Are you there, Serotonin? It’s me, Suzanne.

[Trigger warning for suicide ideation, depression, mental illness, stigmatization]

I am a proud member of Prozac nation.

I refuse to solve my problems and deal with unpleasant emotions. I don’t treat my depression with good ‘ol hard work and bootstraps. I take the easy way out. I medicate. My moods are chemical, my personality is a façade created by neurotransmitters.

Ah, manufactured happiness.

***

All jokes aside, I love it when I’m told that treating depression with medication is the “easy way out.” Nearly forty thousand people commit suicide every year in the United States, and approximately 60% of those people suffered from major depression. Moreover, 15% of the population will suffer from clinical depression at least once in their lifetime, and 30% of clinically depressed people attempt suicide.

I’m sorry, what, exactly, is  the problem with using an “easy way out” of depression?

The idea that antidepressants are a lesser treatment is rooted in the narrative that depression is a personal failure rather than a disease. If depression is a personal failure, then you can correct it through hard work. Taking a pill to “solve” your mistake is a cheat, an unfair shortcut to redemption.

One of the consequences of ableism is our collective distaste for vulnerability, whether of the body or of the mind. We want to believe our bodies are under our own control. We especially want to believe that our minds are under our control. The idea that our brains could suddenly get sick, and we wouldn’t be able to switch them back to healthy is, frankly, terrifying.

So we lie to ourselves. We tell ourselves that depression doesn’t exist, that it’s an invented disease, that it’s just people complaining too much about bad moods, laziness or hard times. It’s easier than confronting the reality – than realizing that yeah, there are mental, and we can’t magically control them with the flip of a mental switch.

Unfortunately, the “make loud noises and hope the problem goes away” tactic isn’t exactly helping. In a 2011 study on why people with depression don’t seek treatment, sixteen percent said they perceived treatment as ineffective, while ten percent cited stigma. 21.2% of the people who drop out of treatment do so because of stigma, and 21.1% do it because of perceived ineffectiveness.

So yeah, when you start denying that antidepressants work at all, or when you say that depression is a made-up disease and the people who have it are weak… there are consequences to that.

***

This discussion isn’t theoretical for me. When I started taking antidepressants, I, like many people, didn’t believe they worked. I thought the “hard work” of therapy would fix my depression, not the “quick fix” of medication. Thus, when the antidepressants did nothing, I didn’t bother to alert my doctor.

It took a long courtship to reunite me with antidepressants. Our reunification took a the form of a classic, 19th century marriage plot:  we had to go through misunderstandings, affronts, passions, separations and despair before we finally found each other.

Pride and Prejudice, Elizabeth Bennett, Mr. Darcy, Ball scene,

1. Misunderstandings: Fluoxetine, part 1

It was my first year in college. I hadn’t wanted to go to my university – McGill – because I thought the school was too big and I would be isolated and alone.

And, since  17-year-old me was quite prescient, I was precisely right! I did feel isolated and alone.

I did have one small ray of light: I was in a play! Whooo! Unfortunately, the play had an end date. And on the aforementioned end date, I went back to my dorm, fell asleep, and didn’t come out for three months.

Okay, so I’m glossing over some details. I did leave to get food and go to the bathroom. But I didn’t go to class. I didn’t go outside. I stopped reading. I stopped contacting the outside world. I spent my days lying in bed, listening to music, and watching every single episode of America’s Next Top Model.

I wasn’t sad. I wasn’t filled with angst. I wasn’t even anxious – which, if you know me at all, is pretty rare. I was just numb. Numb, numb, numb, numb, numb. WHEEEEEEE, numb.

Hyperbole and a half, Allie Brosh.

Hyperbole-and-a-half, characterizing me exactly (http://hyperboleandahalf.blogspot.com/2013/05/depression-part-two.html)

Sure, I was failing all my classes, ruining my academic career, spending my days in bed and doing absolutely nothing. But I wasn’t worried!

I wasn’t anything at all.

To me, nothing was wrong. I was just incredibly lazy. That was the problem. Any day now, I would snap out of my incredible laziness and start working again. Bootstraps! Yes sirree. (This strategy did not work)

Three months in, I finally told my mother that I might be a “little depressed.” Because my mother knows that I have an *incredible* gift for understatement, she interpreted this correctly as “I might be really really depressed, oh god help.”

The mental health clinic at my school had a three-week waiting list for an appointment, and my health care coverage in Quebec was crap, so my parents flew me back to the United States to see a doctor. I took the two-page test medical practitioners give you when they think you’re depressed (some of you know exactly what I’m talking about) and my doctor took one at it before he said: “Uh… yeah, you’re pretty fucking depressed.”

Except he didn’t use the word “fucking,” and he did use the phrase “major medical disorder.”

Then the Doctor recommended that I take a medical leave from school (before I failed allllll my classes) take antidepressants, and start therapy. I was worried that therapists wouldn’t think I was depressed enough to take a medical leave (remember, I still thought I was just a “little” depressed), but the two therapists I saw back home couldn’t sign the “This student should really take a medical leave of absence” sheet fast enough.

Meanwhile, my doctor put me on one of the most common antidepressants: Prozac, AKA Fluoxetine.

Fluoxetine is an SSRI – a Serotonin Selective Reuptake Inhibitor. The way SSRI’s work is by inhibiting the reuptake/ reabsorption of serotonin, a neurotransmitter that regulates mood. Because your brain isn’t “reuptaking” the serotonin, there’s more of it around, which leads to more ‘happiness.’  At least, that’s the theory.

serotonin

My buddy Serotonin!

I took a medical leave from McGill. I came home. I took antidepressants. I started therapy. Therapy was good. Not being in school was good. Being home was good.

Fluoxetine… was not so good.

“It works pretty fast,” people told me. “It was pretty instant when I took it.”

Well… I wasn’t feeling anything. Not after two weeks. Not after six weeks. Not after two months. Therapy and lack-of-school were making me feel better, but I didn’t feel like the numbness – the nothingness – was gone.

Hyperbole and a half, Allie Brosh

Hyperbole-and-a-half again, encapsulating the feeling perfectly.

Then again, I’d never taken antidepressants before – and frankly, I didn’t really think they “worked.” Maybe the effect was really subtle. So I never brought the “not working” part up to my doctor.

