Yves here. The fact that antidepressants loom so large in our collective discourse says that there is something wrong with society. That is not to say that a lot of people do not benefit from them. But even before how people are being treated, look at some raw figures from Statista:
These results are significantly due to a society that has no interest in what it takes to create emotionally satisfied lives. Neoliberalism demands that community and personal relationship be subordinated to job needs. Relentless advertising and status competition reinforce the message that happiness lies in having better stuff and staying on the sugar high of gratification-by-shopping. And many if not most are also very poorly trained in coping skills, like an acceptance of failure and losses. The purpose of the world’s major religions is to help followers deal with the inevitability of suffering and death.
One of the reasons of the broad use of antidepressant is not just the hope of a quick fix, but the need for one in which for nearly all, selling your labor is a condition for survival, and thus one cannot afford the productivity drag of depression and grief.
Johann Hari is a forceful advocate of this line of thinking. One can contend that he’s too doctrinaire, but it is hard to deny that he is on to something. From a 2018 post:
Below we’ve posted an interview with Hari on his new book, Lost Connections, which is an investigation of the depression industry, although he doesn’t call it that. His work started with his own experience, of being medicated for depression starting as a teenager and only having at best short-term relief. He found it striking that his experience of rising doses with what amounted to relapses was common and was also taking place when the number of people taking anti-depressants and other psychoactive medications was exploding.
As you will see, Hari makes a strong-form argument that the causes of the big increase in reported cases of depression are social, that the modern work environment is particularly hostile to people having a sense of control and purpose that is important to well being. He also contends that the “brain chemistry imbalance” theory of depression was not proven when selective serotonin uptake inhibitors like Prozac were becoming popular and even as of today does not have a solid scientific foundation.
Another angle Hari discusses is the way that advertising induces people to make unhealthy social choices. I wont’t give away the anecdote in his video. But more broadly, advertising is designed to create needs and wants, which means preying on insecurities and desires. Moreover, a great deal of advertising presents people who are “happy” as the result of consuming the product or service on offer. That happiness is seldom contentment or relaxation; instead it is usually giddy or euphoric. Those aren’t sustainable states. They are brief highs. But the message to consumers on a large scale basis is that that is what your life should look like, and if it doesn’t, you must be doing something wrong…
Some medical professionals have objected strenuously to Hari’s book. They content that he’s incorrect in depicting anti-depressants as generally not beneficial and claiming that psychiatrists don’t give much/any weight to life experiences when prescribing anti-depressants.
The wee problem is that there is a big gap between the theory of how psychiatry ought to be done and what is actually taking place. My large sample (relatives who’ve suffered from depression, and way too many people I know personally who are taking anti-depressants) is that at least in the US, the pattern conforms to what Hari describes: doctors, including GPs, all too eager to hand out drugs like Prozac and Adderal, with no psychological evaluation whatsoever. From what I can tell, in major US cities, they are seen as productivity enhancers and thus perfectly fine to prescribe casually.
By contrast, one of my former lawyers who is also a biomedical engineer is FDA specialist, and many of the partners in her boutique intellectual property firm are former FDA commissioners with serious medical and/or science backgrounds. She has mentioned repeatedly that while they take Valium casually, to a person they’ve made clear that they would never take an SSRI and have advised her to steer people away from them. So it isn’t just members of the great unwashed public who have reservations.
As Hari points out in an excerpt from his book, one of the problems with talking about SSRIs is that the drug companies have been cherry-picking studies for decades. Not only is the efficacy of SSRIs not so hot (around 50%), it’s not much higher than the placebo rate (30%).
The focus of this article is a new JAMA study on anti-depressant withdrawal, finding that it was typically no biggie. But that study has been savaged by critics. It included only short-term users, for eight to twelve weeks, when other studies have found a strong correlation between the duration of usage and the severity of withdrawal issues.
So this article is good as far as it goes and does raise important issues about how the success or failure of antidepressants is often improperly framed, in a way that too often can make the patient feel hopelessly broken. But IMHO it does not go far enough.
