A couple of days ago, Carolina Squirrel asked if antidepressants helped those of us in crisis find clarity when things got really bad. Annie answered in a way only she can (go read it if you haven’t already) but I’m afraid my answer will be much more quotidian.
Sadness, despondency or depression can be measured on a spectrum, of course, but there’s two kinds of cause: depression you get from unfortunate neurological imbalances, and depression you get from unfortunate outside circumstances. I’m going to skip the part where we talk about one causing the other, or people with a combination of both, because that’s a conversation that never ends.
All I can say is this: if you have a neurological depression, you need to treat it as you would any disease or tooth decay. Even sensitive, judgment-free people have denied themselves proper care for years out of some outdated notion of what they thought they could cure themselves.
Bacterial infections are treated with antibiotics; Athlete’s foot is treated with antifungals; chemical depression is treated with antidepressants. The only difference? It’s a little harder to pick the right antidepressant for your particular brain chemistry, because the underlying problems are geometrically more complicated. But the comparison is still apt.
Chemical depression, stemming from deficiencies in certain neurotransmitters and how they interact with your amygdala, is a fucking iron-clad clawfoot bathtub falling from the sky. It is being drunk on black death tar. It is the place where nothing will ever be funny again, and the future is synonymous with torture. If you’ve ever been in the throes of it, even briefly, you no longer judge people who commit suicide.
If you’re anywhere on that side of the depression spectrum, an SSRI (or an SNRI, like the one I take) doesn’t just provide clarity, it provides something close to sanity. The thing about true depressives – like alcoholics – is that they know themselves if they tell themselves the truth. If the noonday demon has visited you off and on throughout your life, you’ll know it.
If any of that strikes a chord, then trying an antidepressant for a 3-month period is a very good idea. You can always stop taking it, as long as you taper off. It’s not going to kill you, nor mess up your brain, and remember, it may convince you that you don’t need it.
One of the most profound moments of my medical life happened about ten years ago, when I was telling my psychopharmacologist about my despondency. “I think things are really getting better,” I told her, “I only spiral downward into oblivion about twice a week these days.”
She put down her pen and looked at me. “Ian,” she said, “Forget twice a week. You’re not ever supposed to spiral downward into oblivion.” And with that statement, I finally allowed myself the luxury to demand contentment, to have a goal of actual happiness rather than survival, and to view the little pill as more than a guilty trifle.