When I went back to McGill at the end of the summer, I fell straight back into depression.

So much for fluoxetine!

Mr. Darcy, Pride and Prejudice, Marriage Plot, Elizabeth Darcy

Told you. It’s a complicated courtship.

***
This time I made it through the semester – somehow. It was a pretty terrible semester.

During the winter break, I found a new, less stressful, living situation. I decided to take only classes I thought I’d enjoy. And I stopped taking fluoxetine. I did not consult a doctor – I was in Montreal, and I didn’t have any medical authority to turn to. I just knew that the fluoxetine wasn’t doing anything. So I stopped.

Things got better. I lived in a good place; I went to interesting classes; I started making friends. By the end of the semester, I was in recovery.

***
So hey! you might be thinking. Doesn’t this story prove that antidepressants don’t really work, while therapy and changing your life circumstances does? You took antidepressants and things got worse, you stopped them and things got better. Case closed, right?

Not exactly.

Here’s the thing about depression: we haven’t quite figured out how the fuck it works. Some of it has to do with brain chemistry, but some of it is definitely due to environmental or psychological factors. And we’re not sure how those three interact, or which ones to “treat” first.

Let’s look at those factors in the case of my depression.

1. Environmental: I was in a university I hated. I had no support system. I had no community. I had no friends. There was nothing to be happy about.

2. Psychological: Without getting into a ridiculous amount of details, one of my parents was emotionally abusive (or, to quote my first therapist: “your parent is a real bully, huh?”), and the emotional abuse caused me to adopt some pretty maladaptive lines of thought. Like blaming everything on myself; thinking I was worthless, hating myself etc. The usual.

So these environmental and psychological factors were definitely fueling my depression. And then we get to:

3. Weird brain chemistry stuff.

Hey, look! This is what depression looks like.

We know that depression changes a person’s brain (see above). We think it might have something to do with the neurotransmitters that regulate mood, like serotonin and dopamine. It’s not entirely clear whether your brain chemistry gets weird, so you get depression, or whether you get depression, and then your brain chemistry becomes weird. Maybe it’s both. Maybe it’s different for different people. Probably it’s different for different people.

But right now, science is still a bit baffled. Yes, we’ve got antidepressants, but no one’s quite sure how they work, or why they work. We know they’re doing something, because they help a lot of people. But they’re also totally useless for a lot of other people. Some people respond terribly to one antidepressant, but do great on another one.  And nobody’s sure why! But we’re dealing with a pretty terrible illness, and if a tool works, we’re going to use it, even if we’re not sure exactly what it’s doing.

(This is, obviously, a massive oversimplification of the current state of depression studies)

So, to recap: since environmental and psychological factors were a big part of my depression, changing them – finding a better living situation, going through talk therapy, surviving the hell of my second semester – made a big difference. Enough of a difference that I went into depression-recovery even though the meds I was taking to target my brain chemistry weren’t working.

Here’s the flip-side: it took me over a year-and-a-half for me to recover from my first depression without the help of medication. And it was not a fun year.

Still, you think: all the medication and neurotransmitter stuff  I just talked about? That’s all theoretical. The proof is in the pudding. You got better without antidepressants!

Just wait. You’ll see: there’s more to this story.

***
 Affronts – Fluoxetine, part 2:

The next two years went pretty well. I switched my major, fell back in love with school, made friends, participated in a play, found my community. When I had the time and resources, I went to therapy.

And then: the migraines.

My migraines have always been problem, but in my junior year at McGill, they became a plague. I got them almost every day: blinding pain in the back of my skull, accompanied by dizziness and aching muscles.

I decided that the solution to my migraines was to overhaul my diet. Protein, I thought, was the key. Cut out all those carbs and sugars, and eat miles of protein instead. Oh, and I should start an exercise program. An hour at the gym every day.

I told myself these changes – the diet, the exercise – were for my migraines. But deep inside, I knew the truth: convinced I was too fat, I wanted to lose weight.

The migraines got a lot worse. Shockingly worse. Before I started going to the gym, my migraines would always go away with a good night’s sleep. Now, I would come out of the gym and have migraines that lasted for days. Nothing made them budge – not medication, not sleep, nothing.

And even though I knew the exercise was causing the migraines, and the diet was making it worse… I kept going.

That’s when the shit hit the fan: my migraines became light-sensitive.

I would go to school feeling fine, and after an hour under fluorescent lights, I would have a migraine bad enough that I’d need to go home immediately. I couldn’t handle any light – I closed all my shades, turned off all the lights, switched my computer off – and spent the day in the dark. I couldn’t do anything. When I tried, the pain would be so bad that I would start throwing up.

Not surprisingly, these circumstances took a psychological toll. Combine the pain from the migraines with the fact that I couldn’t do anything and you’ve got a recipe for a very unhappy Suzanne. Before I even realized what was happening, I’d landed back in the middle of the town of Total Numbington.

Once I stopped going to the gym, started eating better and kept spending all my time in the dark the migraines got better subsided. My residency in the town of Numbington, however, was far more permanent.

In a repeat of my first depression, I spent most of my time in bed, reading piles upon piles of X-Men: First Class fanfic. Fortunately, this depression didn’t seem as severe as my first, so I was still able to go to class and do work. My grades held steady.

I did not see a doctor in Montreal.

When I finally came home to Wisconsin, my parent had switched health insurance plans, and I could not longer access my long-term therapist or doctor. My new doctor asked me almost no questions before diagnosing me with depression again. Then she asked me if fluoxetine had given me any side effects when I’d first taken it.

“None that I noticed.”
“And did it help?”
“I’m not sure. I didn’t feel anything, but maybe it was subtle.”

She started me on fluoxetine again.….I am not a good advocate for myself in health situations. At all. Because I should have stopped her there and said “no, fluoxetine didn’t work, we need to try something else.” But since I still didn’t realize that you’re actually supposed to * feel * the effects of antidepressant, I just acquiesced to the fluoxetine. Again: telling people that antidepressants don’t work HAS CONSEQUENCES.