By Dr. Eric Reinhart, a psychiatrist, political anthropologist, and psychoanalytic clinician. He works with individuals and collectives around the world. Originally published at Undark
A recent study in the journal JAMA Psychiatry claims to offer reassuring news to hundreds of millions of people who are taking, or considering taking, antidepressants: Withdrawal from the medications, it said, is usually mild and below the threshold for clinical significance. The analysis, which drew on data from more than 17,000 patients, was quickly picked up by international news outlets. Critics responded just as quickly, calling it misleading and dismissive of real-world suffering.
As both a practicing psychiatrist and critic of the harms inadvertently inflicted by my own field, I fear we’re having the wrong debate — again.
Every few years, another study or media exposé reignites controversy over these drugs: How effective are they really? Are withdrawal symptoms real or imagined? Are antidepressants harming people more than they help? These questions, while important, are stuck inside the narrow terms set by a medication-centric psychiatric industry, even when criticizing it. They flatten the experience of patients and ignore the intersecting role of clinicians, families, institutions, media, culture, and public policy in shaping both suffering and relief, trapping us in circular debates and deflecting attention from other ways of understanding and addressing what ails us.
Yes, antidepressant withdrawal is real. Yes, some people suffer greatly while trying to come off these drugs, with withdrawal risk varying among different kinds of antidepressants. I have also seen many patients appear to benefit greatly from such medications. But when we focus only on the biology of response and withdrawal, or treat psychiatric medications as purely pharmacologic agents whose harms and benefits can be definitively measured and settled by clinical trials, we obscure the more complex — and far more consequential — dynamics by which these medications affect self-perception, social relationships, and political life.
Although antidepressants have an appropriate place in psychiatric treatment, they’re frequently prescribed in caseswhere they are unlikely to do much good. The risk of harm commonly outweighs likely benefits, especially under the norms of highly time-constrained, decontextualized, and impersonal clinical practice today, in which medications are often prescribed at the very first appointment. And while I am a critic of the overprescription of antidepressants, I am also wary of the growing public discourse that treats them and psychiatry itself as the primary cause of ongoing pain.
In some cases, what gets labeled as withdrawal is not a straightforward physiological reaction to discontinuing a chemical agent. It can be a complex response to the loss of an object that was invested — often by one’s doctor, one’s family, dominant cultural ideas, and patients themselves — with enormous psychic and symbolic significance. If a pill is presented as a cure for debilitating anxiety tied to grief or trauma, for example, or accepted by a patient as a last-ditch attempt to stave off despair and self-harm, its failure to deliver relief can be devastating and worsen the distress that led to starting the medication.
Symptoms after stopping medications can also represent the return — whether in new or old forms — of underlying suffering that was never addressed. This often happens in part because treatment has primarily revolved around generic symptom checklists and decisions on what medications to use rather than meaningful engagement to understand a patient’s experience in the context of their unique life history, needs, conflicts, and desires.
This isn’t a claim that withdrawal symptoms are “all in your head.” It’s a repetition of the well-known but widely disregarded reality that mind and body are not separate, and neither are biology and culture. Symptoms emerge in particular social contexts and take shape through the meanings we attach, typically without our awareness, to them. This is how, for example, what was once considered ordinary sadness or grief has been transformed into a symptom of depression, or how experiences of fatigue or loss of interest that might come from overwork or boredom have been recast as mood and attention disorders.
How we name our experiences and how people around us respond to them affects, in turn, how we feel and navigate them. This culturally contingent nature of symptoms also holds true for the experiences of taking and stopping medications like antidepressants, and it’s true for the conditions they’re meant to treat.
