Joanna Sheldon wrote:
[Carrol] Any article which allows the suggestion that anti-depressants have an
*immediate* impact on consciousness are very nearly criminal. It is the equivalent
of someone claiming that one dose of an anti-biotic will cure TB in 24 hours.
Anti-depressants have *no* immediate effect whatever. There are probably people
dead today who would be alive if they had not been led by such shit as this to
believe that Prozac or some other medication would have the same sort of immediate
results as the various mind-altering drugs
[Joanna] .Okay, maybe not immediate. How about almost immediate. After all, my sister, who was prescribed Prozac when she was grieving over the death of her lover, *almost* immediately began having horrendous nightmares involving extraordinary violence, such that she thought she was losing her mind. Those dreams stopped occurring a day or so after she stopped taking the drug. Some people do well on that stuff, others don't. Perhaps we should admit we don't know everything there is to know about anti-depressants.>>>
Anti-Depressants DO NOT HELP GRIEF. Sometimes grief can *trigger*, perhaps even cause the onset of, depression, and then anti-depressants can help. But they are *NO HELP AT ALL* for "depression" caused by depressing events.
Let me repeat: "depression" (the ordinary word) DOES NOT ACCURATELY DESCRIBE the illness called Depression. It is *much* better to call it Unipolar Affective Disorder (or even call it jsljapasdjdkd) -- ANYTHING but "depression" or "sadness" or "melancholy" or any other word that also describes emotions or feelings or thoughts evoked in the normal course of life.
Let me repeat: "depression" (the ordinary word) DOES NOT ACCURATELY DESCRIBE the illness called Depression.
Unless your sister suffered from a mental illness and *not* simply grief, she did not suffer from Depression. And it is stupid to take a medication for an illness if you don't have the illness.
It so happens that at the time my first wife died was at a time when I was not suffering from unipolar affective disorder, and the grief I suffered at her death, the glumness I suffered, was *totally unlike* the feelings/emotions which characterize an 'attack' of unipolar affective disorder. In fact, I felt good in contrast to the way I feel when suffering an attack of that mental illness called depression.
Before I go on, one thing you say above is as stupid, and I mean really stupid, as it would be to say that we ought to admit that below zero weather causes us to feel cold. You say, "Perhaps we should admit we don't know everything there is to know about anti-depressants." This makes me want to scream. I have never read anything about anti-depressants by anyone who knows anything that did not say this. "Perhaps" -- SHIT. "Admit" -- SHIT. "don't know everything" -- SHIT. We *know* (no perhaps about it), we *claim* not admit, we take for granted, not admit, that we know very little about anti-depressants. That's what most psychiatrists tell their patients. For you to write a silly sentence like this is to broadcast to the heavens that you know nothing at all about anti-depressants.
With that understood, I hope, let me move on to a part of my post that was not clear enough, and it's my fault that you misunderstood it. And it was unfortunate unclarity because it involves exactly the misunderstanding that I was trying to clear up.
When I said anti-depressants have "*no* immediate effect whatever," I meant no therapeutic effect immediately. Unfortunately, side-effects might well come very quickly. As a matter of fact, I did feel one effect from Prozac at a time when it had not yet had any effect on mood whatsoever -- I began itching all over and had to stop taking it. The same thing happened with Zoloft (chemically almost the same as Prozac). Paxil, however, did not cause itching, and I was able to continue taking it until (after about six weeks) it began to have an effect on mood. The first really noticeable effect was that for the first time in six months I was able to read a book straight through from page one to the last page. For those six months, I couldn't read more than about 10 consecutive pages, and to read a book I had to page back and forth through it, reading three pages here, than 8 pages back a chapter or two, and so forth. In other words, while I was clinically "depressed," to read a book once I had to read it in fragments, in effect re-reading it three or four times to get through it once.
Consider how odd it would be if (say) pot worked as anti-depressants do. You would have to smoke three a day for six weeks before you got your first "high," but you might be suffering from *negative* side effects from the third or fourth day.