The doctor, of course, wins a gold medal in “wut” medicine for translating my “I’m not sure fluoxetine did anything” response into “let’s just throw more fluoxetine at the problem.” (In a shocking twist of events, fluoxetine did absolutely nothing. Who could have predicted that result, huh?)

Some good things did happen that summer. I found a great new therapist. I started a fairly effective migraine treatment. The lack of school-related stress from school also helped. I certainly wasn’t as depressed at the end of the summer as I was at the beginning.

Eventually, I saw another doctor. I brought up the fact that fluoxetine (still) wasn’t doing anything. She decided not to switch my medication since I was about to move back to Montreal.

“We don’t want too many changes at once.”

pride and prejudice, introduction

Fuck you, antidepressants!

I was pretty much on the “FUCK ALL ANTIDEPRESSANTS FOREVER” train by this point.

Passion, or Wellbutrin Part 1

I returned to school, still on fluoxetine. Though the fluoxetine remained useless, my depression was under control.

It was a good semester. I found a low-cost therapist. I started dating the Feminist Philosopher. I worked on my honors thesis, I enjoyed my classes, I wrote some popular blog posts.

But even in those good moments, part of me was still stuck in Numbington. And I was sick of it.

The next time I went to Wisconsin, I made an appointment with a new doctor. This was the third primary care doctor I’d seen in less than a year, and I was not optimistic.

But this time, I did my research. I wrote a list of concerns. I found a website with lots of information about antidepressants (Crazy Meds), and I read the relevant information. I knew enough that I could advocate for myself.

And this time, the doctor actually listened to me. Our appointment was supposed to be fifteen minutes long, but she spent an hour with me. We went through my list of concerns, discussing the various things that could be contributing to my mood, making a plan. She asked my opinion on various medications.

I walk out with a list of concrete suggestions and a prescription for Wellbutrin.

***
Wellbutrin, otherwise known as Bupropion, is not an SSRI. And it’s not… entirely clear how it works (you may have noticed a trend here).  Our best guess is that it inhibits the reuptake of dopamine and norepinephrine, two neurotransmitters that, like serotonin, work as mood regulators. Since I hadn’t responded well to an SSRI (fluoxetine), my doctor bet that targeting dopamine and norepinephrine would work better than moving on to another SSRI.

Ignore the last one; I couldn’t get rid of it.

Wellbutrin works quite well with depression. It also has very few of antidepressants most infamous side effects: it doesn’t (usually) cause sexual dysfunction, weight gain or somnolence (feeling tired all the time). It occasionally leads to weight loss – which some people may feel is a plus, but which could be a problem for others.

Crucially, Wellbutrin works particularly well with people whose depression is coupled with social anxiety (*raises hand*) and people whose depression manifests through anhedonia – an inability to take pleasure from activities you usually enjoy (*raises hand*).

Wellbutrin, in other words, was an ideal antidepressant for me. It wasn’t an SSRI, it had few side effects, and it tended to work well for people whose depressions were similar to mine.

I felt so much better when I walked out of the doctor’s office, in large part because I wasn’t just taking a pill on faith. The doctor had explained her reasoning, and I felt that she was addressing my specific needs, rather than giving me a one-size-fits-all medication.

Thus, armed with a new antidepressant and a whole lot of hope, I returned to Montreal’s cold embrace.

***
Reader, Wellbutrin worked.

pride and prejudice, gif, Elizabeth Bennet, Mr. Darcy

Two and a half weeks after I’d started the pills, I woke up at nine, lounged in bed for less than five minutes, got up and started making breakfast.

Wait. Pause. If there was something I’d never been able to do during my depressions, it was actually waking up. What the hell was going on?

It kept going. I started getting out of bed with energy in the morning. I was motivated to do things. I was procrastinating less. I’d finally started outlining my honors thesis. My appetite was back. My insomnia was gone. I planned for meals and sleep. And my anxiety, the electric beast perching on the back of my head day and night, seemed to have gone to sleep. I only felt occasional prickles.

Then, reader, I had to have a bit of a sit-down. Because if a medication could make my depression better so quickly and so radically, then maybe I wasn’t the problem.

Maybe I actually did have fucked-up brain chemistry.

Elizabeth bennett, gif

You think I would have figured this out earlier. But even though I believed that depression was a disease, not a personal failure, and even though I knew the mechanics of depression, and even though I knew I couldn’t just “snap out of it – subconsciously? I was pretty sure it was my fault. I bought into the “depression as personal failure” model.

Wellbutrin knocked a couple legs off that theory.

 Part 4: Separation, or Wellbutrin, part 2

A few weeks after Wellbutrin started working, I started fainting. Plus, I had a noxious combination of dizziness, nausea, constant-never-ending hunger and hypoglycemia.

… side effects.

I was in Canada, and I had no way to pop down to my doctor’s office in Wisconsin to figure out if Wellbutrin was indeed causing these symptoms. They weren’t on the list of common side-effects, but there weren’t a lot of competing explanations. At some point, my doctor stopped responding to my emails. I was cut off of medical advice. Any doctor I could have seen in Canada would have cost a whole lot of money, and would have zero knowledge of my medical history.

And meanwhile, I was dizzy/fainting/hungry/nauseated/ freaking out.

I stopped taking Wellbutrin. Cold turkey, no titrating. It seemed like the best option at the time.

Pride and Prejudice, Mirror scene, Elizabeth Darcy

I stopped fainting. The dizziness went away. And the depression, temporarily banished to the outer atmosphere, fell straight back home. With a vengeance.

Going from “doing good!” to “severely depressed” in a week was viciously painfulI spent a lot of the month of February and March curled up in bed, watching Elementary and drawing pictures of naked women (don’t ask).

But I did return to functionality. Depressed functionality, true, but functionality. All of my assignments got turned in on time. I missed minimal classes. I finished my honors thesis with time to spare. I graduated with first class honors. I made some big life decisions; I moved apartments; I dealt with bed bugs. I started playing video games.

Three people are now rolling on the ground, laughing at this Dragon Age joke. Credit: http://falseteethcyborg.deviantart.com/art/Shale-DESTROY-ALL-PIGEONS-198074293

I was depressed, but I was okay.

Part 5: Despair

Then I stopped being okay.

It was summer. I was no longer in school. I was facing a really massive change in my life: the end of college, the beginning of my adult life, a move to a terrifying new city etc. etc. etc.