Psychiatry, since the 1970s, has fostered a widespread misrecognition of psychic suffering as the product of discrete brain disorders. This medicalizing narrative has encouraged people to understand their experiences of distress as, first of all, a biological problem to be chemically treated. And when the chemical fix fails, which psychiatry’s own data show it often does, patients are left not only with their original problems but also with a sense of betrayal and confusion. Some come to attribute their suffering to psychiatrists and medications themselves. In some cases, that attribution is almost certainly correct; there are reckless doctors and serious medication side effects. But it’s rarely so simple.
This misrecognition often reflects a deeper one that psychiatry has long cultivated: a tendency to conflate complex social and psychic distress with biological dysfunction. It then fuels what medical science calls the nocebo effect — a negative placebo response — whereby suffering becomes attached to and caused by the idea of a drug, even when the chemical effects of the drug are not in fact the direct cause of one’s symptoms. The nocebo effect, in this case, is not incidental, nor does it mean that psychiatry is not responsible for it. It is an unintended consequence of the very narratives that psychiatry has used to justify its authority and economic value.
Psychiatry has offered simplistic diagnostic labels as if they, by themselves, provide adequate explanations. The result is a vicious cycle: A culture prescribes pills in response to psychic pain, then blames those pills for pain when it persists.
Myriad unintended consequences ensue. People can become locked into an identity as patients defined by biological defectiveness. And even if some patients later reject psychiatry entirely and turn away from psychiatric treatments, many remain captive to them by fixating on those treatments as the source of their problems. Many people invest enormous time, money, and energy into peer forums, withdrawal support communities, and alternative wellness treatments that, while offering a crucial sense of community, can also risk reinforcing the very captivity they seek to escape. These alternatives promote a fixation on the body as a malfunctioning machine, now recast not as chemically deficient but as chemically damaged. In both frames, suffering is narrowly viewed through biology, rather than through the layered histories and defining contradictions of each individual’s singular experiences acting in conjunction with their effects on the body.
Side effects or withdrawal symptoms aren’t the most pernicious harms inflicted by contemporary psychiatry and its medications. Rather, they lie in the failure — of both the clinic and the popular public discourse that has been shaped by psychiatric ideas and language — to facilitate the development of nuanced, individually contextualized, and practically useful frameworks for patients to make sense of social suffering. That failure leaves people vulnerable to simplistic pseudo-solutions: Take another pill, or never take a pill again.
It also feeds into misguided and misleading rejection of medical science and psychiatric care by opportunistic figures like Robert F. Kennedy Jr. and the aligned, profit-driven “Make America Healthy Again,” or MAHA, wellness industry. Kennedy has suggested that antidepressants fuel school shootings and has called for a government investigation into the “threat” to society posed by psychiatric medication. He and his allies in President Donald Trump’s administration take advantage of popular culture’s lack of understanding of social experience and mental health to promote moralistic, racist, punitive, and ultimately eugenicist ideologies. With these, they then dismiss suffering and mental illness among poor, disabled, and minority groups as an individual’s own fault, suggesting that they should be ostracized and punished rather than provided support and care.
This narrative, in turn, supports attempts to justify cutting essential public welfare and medical programs while reallocating their funds into expanding systems for policing, incarceration, and deportation. The strategy is encapsulated in Trump’s recent executive order aimed at reopening mental institutions by using police to arrest and then, apparently without any due process, indefinitely forcibly institutionalize poor Americans who are unhoused, judged to be mentally ill, or struggling with addiction.
To stop these cycles of harm, what we need is not yet more superficial debates about medications but a reckoning with the policies and associated ideas that generate and perpetuate distress that drives demand for pharmacologic balm. Mental health professionals should help people — and culture writ large — to identify the psychosocial, historical, and political roots of what they are experiencing and how their suffering could be modifiable through social action at both individual and collective scales. That means reversing the overmedicalization of mental health and illness in order to confront the political determinants of health: poverty, racism, social isolation, inequality, mass incarceration, and growing levels of political violence and nihilism amid the rise of oligarchy. It means reinvesting in public systems of care and rebuilding them on a new community-oriented basis that offers time, attention, and sustained relationships, rather than just doctor’s appointments, diagnostic codes, and 15-minute medication checks.