And of course (this part of the defective knowledge which all psychiatrists proclaim not admit) an anti-depressant which works for one person, may not work for another. Or it may work for awhile, then stop working. My first anti-depressant, desiryl (sp?) began working as an anti-depressant in only a couple of weeks, but then it began to have a side effect that for males is not acceptable. So I switched to Elavil (amitriptylin). And five days after the dosage reached 100 mg. I snapped to life. On a tuesday afternoon class my voice had run down like one of the old wind-up record players would -- and I had to dismiss class. Five minutes before a class at 9:00 the next morning I was sitting in my office trying to think how to get through the 50 minutes, when click, my mind was back. I could think. It worked well for several years -- then stopped working. That is when the trials with Prozac, Zoloft, and Paxil began. Then Paxil worked for about six years (more or less). After Paxil stopped working, I tried Serzone for almost a year -- no luck. Then I shifted to Celexa, which is working on most but not all the symptoms: if I accept some responsibility, I tend to fall to pieces, but otherwise my mood is quite cheerful.
Now your sister's dreams. That's not an uncommon side effect from some anti-depressants. Paxil caused me to have super-realistic dreams, such that later I could not be sure whether the event had occurred or I had dreamed it. (During this period I had one dream in which I had never finished by dissertation, I was in my '60s, and trying desperately at some party to sort of parenthetically get in an explnation to some stranger of this condition. No nightmare could be as frightening.) These side-effect tended to disappear after about a year. Similarly, when I first took amitriptylin it caused severe dry mouth, with the additional effect (surprisingly scary) of having difficulty in swallowing. That went away in about 6 months. Had your sister suffered from unipolar affective disorder, the mental illness misleadingly called depression, instead of ordinary grief, which from your account is the case, she might or might not be alive today.
(One effect of one medication, lithium for bipolar, has been definitely established: those who stop taking it, show a great leap in suicide over those who stay on it. It definitely saves lives -- even though it has some rather nasty side effects.)
To summarize: Side effects of anti-depressants are apt to come quite quickly. Their therapeutic effect takes much longer. After that effect does kick in, one can skip for a day or two without much risk. They don't have immediate effects on the mind/brain in the way that some (non-existent) "happy pill" might, and it is worthless to take them unless one takes them regularly. Psychiatrists don't know why they work. (The SSRI's help maintain serotonin levels, but it's not known how they do this, and it is probable that other neurochemicals also figure in depresson.)
Incidentally, amitryptilin is one of two drugs (the other is ambien) that aid sleep but do not interfere with rem sleep. I still take 50 mg. of amitriptylin each night, because without it I'll wake up at about 3 a.m. and be unable to get back to sleep. (Some sufferers from depression sleep constantly. Others are unable to sleep at all. It's a sort of baffling illness and we don't know much about it yet, despite all that has been learned in the last two or three decades.)
To repeat once more in slightly different words. Anti-depressants have no direct effect on mood but only an indirect effect achieved after some time through their impact on the flow of neurotransmitters. People who take a Prozac and expect at once to feel a difference have been seriously misled by much of the popular shit (including Cockburn's) on anti-depressants.
Only those who have actually suffered the various symptoms of depression can even begin to balance the advantages and the (very real and unpkeasant) side effects.
One woman in our support group suffered from unbroken depression for six years. The medication she began to take last winter pulled her out of it but had the side effect (for her) of extreme fatigue. She dropped it, and within two weeks was in deep depression. She began taking it again, and when I last talked to her she was definitely of the opinion that being alive but dead tired was better than the alternative. No cackling about the current low level of understanding of depression and of anti-depressants should push should be allowed to interfere victims of depression making that judgment for themselves -- and they can't make the judgment unless they first take ADs (maybe trying several) for a number of months and then compare the results of taking them with the results of not taking them.
ADs probably help around 70% of patients. Placebos help about 30%. My own suspicion is that placebos help more with physical than with mental illnesses. Placebos can trigger the body's defenses against the body's ailments. They are perhaps less effective when the illness is mental.