And I was now entering year two of an untreated depression.

My depressions were usually characterized by numbness, exhaustion and lack of interest in the world. I did have moments of overwhelming sadness, but they were moments. They lasted twenty minutes to an hour at the most.

Now they lasted days. My numbness now translated into constant sadness and despair. I took frequent breaks during the day to lie in bed and cry. I cried myself to sleep most nights.

And then, for the first time in my near-five years of experience with depression, I experienced suicide ideation.

Feeling suicidal is Not Fun. Especially when it’s happening 2-3 times a week, and you’re too terrified by the feeling to tell anyone. I’d always been able to handle my depression. I didn’t know how to handle this. I didn’t know how to handle the overwhelming sadness and shame and guilt that made me want to die. I’d always felt like a burden; now I felt like so much of a burden that I just wanted to disappear, to make everyone’s life easier.

Hyperbole and a half

Yes, I wanted to live; I wanted to live desperately. I had so much to live for. But I also wanted desperately not to feel, to stop the pain of living, to end my constant guilt. In those moments, I felt trapped – I couldn’t see a stopping point to the pain. I didn’t believe there would be a stopping point. I just wanted it to end.

It never got bad enough that I started planning, or even considering options. But the “not bad enough” was more than bad enough for me.

I was so scared.

A friend and I were talking over facebook around this point, and she said, “I don’t understand. You have the Feminist Philosopher. You two seem so happy together. And you’re moving to NYC, and there’ll be lots of opportunities there. Why are you depressed?”

See,  that’s what’s so terrifying about depression. It’s not necessarily a response to something. It can be caused by psychological and environmental factors, but it doesn’t need to be. It’s an illness.

It doesn’t need to be caused by anything.

Which, when you’re lying in bed thinking about death, is horrifying. Because if it isn’t caused by anything, how are you going to make it go away?

Reunification, or Paxil

Paxil!

To cut a long story short: I found a way to get back to Wisconsin (for a ridiculous amount of money). I saw my doctor and left her office with a prescription for a new antidepressant: Paxil, AKA Paroxetine

Even today, I have zero idea why I was prescribed Paxil. It’s one of the more prescribed antidepressants, but it’s not one of the most effective ones – in a lot of trials, it’s not even as effective as fluoxetine, which we’d established didn’t work for me at all. It’s also one of the worst, if not the worst, antidepressant for side effects – especially for sexual side effects.

I… was not happy about that. I really like sex. Sex was one of the things that remained wonderful despite the depression.

And, on top of the horrible side effects, Paxil has a notorious discontinuation syndrome. If Paxil didn’t work, not only would I have to find a new antidepressant, I might also have to deal with withdrawal.

At the same time… Wellbutrin was supposed to work great and cause zero side effects. But it didn’t. So maybe I wouldn’t know how Paxil would work for me until I tried it.

So I tried it! Very unhappily, but I did!

tumblr_li9vljpWlo1qcrza7o1_500

I really wasn’t expecting much.

But taking Paxil, my friends, was a good life choice, because two-and-a-half weeks later, the fog just – lifted.

I know this whole “fog-lifting” thing sounds like a figure of speech, but it did not feel that way at the time. It was as though every color in my brain had reset to a brighter setting. Two weeks.

Pride and Prejudice, Mr. Darcy, sunrise scene

Antidepressants rising

I stopped feeling suicidal. I haven’t had a single episode of suicide ideation since I started taking Paxil. All my random crying jags ended. I mean, I still cry, but there’s always a reason – I’ve had a bad day, I’ve dropped a stack of books on my foot, I’m watching Catching Fire and I can’t handle the flashbacks to RUUUUUEEEE.

My moods made sense. I wasn’t randomly desperate or unhappy or mad. If I was sad, it was because something sad had happened. And my default was no longer “numb/sad,” it was “fairly happy.”

Yeah, when antidepressants work, they can really work.

A few weeks later, I moved to a new city – New York City, in fact. Unlike my first major move (to Montreal), this one did not provoke a new depression. In fact, I was pretty thrilled. I found a great job. I found a second job as a freelance book reviewer (!!!). I made friends. I explored the city. I spent lots of time with my boyfriend.

When people say that antidepressants squash creativity, I laugh and laugh. Sometimes I can stop laughing before they start talking about calming drinks.

Prior to Paxil, I was basically incapable of reading, much less writing. When I got to New York, I started writing again. I managed to publish a few blog posts – those had essentially disappeared during the Major Depressive Summer. I began writing fiction again for the first time in years. I taught myself how to spin yarn using a drop spindle. I started painting my nails. I took the GREs, I applied to graduate school, I got a 750 on the GRE in Literature. The three people who have taken that test are now suitably impressed.

I started volunteering.

tumblr_mayaoxQWRA1rrghlso1_500

Dear Paxil:

… yeah, I’m pretty sure the antidepressants aren’t destroying my personality.

Okay, let’s talk about the bad news – the side effects.

I’ve got a couple. The usual vivid dreams – serotonin is notorious for this one – but vivid dreams don’t really bother me. I’m sleepier, although I can’t tell whether this comes from the paxil, or from all the migraines I’ve been getting. I now shake my leg when I’m working at my desk – again, I can’t tell if this is a side effect from paxil, or if I’ve just picked it up in the last few months.

I haven’t had any sexual side effects, which is BLOODY FANTASTIC. My sex life is great, thanks for asking!

I have gained a lot of weight. Side-effect fatty over here! Obviously, it is possible that this is an unrelated weight-gain, but the evidence seems to indicate that it stems from the Paxil. I’ve also been eating less and exercising more since I started Paxil (it’s amazing how not being depressed can help you get out of the house/cook food). And I gained weight on my other SSRI, fluoxetine, which I lost it when I stopped taking the drug.

I think I’ve gone up a couple dress sizes. Am I super-happy about this? Nope!

I am a product of our society, and although intellectually, I don’t think there’s anything wrong with being fat(ter), I struggle with a shit-ton of body issues. Plus, you know, having to buy new clothes sucks.

At the same time, I’d rather be bigger and happier than thinner and depressed. At least when I’m in recovery, I have the emotional resources to deal with body-image issues. When I’m depressed and thinner, I still hate my body, but I have no capacity to deal with it.