It requires psychiatrists to ensure that people have the space and time to tell (and retell) their stories on their own terms — not by simply describing their symptoms, being assigned a psychiatric diagnosis, or completing six sessions of formulaic cognitive behavioral therapy, but by sharing their personal histories, desires, losses, and dreams. And it also requires providing people everyday opportunities to care for one another, which is an essential role for feeling and affirming one’s own social value, rather than defaulting to the presumption that only licensed medical professionals are capable of providing meaningful care to people experiencing distress.
To achieve this, we need to invest in more and better care, not less. And to make that happen, we need to rally as a political community to demand policies that support this goal rather than allow the Trump administration to continue decimating the nation’s already deficient public health and welfare infrastructures in service of further privatization and profits.
This must be the crux of any real plan to accurately diagnose and effectively address the causes of declining mental health in America. It is what we must insist upon at every turn. And it is only when we do so that the uses and limits of medications like antidepressants are likely to finally be put right.
A lot I could comment on here, both from being co-supervisor (along with a mental health clinician) to a PhD student and from a LONG history of mental illness that I’m not shy about. Firstly, withdrawal. It may or may not be real, but my experience (plus anecdata from senior and older psychiatrists plus stuff from patient forums) suggest it’s more serious for the meds used more to address anxiety than depression. Getting off Pregabalin was torture. I have been on 20-30 antidepressants and never had withdrawal. My Diazepam is prn and I am VERY strict about its use so as never again to develop tolerance/addiction – plus I obviously can’t drive if it is in my system. It was “mother’s little helper” (plus huge amounts of alcohol) to my grandmother who wasted away and was a nervous wreck.
Re anti-depressants. Alas I never saved the link but I’m pretty sure it was a NC post years ago that shone a light on how blinding was now routinely broken in RCTs of SSRIs etc. Men who get ED and people who start piling on weight instantly know they’re in the active arm. What does this do to their self-evaluation answers? Hmmmm. (Plus people who correctly guess they’re in the control arm).
I have NEVER bought into the view that antidepressants are “all benefit little cost”. Yes, there are exotic drugs being developed in areas like cancer which ARE. However, I have dealt with senior mental health professionals in 3 countries across 2 continents and the view is the same. You take the rough with the smooth. But ALSO that Prozac was licensed not for the psycho-pharmacological reason it actually works (which only came to light recently). The best understood class of anti-depressants are the original MAOIs. (I’m on one). The one I’m on has been called “the anti-depressant of last resort” or “the mother of all anti-depressants” (since subsequent meta-analyses have shown its enormous efficacy but with the rather large issue of the dietary issues*). The issues with MAOIs (the link between brain and gut) is hilarious because we forgot all that and now are re-learning it! This is a REAL clinical imbalance.
*The infamous “cheese effect” and other supposedly horridly strict dietary restrictions imposed by MAOIs are VASTLY overstated (opinions expressed by psychiatrists and IMNSHO). I can eat a whole bloody pizza with no BP spike. Ironically the only nasty surprises I got was because Australasia post UK EC entry left them adrift and their food safety standards became more like USA. Why was SOY in an archetypally Anglo Cottage Pie Ready Meal I had in Auckland at a conference? I spotted the symptoms but they settled before I had to make the nasty decision of whether to call for an ambulance to try to head off a stroke/heart attack. Final note, the anti-depressant is a POTENT anti-hypertensive thus meaning that I take one drug instead of 3. Yet the NHS clearly wants this drug gone *sigh*.
I consider this bit from the article to be important:
My personal opinion is that I consider the difference between mild depression and severe depression to be so large that I am reluctant to say it is even the same disease.
One similar example might be that common cold does in some cases lead to pneumonia but I would not say that the common cold and pneumonia is the same disease in different stages of one disease. Treating the common cold as if it was full-fledged pneumonia might do some good but it would in my opinion not be the appropriate treatment. Same with what is now said to be mild depression, I would not recommend treating someone suffering from mild depression with something that is meant to be for treating severe depression.
