not read the whole piece, I have to give this another "oh, come on." There's a straw man not very carefully hidden in there - almost nobody, not even Adbusters people, believe that every case of depression is constructed by mental health professionals colluding with the pharmaceutical industry. The existence of suicide is a strong argument in favor of the reality of depression. E.g.

But it's easy to see that depression has been defined down since the introduction of profitable pseudo-therapies*. The National Health Policy Forum at GWU says: "In the decade between 1987 and 1997, the number of Americans treated for depression increased three-fold." Surely that is at least partly attributable to the 1987 introduction of Prozac to the market. Sadness, once just a symptom of depression (and not even necessary for diagnosis), is now sort-of treatable - but should we treat it? At what cost, financial and spiritual? Is it puritanical to wonder whether sadness plays an important role in our mental lives?

Yes, I know, it's not just sadness. There's lack of motivation, suicidal thoughts and actions, self-destructive behavior, and more. But not for every, or even most sufferers of post-Prozac "depression." I think it's misguided at best to throw pills at people who might do better to change their lives in other ways. Or to listen to depression as carefully as they listen to Prozac.

Let me recap by explaining what I am not saying:

* Depression is fictitious.
* SSRIs are wholly without merit.
* Free citizens should not have the right to alter their minds and bodies as they see fit.

What I am saying: depression is overdiagnosed and, given how little we know about the mind, SSRIs, and how they interact, I'd prefer my friends and family to err on the side of caution.

But if you like 'em, go nuts. You're all grown-up now.

--

* I affix "pseudo" because we don't know how they work, and muffling symptoms isn't therapeutic.

[Paul]

Your response to my selective quoting might be appropriate (what's up with that? read the damn post, Lightner!), but it's not entirely relevant given the rest of what was said, including,

"Since I hang out with goths so often, I know that there exist people who believe they're clinically depressed but aren't, and the drugs they think are helping are either a waste or harmful. But what is the harm from a type I error (depressive doesn't get drugs) and the harm from a type II error (nondepressive takes extraneous drugs)? If the harm from a type I error is orders of magnitude greater---which it is---then don't build barriers around blocking access to the darn drugs. No offense to my dark pals, but writing the nation's drug policy around goths is just silly."

It's hard to argue that the bar for depression hasn't been lowered since treatment became more profitable. I totally agree. But I'm curious: Are "most" sufferers of "post-Prozac depression" really just sad? What do you base that on? (And what's up with your "symptom-muffling" distinction. As you're defining chemical depression, I don't see what you'd even allow as truly therapeutic, aside from changing a human into something else. Like a happy unicorn, maybe?)

I don't know. Anecdotally, I haven't known very many people who have taken SSRIs lightly--and I might even argue that any dumb person prone to gobble pills rather than feel "sad" isn't going to be made any worse by taking them anyway, at least from my perspective. (In fact, at least some people who don't "need" them don't find the side effects worth it anyway: http://slate.msn.com/id/95903/) But making that argument would probably make me a bad person, so I won't. Maybe I will later. Hmm, yes: Ask me later. I'll make that argument. Especially if letting dumb sad people get pills is just a price for letting smart depressed people get pills, too.

For me, re: sadness vs. depression, the first time I was actually diagnosed with bona fide clinical depression, I was in the fourth grade. Over the course of my life since then, I've learned the difference between feeling down, feeling totally enervated, or feeling something in between--and occasional use of SSRIs has helped me define that difference much more clearly, so hooray for SSRIs. (Or at least they've helped me define that difference much more clearly than beer ever has. Stupid beer.)

[jill]

The difference between sadness and clinical depression is officially documented in a whole lot of places; I think a better difference to look at is the one between chronic boredom and clinical depression. Like the tie between chronic pain and depression, no one knows which comes first, because, of course, it varies among people. The linked article--which I took the time to read, yes, Paul--even touches on that. Solve for K. (Who's more chronically bored than a goth? No one. They should go clean their rooms.)

Some symptoms are better muffled, says the one who has permanent, pointless nerve damage. Sure, if I one day don't notice when my legs catch fire there'd be a problem with symptom muffling, and I do sometimes worry that I have a new injury that is being masked. But in general, taking weird little pills help my brain ignore misfires, which then allows me to walk semi-normally, leave the house, bake cookies, work and respond to blog posts. If SSRIs allow people to have fun solving for K endlessly throughout the years, then by all means keep on munching.
And, duh, if you have a chronic issue that requires longterm medication, you need to have a-better insurance, and b-a good, sympathetic doctor who monitors drug your drug usage regularly, rather than just when your prescription runs out.

[Karen]

I think the solution is elswhere, i.e. in changing one's brain chemistry that is making one sad, yes, but in doing it by the chemical means that are natural to the brain.

ADHD kids have much lower magnesium, etc. I highly highly highly highly HIGHLy recommend any book by Sherry Rogers. I think her book on the biochemistry of depression, and the natural biochemical cures, is Depression Cured at Last. This woman will change your outlook once you get past her iconoclastic medical style, and odd writing style.