So. On balance, I’m quite pleased with Paxil. It took three medications, but I’ve finally found one that puts me in recovery, and where the side effect are tolerable.

Part 7: The end of the courtship

Having been through the whole courtship and marriage plot shindig, let me tell you, I’ve learned a lot about antidepressants. I know how to make a relationship with serotonin and other neurotransmitters work.

Let me share my secrets.

1. If you don’t feel antidepressants working, they’re not working

I wasted an incredible amount of time taking fluoxetine because I thought it might be working even though I didn’t feel any different. Now I know better: if you don’t feel an antidepressant working within six weeks, it’s not doing anything.

You definitely want to give it six weeks (although many doctors will want you to check in after three weeks to see if they should up the dose) because some antidepressants take time to work. But if you’re not feeling anything, or if what you’re feeling is so subtle that it’s meaningless, you have the right to bring it up. There’s nothing wrong with you because a treatment didn’t work. And you are not obliged to keep quiet about it to make the doctors feel better or to avoid inconveniencing anyone.

Moreover, just because one dosage of one antidepressant doesn’t work does not mean that antidepressants are wrong for you, full stop. After using fluoxetine, I was pretty sure antidepressants did nothing for me. Five years later, I can say with certainty that some antidepressants do a whole lot for me.

Is it a pain in the ass to deal with the trial-and-error of finding the right medication? Absolutely. Just like it’s a pain in the ass to do the trial-and-error of finding a new therapist.

But one experience with antidepressants does not seal your fate with psychiatric medications.

2. Doing your own research is a good idea.

Understanding how antidepressants work and having my own internal database of medications, their side effects and their efficacity went a long way to reconciling me to the idea of psychiatric medications after my bad experience with fluoxetine.

Obviously, it’s important to remember that what you find in your research doesn’t determine how you’ll react to any given antidepressant. See: my experience with Paxil. But it can help demystify the process and allow you to advocate for yourself in the doctor’s office.

You can also get an idea of what side effects are unacceptable to you. Heightened anxiety? Cognitive problems? Somnolence? Loss of libido? If you give doctors an idea of what you don’t want, they can try to tailor their prescription.

At the very least, if you’ve done your research, when your doctor says something you know is false, you can run. 

(I’m personally a big fan of the irreverent and comprehensive website Crazymeds. It’s got a ridiculous amount of information on various psychiatric medications (not just antidepressants). It’s also run by crazy people, for crazy people, which I find reassuring))

3. Advocating for yourself is important, but is also paradoxically the hardest thing to do while depressed.

Finding the right antidepressant involved a whole of lot of me standing up for myself, demanding that doctors help me and refusing to believe that it was all my fault.

In other words, it took a lot of investing in myself.

But there’s a reason it took me five years to get to that point. Because when you’re depressed, you have nothing to invest in yourself. Your resources are gone.

And depression, meanwhile, is actively convincing you that there’s no problem at all… except you. You’re the problem. You’re not sick, you’re just lazy/stupid/etc.

Which is why:

4. Getting good treatment involves supportive, continuous healthcare.

 You know when I started getting good treatment? When my doctor started listening to me. That’s how I got prescribed Wellbutrin. That’s how I got prescribed Paxil. Before then, I’d been through two separate doctors who either hadn’t listened to my problems, or hadn’t inquired further about my experience with antidepressants when I said they weren’t doing much. That… was not okay.

Mental illnesses are a chronic problem, and they need continuous care. A prescription is not the end. Often, problems will arise, the dosage will need to be adjusted, side effects will appear, or the medication won’t work at all. Healthcare here needs to be seen as a long-term process, both by the patients, and by the doctors. My biggest problem with recovery has been my lack of continuous healthcare. Even when I found medications that worked for me, I couldn’t go see my doctor for a regular check-in, because I was in Canada and she… wasn’t. I probably would have found the right antidepressant a whole lot faster if I were able to access healthcare more often.

But unfortunately, access to healthcare was geographically and economically impossible for much of my college life. (It’s still economically impossible for me at this point, which… is great! (not))

5. Who gives a shit if Antidepressants Are the Easy Way Out?

So, are antidepressants the easy way out?

Time for a rant: The idea that antidepressants are an “easy solution” to depression is such bullshit. The flip side of that coin – that therapy, exercise, diet change etc. and tackling the “root psychological problem” – are the “correct” way to solve depression is also pure BS.

Both these ideas are rooted in the narrative that depression is a personal failure, a mistake you can “correct.” Some people choose the “easy” way out and just take pills, which means they never “correct” their personal failures. Others pull themselves up by their own bootstraps by doing therapy and running 30 miles a day. Those people are actually “correcting” their personal failure by doing the hard work of personal redemption.

Yo, depression isn’t a tragic flaw in a shakespearian tragedy. It’s a disease that fundamentally changes the way your brain works. You do not “deserve” to be depressed. You aren’t depressed because you took the wrong path in childhood. You aren’t depressed because you’re lazy. You aren’t depressed because you’re weak. You’re depressed because you have an illness.

And since depression is an illness, not a character flaw, it responds to treatments like an illness. Which means that everyone’s depression will respond differently to therapies and treatments. No treatment is inherently better or worse than another. If therapy helps you, that’s great. If antidepressants help you, that’s great. If a combination of the two is an optimal solution, that’s fantastic.

Important side note: since depression is an illness that no one really understands, you won’t know what works for your depression until you’ve found it. There’s no great way to guess what’ll work for someone, which is why we shouldn’t assume that one treatment is better than another for any particular person (unless, obviously, there are allergies/side effect issues/other health factors).

Finally:  Who the fuck cares about whether something is “easy” or not when you’re severely depressed? Seriously, this is life we’re dealing with, not an endurance contest. There is no prize at the end for the person who Worked The Hardest To Solve Their Brain Chemistry Problems.

***

Disclaimer: This was my long, long, long post about my personal experience with antidepressants. As a reminder, it’s… my experience, not anyone else’s. And there are a shit-ton of problems with antidepressants beyond the fake issues people invent. Hey, it’s harder for people of color to get correctly diagnosed! Doctors make all kinds of terrible mistakes based on stigma! We don’t have the healthcare structure necessary to make sure that people who need treatment *get* continuous treatment!