From what I can tell there is over-prescription of anti-depressants and one of the drivers that over-prescription is the profit-motive. Diagnosing someone with depression is easy money for the employer of the doctor as the diagnosis is subjective and gets the customer/patient out the door quickly so that another customer/patient can come in. The more patients/customers a doctor can see the better it is for the employer of the doctor. Possibly the anti-depressants aren’t dealing with the root-cause and if so then the employer of the doctor has repeat patients/customers coming for prescription refills.
Sadly it does not matter if the doctor is in private or public employ, the ‘efficiency’ drive in the public sector pushes the doctor to see as many patients/customers as possible per day and the one who gains from that ‘efficiency’ is seldom the patient.
Anti-depressants do have their place, however, it is not always the best or even appropriate treatment.
First line treatment of mild depression/anxiety is generally Psychotherapy alone. That can be considered for moderate depression as well. Anti-depressants can be used alone to treat depression but in terms of efficacy, combination of medication with psychotherapy is better than medication alone.
Anti-depressants also ideally shouldn’t be required long-term but some risk factors can make a person more lilely to need lifelong anti-depressants even after completing Psychotherapy.
There is a biological basis to depression but it is highly unlikely it will occur in a vaccum. Basically, Psychotherapy and social interventions would more often be the definitive treatment and anti-depressants are supposed to be the stop gap until you’re psychologically less prone to depression and the environmental stressors are removed/significantly reduced.
That is unfortunately the kicker – what to do when someone’s stressor is not being able to get a better job and having to put up with abusive 12 hour shifts daily (lack of sleep is another biological driver of mental illnesses) and 2 hour transit to work, then back again. Their symptoms often completely resolve if they’re on a vacation but you can ‘love yourself’ out of being treated like a slave everyday and now you end up needing to stay on tablets you have to spend money on because the alternative is you lose your job or kill yourself.
You might get out more.
In NYC and I suspect most large cities, if you merely tell the doctor (your MD, not a psychiatrist) that you are fatigued, they want to give you Adderall or antidepressants. When I came back from Australia, my old GP (who was great) had gone on to a biotech. I was forced to shop for a new GP. I must have seen at least 5. All wanted to give me psychoactive meds with NO psych workup. One even said, “Your problem is you don’t have a smile on your face” as if being a dour Yankee is a pathology and his meds would be happy pills.
@Huey, not sure where you’re writing from but this does not jibe with personal experience and everything I’ve heard from friends in Anglo-Saxon countries.
In France, sure, psychotherapy would be considered an option. In the U.S., by contrast, what I witnessed and the story I’ve heard repeatedly is that literally in the first 10 mins of discussion with a doctor or therapist, they are pushing SSRIs.
Regarding this article, perhaps the most eye-opening thing I’ve read on this subject was a lecture by David Healy given at the Univ. of Toronto:
“Psychopharmacology & The Government of the Self”
https://davidhealy.org/wp-content/uploads/2012/05/Psychopharmacology-and-The-Government-of-the-Self.pdf
Healy had been offered a position at U. of Toronto and this lecture was his job talk. Afterwards, the offer was apparently rescinded, as the school was getting a fair amount of research money from a big pharmaceutical company and somebody was worried that it might be jeopardized. :)
Hey, I typed up a more detailed reply on Yves’ comment that I think should pop up soon.
I realize I came off as though I was trying to counter the points in the article in terms of how the system works in reality, sorry about that. I’m not intending to refute those statements at all, I just wanted to give perspective on what best practices should be for general information, in case it might help someone.
Where I live (Canada) family doctors will often prescribe antidepressants because psychotherapy through the public system is largely inaccessible due to huge demand, and private psychotherapy can be extremely expensive and out of reach of many without (or even with) supplemental health benefits. Many know that psychotherapy has similar efficacy and importantly is a non-pharmacological option (and in fact for children it is the first line therapy), but practically speaking prescription of antidepressants is often the best thing they can provide.
