In the Company of Millions

SSRIs are the most widely prescribed antidepressants in many countries. with sales of $14.3 billion in 2019, expected to reach $15.98 Bn by 2023.

Depression is a notoriously expensive disease, costing society $210 billion per year, according to new data published in the Journal of Clinical Psychiatry. Depression is an epidemic with approximately one in six Americans on antidepressants,  and more than a quarter of those long-term users,

It’s not reassuring to know I have lots of company.

The Grey Tide Wanes and Waxes

Thanks to pharmaceuticals, I’ve had remarkable runs of freedom from serious or lengthy depressive episodes – passages I refer to as ‘donating my brain to science.’

For the past ninety-five days – for the first time in nearly thirty years – I’ve been taking no medication for depression. Stopped cold. Since I hate most kinds of drugs, this was liberation. A few situational episodes of feeling defeated rolled in, but that’s part of the challenge of this passage in my life. For most of these days, my spirit has been doing well. I fancied that my brain had rebooted, free from chemical interference. Of course, as with all experiments, one has to wait for the other shoe to fall.

I used to think of it as ‘the abyss,’ a chaos of black despair. I’ve renamed it ‘the black tide’ and I’m now swimming in the grey part of that tide. My shine’s gone dim. I hunger to be back the sun, fully engaged with all the strange and wonderful and confounding ideas and people and events that life serves up. I’m looking at all sorts of alternatives to return to stable ground.

It amazes me how little science can tell us about brain function. Psychiatrists and psychologists have evidence only of trends in effectiveness and possible side-effects, not that any individual will have these experiences or if, in fact, any given drug will have good outcome without too many bad side effects. We may be years away from knowing the best way forward in the treatment of depression.

In the meantime, drugs that tinker with neurochemistry must stand in as the best-guess response to psychological distress. We accept the little tortures of trial-and-error:  which drug, at what dose?  Sometimes a med does well by you. But if your brain is hardwired for ‘instability,’ are these work-arounds the only option? 

Admitting that depression claims occasional dominion over my life still feels a bit like copping to a secret flaw. How do we make Depression, and mental health in general, part of the wider social conversation – or at least the family conversation?  For so many, depression is the elephant on the coffee table of life. You, dear reader, or someone you love, is needing that elephant to stand down. This is my small contribution to that conversation. Comments welcome.