Tons of problems.
Antidepressants being “easy” isn’t one of them.


Letter to Melissa Harris-Perry

[Note: This post started as an open letter to Melissa Harris-Perry, one of my favorite public commentators and host of The Melissa Harris-Perry Show. Realizing, of course, that Melissa Harris-Perry is highly unlikely to read this letter (since she has other shit to do), and that people on my blog ARE likely to read the letter, the letter evolved into a more general analysis of how we can discuss mental illness in mainstream spaces in a constructive and not-disablist way. My solutions don’t go far beyond the glaringly obvious, but sadly, the current state of discourse is such that even the glaringly obvious would be a victory.] 

[Not that I would complain if Melissa Harris-Perry DID read the letter, but I just wanted to cover all my bases] 

Content note for disablism, mental illness, violence.

****

Dear Melissa,

Hi! My name is CD.

Okay, actually, I’m writing to you from my pseudonymous blog, so my pseudonym is CD. My name is something completely different.

Now that we have that out of the way –

So, first of all: I’m a big fan of the Melissa Harris-Perry show. As a progressive, watching the mainstream news usually makes my head explode. If it’s not the all-white, all-male panelists discussing reproductive rights, it’s the casual sexism, or racism, or transphobia, or classism, or – there’s a whole list.

Watching your show, on the other hand, is… what’s the opposite of “head exploding from rage?”
Whatever that emotion is, that’s how I feel when I watch the show.
The Melissa Harris-Perry show examine issues that no one else is talking about – solitary confinement, the war on drugs, transphobia, poverty (to name just a few). And your panels are meaningfully diverse – I think you’re the only current affairs show I’ve ever seen where white men are consistently in the minority of your panelists.

There is, however, a more… pointed reason for my letter than fangirling over the wonderfulness, head-exploding-with-confetti-ness of the show.

I wanted to talk to you about the way your show has addressed mental illness.

In the wake of the Sandy Hooks massacre, many of your episodes have included segments on gun violence and gun control. For the most part, I’ve thought those panels were fantastic. You and your guests have a knack for refusing to allow unexamined assumptions to remain… well, unexamined.

Mental illness, however, is one assumption that I think has remained unexamined on your show (at least, so far).

It hasn’t been a big thing on the show, let me be clear. Neither your nor the panelists have talked at length about mental illness and its relationship to gun violence. But like clockwork, every time the issue of gun violence comes up, someone will say “Noun, verb, we need to talk about mental illness.”

And then the moment passes.
Unexamined.

Let me give you some examples. On the December 15th show, a guest said we should not stigmatize socially awkward kids (this was in the wake of Adam Lanza being described as “socially awkward”) but we should make sure that their social awkwardness was not the result of a “personality disorder.”The assumption being, I suppose, that social awkwardness is not dangerous, but a personality disorder might be.

[That particular guest might be shocked to learn that 9% of Americans ages 18 and above have a personality disorder] 

On the January 13th show, you said Americans are afraid “a madman” will enter a school and start shooting. Another guest explained that Americans support background checks to keep guns out of the hands of “criminals, convicted fellons, domestic abusers and the dangerously mentally ill.”

Again, it’s just a moment. A passing mention.
But those passing mentions contain a giant truckload of assumptions about what mental illness is, who mentally ill people are, and how mental illness is connected to gun violence.

Here’s a final example. On January 12th, a guest said: “A lot of Americans don’t think [gun violence] is about gun control. They think this is about crazy people. So that’s why you see the President talking about mental health.”

That would be the moment I started arguing with my computer screen [I watch the show online].

Because I am a crazy person.

No, I don’t mean that hyperbolically. I don’t mean that metaphorically. I don’t mean that I’m eccentric or silly or ridiculous or bizarre.

I mean that, assuming your guest thinks “crazy people” are people with mental health issues, I am a crazy person.

Yes, I am a person with mental health issues. I have a mental illness. In fact, I have two! (Sadly, you don’t win any prizes for having more than one – I’ve checked)

So every time someone on a news show casually mentions that mentally ill people are dangerous, or every time an unnamed Governor (*cough* Andrew Cuomo *cough*) passes a law that limits access to guns by the mentally ill, because “People who have mental health issues should not have guns. They could hurt themselves, they could hurt other people”  –

Every time, they are talking about me.

And I don’t like being talked about. I prefer to be involved in any discussion that concerns me. Hence my desire to talk back. To create a dialogue, if you will.

***

On the January 26th segment about Obama’s war and drone strikes, Melissa, you talked about how you think “drones” have become a progressive meme. As you explained, progressive don’t really know why they oppose drones, or what they actually think the problem is – but they will consistently say things like “I support Obama, except for his drone policy.”

I submit to you that mental health has become a similar meme. No one knows exactly why mental health is linked to gun violence, or even whether or not gun violence has anything to do with mental illness.  No one’s seen the research, or talked to people with mental illnesses, or even really considered what they mean by “dangerously mentally ill” or “crazy” or “discussion about mental illness.”But everyone feels compelled to mention mentally illness whenever we have a conversation about guns.

So let’s look at the facts.

– First, and crucially: We don’t actually know whether or not Adam Lanza had a mental illness. We’re just assuming he had one, based on the fact that he shot and killed twenty six people.

His brother and some of his neighbors have reported that Adam Lanza was diagnosed with Asperger’s syndrome or was on the Autism Spectrum. If this is true (and relying on second-hand information is not exactly great), we need to remember that Aspergers and Autism are not mental illnesses. They are developmental disabilities. 

And it is symptomatic of the state of the discourse about mental illness that very few people have bothered to make the distinction. Indeed, at this point we’re using “mental illness” as a catch-all term for everything from developmental disabilities to mood disorder and personality disorders to people who are neuroatypical. Only some of those things are actual mental illnesses.

– Second: Violence is not linked to mental illness

The reason public commentators – and many of your guests – keep bringing up mental illness, Melissa, is because they assume that mental illness causes violence. Yes, we don’t actually know if Adam Lanza had a mental illness, the thinking goes. But because he shot up a school, he must have one  In other words: to pick up a gun and go shoot a group of strangers, you must be crazy.