Another interesting tidbit is that a psychiatrist whose main focus of practice was psychodynamic psychotherapy told me that one of the problems with newer antidepressants is that they’re too safe. Meaning that it’s easy for them to become first line rather than last resort in the case of drugs with more dangerous potential side effects. An unfortunate corollary to this is that insurers will be less likely to fund non-pharmacological options when a pill is available.
*My comment keeps disappearing, I hope it’s not causing a problem somewhere? Really want to hear your thoughts Re: the newer anti-depressants @IM Doc Jr.
Really disheartening to hear about the accessibility of therapy in Canada though.
Where I am, most persons don’t have health insurance but public psychiatric clinics with some Psychologists are available and most persons end up accessing them. For patients who really can’t, we try eclectic Psychotherapy in the clinic, though it’s obviously not ideal.
I’m not sure if I would ever describe anti-depressants as too safe though. Did that person mean in comparison to the MAOIS? All the antidepressants I know have their fair amount of (admittedly less commonly lethal) side effects.
“Antidepressants have their place ….” Maybe so, maybe not. The more I read about psychiatric drug treatment and how often the evidence for their effectiveness is non- existent, the more I believe that drug treatment is quackery. Mad in America reports an example of this with regard to Zoloft as a treatment for depression.
https://www.madinamerica.com/2019/09/zoloft-not-improve-depression-even-severe-cases-study-finds/
A recent report that electroconvulsive therapy or shock treatment, which is still in use,
has had little or no empirical research on its effectiveness for depression since its first use in the 1930s is almost funny, were it not true. Google’s AI says its effective where other treatments have failed.
I’m not sure what you’re saying, there have been many studies published on Electroconvulsive Therapy (ECT) in the treatment of depression, a quick search I just did pulled up articles from 2016 to 2024.
It’s not recommended as the first treatment option but it is recognized and employed as an effective treatment option, specifically for patients who don’t improve significantly on medication.
It’s also, unfortunately, not a one and done deal but there are ECT clinics that exist for persons to get their weekly ECT and go on about their lives depression free.
*Don’t want to delete this and repost in case I trigger any spam flags so just adding that this was meant to be in reply to Yves’ comment.
Sorry, I realize that I should have clarified. I didn’t mean to imply that what is being said isn’t happening.
I was trying to address what Jesper was saying about treating the different severities of depression differently by pointing out that the general recommendation is that Mild Depression should not be treated with medication but with psychotherapy alone, esp ‘cus every med has side effects, drug interactions etc. and psychotherapy is much less risky in that regard.
Similarly, that can be a consideratiom even for Moderate Depression. Even with Severe Depression, pills alone aren’t recommended because as was mentioned in the post, you have to address the factors that put the person in a position to become depressed as well so that, hopefully, they can be taken off their meds permanently.
I’m a practicing Psychiatrist and really my aim was just to be informative in the hope that, knowing more, persons may feel more equipped to challenge their physicians’ decisions related to prescribing anti-depressants since patient involvement in their management is the ideal and any physician who doesn’t at least try to give their reasoning for decisions is, in my opinion, suspect.
I am not American but I do know (this site is always very informative) that in many countries and for many persons, changing practioners is easier said that done. I do hope that at least having extra knowledge is helpful in some way. Apologies again for not making that clearer in my original comment.
Thanks for clarifying. I wish more people in need of help could receive it in the order you describe, i.e., starting with psychotherapy, instead of being pushed straight onto medication because the cost of health care has gone out of control.
Running is the cure for the blues. You never see a sad hamster
I do agree with the value of exercise but not your particular remedy. Women who run regularly ruin their knees. Too much joint laxity for that to be a good idea on a routine basis.
Bicycle.
Swimming, occasional pot or mushrooms and most importantly a 20 hour work week at most doing something creative that you really enjoy.
The plantation organized wage slave economy is murder/suicide.