(Interestingly, no one ever brings up the mental illness argument after a terrorist attack. Why aren’t we concerned about the mental health of terrorists? We don’t need drones in the middle east – we need more anti-depressants!)

And indeed, the research shows that most Americans believe people with mental illnesses “pose a threat for violence towards others and themselves” (source)

But that is not the reality.

Most of the people who are violent do not suffer from mental illnesses. Repeated for emphasis: most of the people who are responsible for violent crimes – rape, domestic abuse, gun violence, assault, homicide etc. – do not have mental illnesses.

Moreover, the vast majority of  mentally ill people are not violent. Indeed, according to nearly every study on the subject, “The absolute risk of violence among the mentally ill as a group is very small. . . only a small proportion of the violence in our society can be attributed to persons who are mentally ill (Mulvey, 1994).”

Moreover, it is a provable fact that mentally ill populations – including mentally ill people with illnesses that we most associate with violence (Schizophrenia, for example) – are in fact no more violent than the rest of the population. 

Now, you might ask: “Okay, but Adam Lanza might have had autism. Are autism/aspergers/other developmental disabilities linked with violence?”

And the answer would, again, be “no.”
To quote Dr. Max Wizniter, a neurologist and autism expert, “Aggression and violence in the ASD population is reactive, not preplanned and deliberate” – exactly the opposite of Adam Lanza’s very carefully planned massacre.

These facts directly contradict the popular meme that mass violence is caused by “the mentally ill” and that if we just get more mental health care, or make sure to keep guns out of the hands of people with mental illness, or create a national database of mentally ill people, gun violence will go down.

It is provably untrue that mental illness causes violence. I will repeat this until I am blue in the face, because people are just not hearing it: it is provably untrue that mental illness causes violence.

When public commentators put mental health care on the list of things we can do to stop gun violence, it makes just about as much sense as saying that more knitting classes will stop violence. Or people eating more tomatoes. Lack of tomatoes is not the problem. Lack of knitting classes is not the problem. And mental illness is not the problem.

This is not, of course, to argue that no mentally ill people are violent. Some mentally ill people are. But  violence cannot be predicted by one’s mental health. Being mentally ill or neuroatypical makes you no more likely to commit acts of atrocity than anyone else.

***

Melissa, I am not just writing this to correct a popular misconception about mental illness. I am also writing because, as you know, discourse has consequences.

Indeed, talking about mental illness as the source of gun violence isn’t just factually incorrect. By talking about “the mentally ill” as though they’re all ticking timb-bombs, ready to explode into violence and aggression, we are further stigmatizing people with mental illness.

When Andrew Cuomo tells the world “People who have mental health issues should not have guns. They could hurt themselves, they could hurt other people,” he is furthering the stereotype that people with mental health issues have no self-control, that they are incapable of making good decisions and society needs to “take care of them.”

When one of your guests says: “A lot of Americans don’t think [gun violence] is about gun control. They think this is about crazy people. So that’s why you see the President talking about mental health” he is furthering the stereotype that “crazy people” are inherently violent.

And when Wayne LaPierre – I hate to bring him up, but he occupies a prominent role in the discourse – says that there are “genuine monsters” in American society, and then, in the same breath, tells us we should create a national registry of the mentally ill…

I’m pretty sure I don’t have to explain that one, do I?

People with mental illness are not the hidden monsters of American society. They are not incompetent crazies who are incapable of making decisions for themselves. And they are not ticking-time-bombs of potential violence.

But that is what the discourse is making us out to be.

And discourse has consequences. 

Hypothetically, do you think that knowing society thinks people with mental illness are violent and dangerous makes someone more or less likely to seek mental health care?

Do you think knowing your mental health professional might have to register you in a National Database makes you more or less likely to seek mental health care?

Do you think believing that mentally ill people are incompetent and incapable of good-decision making makes you more or less likely to seek mental health care?

Speaking about autism, Sara Reed, director of advocacy and family services for an autism resource center in Connecticut said: “We’re very concerned about families feeling stigmatized and being afraid to seek services for fear that their child will be seen as a possible monster.”

Stigma makes people less likely to seek help, not more.

***
I know this letter is getting a bit long (the bad news is that I write best at length. My professors love grading me), but trust me, this is where we get to the good part.

Initially, Melissa, I just planned to write a letter to you explaining why our current discourse around mental illness is harmful. But I’ve already talked about that in other contexts: specifically in a blog post I wrote right after Newtown.

So, I thought: is this just going to be another rant about disablism (social prejudice against people with disabilities)? Because rants are good! Rants are useful! But maybe – you could stretch a bit. Stretching is good.

Okay. You’re writing to a public commentator. You’re writing to a public commentator who you admire precisely because she’s so good at creating constructive, nuanced, non-oppressive dialogue on TV – a space where constructive dialogue is… very hard to find.

Why don’t you take a page from her book and try to address how we could have constructive, non-oppressive dialogue about mental illness in mainstream spaces?

You want better dialogue, CD? Explain what that looks like.

Since my brain tends to order me around, that’s what I’m doing here, in the second part of the letter.

I’m not saying this dialogue has to happen on the Melissa Harris-Perry show, by the way! Presumably, you have lots and lots and lots of other things to do. Like being a professor WHILE ALSO RUNNING A TV SHOW (how are you so awesome? Can you teach me your ways?)

Instead, I’m taking inspiration from the show and trying to imagine what we would need to have a constructive, non-oppressive dialogue about mental health. In mainstream spaces.

[The most obvious thing we need, of course, is to stop linking mental illness to gun violence, but I think I’ve addressed that issue pretty thoroughly above, and people are probably already getting bored.]

1. Inclusion of People with Mental Illnesses

The first, and most important thing that we can do to create constructive dialogue about mental illness is to include and prioritize the voices of people with mental illnesses. 

The Melissa Harris-Perry Show is, I think, probably the best show I’ve seen for this: when you talk about an oppression, most of your guests are members of that oppressed group. When you talked about trans* issues and cissexism, most of your panelists were trans*. When you talk about race, most of your panelists are people of color. When you discuss women, most of your panelists are women.

And that’s something I don’t think I’ve seen any show, any newspaper or any magazine in the mainstream do with regards to mental illness.

Can you imagine having a conversation about women’s reproductive rights without any female speakers?

… wait, this is the United States. Of course you can! In fact, it’s happened before. But when it happens, we are (rightfully) outraged. Yet the very same people who are horrified when conservatives discuss reproductive rights without including women have no problem with a conversation on mental health that does not include anyone with a mental illness.

[It is, I must say, quite frustrating to turn on the TV and hear people talking about me as if I were completely incapable of speaking for myself]

The mentally ill are people we talk about, not people we talk to. We aren’t interested in having a conversation with them, despite the fact that they’re the ones most affected by the issue. They’re some kind of nebulous other, voiceless and faceless.

But we are not a nebulous other. If you know more than four people, you probably know someone with a mental disorder. If you know more than twenty, you probably know someone with a major mental illness.

Approximately one fourth of all Americans suffer from a diagnosable mental disorder in a given year. 6% of people suffer from a serious mental illness like major depressive disorder, bipolar disorder, schizophrenia or borderline personality disorder. Mental disorders are the leading cause of disability in the US and Canada.

Personality disorders? Nine percent of Americans.
Post Traumatic Stress Disorder? Three percent of Americans.
Schizophrenia? One percent of Americans.
Bipolar Disorder? Between two and three percent of Americans.
Mood disorders? Nine percent of Americans.

And when we talk about developmental disorders (when we can be bothered not to lump them in with mental illnesses), we should prioritize the voices of people who actually have developmental disorders. Which, incidentally, means I’m a total hypocrite, because I… have no developmental disorder.

Estimating the prevalence of Autism Spectrum Disorders is difficult given the differences in the ways that cases are identified and defined (and the continually changing diagnostic criteria), but a recent CDC study estimated that the prevalence is around 1 in 110.

(all statistics from: National Institute of Mental Health)

My point, it is this: there are a whole lot of people with mental illnesses, neuroatypical people and people with developmental disabilities. If you know more than four people, you probably know someone with a mental disorder. If you know more than twenty, you probably know someone with a major mental illness.

If you want to talk to us, you can find us. 

So, Step one to constructive dialogue: include and prioritize the opinions/voices of people with mental illness.

MOREOVER, to take a page from the Melissa Harris-Perry Show (again), we should make sure that the conversation is meaningfully intersectional. For example, when the Melissa Harris-Perry show has panels on reproductive rights, the guests aren’t all white, straight women. There are women of color, queer women etc. Similarly, conversations about mental illness should not be dominated by white, middle class, cisgendered, straight people with mental illness.

(Oh, hi, hypocrite award #2! I’m white, middle class and cisgendered)

Which leads to point #2 on creating constructive dialogue about mental illness

2. Talking about issues that actually affect people with mental illnesses in an intersectional manner. 

Which, again, does not include talking about gun violence (except insofar as gun violence affects people with mental illness because, hey, we can get shot too! Also, many people who survive gun violence develop mental health issues)

So what are some of the issues that affect people with mental illnesses?

… whoa. That’s a, er, VERY BIG question.

When I think about the array of issues surrounding mental health and neurodiversity that we, as a society, need to tackle, I feel daunted. We need to work on accessibility. We need to work on accommodations in the workplace, in schools, and in society as a whole. We need to promote a wider understanding of what mental illnesses are (and are not). We need to realize that everyone has mental health needs, not just the people with diagnosed mental illnesses.

And we can’t do any of these things without first destigmatizing mental illnesses. It doesn’t matter if we have the best access and accomodations in the world, if people are too ashamed or scared of being considered “weak” and “crazy” and “dangerous” to use them. So we need to talk about destigmatization, and what that would look like, and how we get there.

Moreover, since mental illness is not a monolith, there will be no single solution, no one-size fits all. It’s possible to destigmatize depression without destigmatizing schizophrenia, for example. People with bipolar disorder, people with depression, people with schizophrenia, people with PTSD – all of them need very different things. When we consider that most people lump developmental disabilities or variances under “mental illness” (even though they expressedly are not) this becomes even more complicated – a policy to help people with autism probably won’t help people with depression.

Not to mention the fact that every individual person experiences illness in different ways.

All of these conversations, moreover, need to take place with a broad understanding of intersectionality. The issues that face a mentally ill person like me – white, middle class, cis, bisexual and female – will be vastly different from the experiences of a person of color, or a trans* person, or a poor person with mental illnesses. And a society that already believes people with developmental disabilities and mental illnesses are violent is even less tolerant towards those bodies that are constantly coded as violent: for example, most of the the violence directed at people with mental illnesses is directed towards black men (girl janitor).

There are really important, HIGHLY under-discussed ways that disablism intersects with race, class, gender identity (and expression) and sexual orientation.

We want to have a conversation about mental health issues?

These are good places to start.

***

In my perfect fantasy world, of course, this conversation would actually happen on your show, Melissa. But you, I think, have a lot of other things on your plate. So instead, I hope (ambitiously, for a small blog) that this letter/blog post can serve as a starting point for people who want to have good-faith conversations about mental illness.

Thank you for showing that constructive conversations can happen on TV, Melissa. And keep being awesome.

Sincerely,

CD

p.s: if I could ask one favor, though, Melissa, I would really, really appreciate it if you steered your guests away from saying problematic things about mental illness. It… gets wearying.

p.p.s: For everyone who is interested, here are further resources about mental illness. They are also some of the the resources I used to write this post (so everyone can verify my research! Hey, I’m writing an open letter to a Professor. My research better be solid)

Stop Linking Autism to Violence 

The Numbers Count: Mental Disorders in America

In Pursuit of Doing Something Meaningful 

An Observation About Mental Illness (on how trauma, like that suffered by the students at Newtown, often causes mental health issues)

On Sitting With Fear (Analysis of why all the mass shooters have been white men)

Girl Janitor: Race and Mental Illness (if you are a white person with mental illnesses and you cite statistics on mentally ill people being shot by the police (Hi, I was one of you, once!) , YOU NEED TO READ THIS)

Dispelling the Myth of Violence and Mental Illness 

On Not Being Adam Lanza (shameless self-promotion)

Feel free to add onto this in the comments.