Yves: In your first three paragraphs, you nailed it. Thank you for clarifying the bigger picture in which all this is taking place.
Hard physical work the best cure for my depression. OCD urge to doomscroll and comment……I’m afraid there is no cure….
Different people react differently to antidepressants, so you can get misleading information from averages, as is always the case when there is lots of variance in the statistical outcomes. There are definitely withdrawal symptoms from SSRIs, but maybe not reported for some people for reasons of either individual neurochemistry or the particular drug used or just tolerance for discomfort in general. As it says above, the “happy” part of the response is more likely to be mild hypomania in the percentage of the respondents that have bipolar type depressive etiology. What antidepressants do in many cases is very slightly increase “energy levels” (which could be looked at as “restlessness” from another angle), and SSRIs in particular are good at blunting emotional reactivity (which decreases the anxiety and rumination that afflict people with anxious depressions). There is no way that such a larger percentage of our population should be taking antidepressants, there is no excuse for early adolescents and children to be given them at all, and there is no good data I know of that would say long-term (as in multi-year, chronic) use of them has a net benefit on physical and mental health.
Yes:
Which pretty much sums up a large part of the empirical research I did over a 20 year period. Frankly I was surprised whenever I got a vaguely normal distribution in a study, rather than a bimodal/multimodal distribution. NB just to be nitpicky the “variance” in outcomes that causes this problem is variance WITHIN the individual, which I tried to explain in guest post on here before, NOT “traditional” between-individual variance (though that certainly CAN matter when you’re dealing with numbers of patients that are not approaching the population of planet Earth). The Central Limit Theorem is VASTLY over-rated….or at the very least VASTLY misunderstood and relied upon when the assumptions underlying it DO NOT HOLD.
RE: Emotional Reactivity. Decades ago when I expressed anxiety to our family physician, his response was: Knowing your mother, you definitely need an SSRI. I’ve been on 200 mg of Zoloft since. When I started it seemed that I became somewhat numb, less reactive for sure. Over the years I’ve tried to cut back but my spouse believed my anxiety only increased. Now, my healthcare professional asks: Is that working for you? How would I know; it’s been decades. Hard to believe I have to do this for the rest of my life.
“And many if not most are also very poorly trained in coping skills, like an acceptance of failure and losses.”
My personal opinion and that is all it is, after nearly 7 decades on this mud ball, is that this fucked up world and the people in it is (are) designed expressly to fuck you up. If you have not been dramatically and irreversibly altered during your lifetime, then you have not truly lived with both your eyes and thought processes wide open, i.e., for example, “And Vanini—whom his contemporaries burned, finding that an easier task than to confute him—puts the same thing in a very forcible way. Man, he says, is so full of every kind of misery that, were it not repugnant to the Christian religion, I should venture to affirm that if evil spirits exist at all, they have posed into human form and are now atoning for their crimes.” Or apparently, as the case may be, living out their wildest dreams/fantasies.
Further, see for example, https://www.newyorker.com/news/the-lede/treating-gazas-collective-trauma
No amount of ‘coping skills’ or ‘acceptance of failure and losses’ in this entire world will ever be enough to ameliorate the trauma generated and/or facilitated, deliberately or otherwise, by the insane talking beasts that inhabit this particular planet.
Get a grip. We aren’t talking about Gaza, which as horrible and disgusting as it is, is not something you personally are experiencing. We are talking about the level of hardship suffered in countries rich enough to dispense psychoactive meds as a solution. We are pampered by historical standard (just look at the level of deaths in childbirth and childhood deaths from disease, for starters, even before getting to greater exposure to the consequences of bad harvest). Demand for meds is in part driven by unrealistic expectations v. routine and predictable hardships of life.
Taking drugs at best helps you forget that your life sucks. It does not stop your life sucking. If anything choose weed.
If you are middle class, you have options, stop whining, I couldnt care less.
To my working class bretheren, my heart goes out to you, if you are lucky enough to get an opportunity I hope you see it and take it.
If you make a nice living pushing poisons on people with miserable lives, you are a pusher. Would I be sad if one of your long suffering patients ‘Luigied’ you in exasperation? No.
My childhood friend was in the world trade centers when it was hit by a plane. He barely escaped with his life. Because of the PTSD they put him on an antidepressant called Paxil. When he tried to stop it, he couldn’t. He was literally shaving micrograms off of the pills to stop to withdrawal symptoms.
You can read his story here: (PDF)
https://digitalcommons.law.ggu.edu/cgi/viewcontent.cgi?article=1880&context=ggulrev
He’s responsible for the black box warning on Paxil.
As for myself, I’ve had the side effects of coming off of many antidepressants and antipsychotics. I am no longer on any psychiatric medication’s. Ever since I’ve understood my genetics and the way that Epigenetics affected my health, well, let me say everything’s changed in my life. I have a pretty serious genetic deficiency that was causing hyper methylation which intern caused whole pattern of other health problems.
But most people aren’t me, because most people weren’t hospitalized for their mental illness. I wanna hear some people I know talk to me about their mental health and I hear they’re on antidepressants it makes me wanna scream.
Dr. Bruce E. Levine has written much on this subject.
Apologies for getting to this late. I work as a psychodynamically-oriented psychotherapist. I’m struck by the way in which very merited criticisms of the priority given to antidepressant treatment are almost never supplemented with case vignettes that specify what the idea of “overlooked psychosocial factors” refers to. Here ya go, duly anonymized:
– A young woman is happily married to a man her mother can’t stand and subjects her to steady carping about him. She begins to to suffer panic attacks and moderate depression. Her MD prescribes Prozac. Her brief, effective treatment reveals that symptom onset was triggered when, upon picking up a kitchen knife to chop some vegetables, she felt an impulse to stab her mother, who was in the next room. She couldn’t tolerate her murderous thought. She quickly learned to, and also for the first time in her life told her mother to stfu.
– A middle-aged man becomes depressed just after his father’s death. His MD prescribed Prozac, it’s not effective. His brief, effective treatment reveals that symptom onset developed out of his dawning realization that he hated his father for having ruined his marriage by having numerous affairs, some in front of the patient, and driving his mother to a state of despair (let’s not always resort to “depressed”). As a boy the patient had felt complicit somehow, and this in part was due to not confronting his father about what was going on, even though his father would have beaten him.
– Finally, a young woman has had enough of taking care of her drug-addicted mother and wants to cut her out of her life. Her Christian counselor, as other counselors before her, regards “abandoning” her mother as wrong. Her MD prescribes an antidepressant. Her not so brief therapy involves struggling with her rage towards her mother and the seemingly obligatory guilt she feels crushed by. She is finally able to establish a relationship with a man she has known for years but who she fended off because of her mother. She is happy with him and they leave the area.
I’ve no idea how representative these cases are. But you’ll note that a primary driver of the depression is conflict with parents, conflict both in the immediate sense and as experienced in the contorted defenses that can build up around the “real” conflict over time, especially in childhood when powerless children have to resort to defensive containment of their feelings. If we just look at these cases, the flight into medication mimicked the original defensive moves of the kids, parents were off the hook. It would be very wrong to generalize — the scandals over the “schizophrenogenic” mother were merited — but it boggles me why critics are so hesitant to clarify what they’re talking about with reference to cases like these.
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@hemeantwell, Thanks for posting this, it’s great. In my opinion, the greatest collective damage such overprescription does is interfere with the normal functioning of the mind. It trains us not to use tolerance, reflection and self-care to get through mild to moderate periods of anxiety and depression. I think the best way to improve this aspect of our culture would be to increase the depth and breadth of each person’s social support network. I think anyone with a financial motive shouldn’t be counted. Stop and think about how many people in your life you can talk to about your worries and feelings, and whose advice you would trust. I think this number is going down for us (on average) decade by decade.