Comment of the week

Julia responded to my recent post about antidepressants and weight gain:

You might want to try fish oil or flaxseed oil supplements instead of (or in addition to) meds. A Harvard study found that omega-3 fatty acids help with bipolar disorder and depression. I have used it for about ten years with no need for antidepressants or other meds to regulate my moods. And, whether or not it helps with moods, it's good for your heart and HDL. Good luck.

Good advice. Someone recommended St. John's wort before I started on Lexapro, but I've heard mixed things about it. Re: fish oil, I'm vegetarian, but flaxseed would work. I could even eat it on popcorn. Thanks, Julia!

Lexapro vs. everything else

Someone responded to my most recent post about antidepressants by asking whether I'd tried non-Lexapro meds. The short answer: Yes, I gave Celexa a whirl, and it seemed to diminish my verbal abilities. This was upsetting but not entirely unexpected, as I'd been warned many years before that some SSRIs have that effect.

Lexapro is ridiculously expensive at roughly $100 per monthly supply, but I'm reluctant to mess with other meds when this one has worked, on the whole, so well. I also know that my weight gain is almost certainly due to a variety of factors -- Kibbutz food, waves of mild depression that elude the drug, etc. -- so I'd be more likely to drop meds in general than to go searching for a "better" one. It probably doesn't get a whole lot better than this.

Antidepressants and weight gain

The other night at the Kibbutz's second-night seder, someone I know asked me if I'm on an antidepressant.

"Yep," I said. "Lexapro."

"I figured," he said. "That's no normal weight gain."

In the past I might have been upset, but he's right: I've gained a lot of weight since I went on Lexapro in October of 2008. Then again, my weight has gone up and down pretty dramatically throughout my life, and living at the Kibbutz exposes me to a lot of good food, and a lot of communal meals, where the social aspect of eating often gets the better of my willpower. Yet I do think that the antidepressant has something to do with my ascent to 225 pounds, possibly my highest weight to date.

While some Lexapro users attribute their weight gain to the drug's biochemical effects, I believe that, at least in my case, its psychological impact is just as significant. In the past, when I put on weight, I felt bad about it. I would eventually reach a point where I started feeling fat and unattractive, but I'd continue eating too much and not getting enough exercise until I finally snapped. Then I'd begin combating my overweight with a combination of exercise and self-deprivation, a tactic I learned as a teenager with anorexia. My weight would drop, and I'd feel better about my body on a superficial level, but I'd remain extremely afraid of relapse -- i.e., gaining the weight back. Since depriving oneself isn't a sustainable long-term strategy, I'd suffer the sad fate of many a yo-yo dieter: I'd end up even heavier than I started.

Even though unemployment is hard and I have a lot of work ahead of me if I want to attend Bastyr (for nutrition and health psychology, of all things!) in 2011, I'm thinking about going off Lexapro on a trial basis, to see how I feel without it. I'm unlikely to start losing weight simply because I drop the drug, yet I can't help but be curious about what would happen. Not freaking out about being overweight is a double-edged sword. It opens up the possibility of more fully accepting my body, flaws and all, which is something I'm eager and determined to do. On the other hand, overweight isn't healthy in the long run, and being too okay with it -- indifference isn't the same as acceptance, after all -- might not be such a good thing. I'll consult my therapist about it and do some soul-searching, but I imagine that if I go without the meds for a while and I feel the weight of the world return, I can go back on them.

I'm pretty pleased, all in all, that I've been able to use an antidepressant without taking an absolutist view of a complicated issue: the question of whether the positive effects of SSRIs outweigh their downsides. In my 18 months of use, I've decided that they help, but they alone are obviously not enough. And no, they don't steal your soul or make you an unwitting slave to the Man. If anything, people who aren't completely demoralized are more likely to stand up for what's right and fight against what's wrong. There are few simple choices in this world, and to inhibit serotonin reuptake or not to isn't one of them.

Louis Menand on psychiatry

He's been one of my favorite New Yorker writers for nearly 10 years, and his new piece on psychiatry is as witty, wise, and humane as anything he's written. Highly recommended.

Here's the exchange that followed my posting a link to the article on Facebook:

Neal Schindler
I love Louis Menand. This piece is a great reminder that the debate about psychiatric meds is much more complex than we're generally told it is. Big Pharma may have an agenda ($$), but proselytizers against psych meds piss me off just as much sometimes. But of course they're not The Man, so they must be right. Gwen Davis, thought you might appreciate this especially.

Thursday Rome
word.

Gwen Davis
That was a good piece. Newsweek, a couple weeks ago, came out with a similar story. It is toss up whether to take meds for depression and other disorders; though, I am probably of the opinion, if something is going to take away suffering -- however good-nothing the something may be -- take it. If it improves the quality of life, most likely nothing to lose. Leave it up to scientists and physicians to fix the psychiatric mess.

It is important to also be aware of the difference between mild depression and other more critical mental illnesses. For severe conditions, medication all the way. Don't want to return to pre-1950s, where people were locked in insane asylums for life, because they could not function in regular society.

It's a confusing, world! Hopefully as time goes on, treatments (or lack thereof) will improve.

Neal Schindler
Agreed re: severe vs. mild. I certainly know of people who can't function without meds, and anti-meds advocates probably don't want those people stuck in completely dysfunctional lives when there's an alternative. What bugs me about anti-meds proselytizing sometimes is the same thing that bugs me about the Republicans' obstruction of health care: It's easy to object, but it's hard to come up with a superior real-life solution. Objecting to meds on principle is fine and good, but some people need something to actually make their daily existence bearable. Their situation isn't outside the realm of principled argument, but sometimes practical necessities are the priority over principle. That isn't always giving in; sometimes it's just compromise, of the kind that adults sometimes have to do in a complex world.

Antidepressants on KUOW

This past Monday on KUOW's daily show "The Conversation," host Ross Reynolds interviewed Columbia University psychiatrist Dr. Mark Olson about a study that lasted from 1996 to 2005. During its span, Olson found that antidepressant use doubled among Americans. Currently, roughly 10% of us are on some form of psychiatric med. Some of his findings were surprising. Antidepressant use is lower among African-Americans and Latinos; Olson believes this is because medication is less culturally accepted than other treatments, such as talk therapy, in some minority populations.

The largest groups of antidepressant users? Young women, and women between 50 and 64. Women's rate of depression is double men's, and Olson noted that it can be tricky to diagnose it among older people, since aging brings certain challenges that may manifest themselves as forms of depression, even if the individual's all-around psychological condition isn't that of a depressed person. Perhaps the study's most troubling discovery was that doctors are more likely to prescribe medication if a patient mentions an advertisement he or she saw for a particular drug. (Actors were sent to doctors' offices to complain of depressive symptoms; only some of them mentioned having seen an ad, and they were given meds much more frequently.)

Also interesting: Olson said around 40% of antidepressant users quit after a month, which means they don't get the full benefit of the medication. (Mine took a month just to kick in at all; I imagine that some users who feel desperate for relief aren't willing to wait that long.) A few callers talked about their experiences with meds. One woman complained that Paxil proved extremely addictive, even though it had originally been advertised as anything but. She mentioned that Paxil is illegal in the UK and parts of Europe. Another caller said she was on Paxil for eight or nine months, and it saved her life. The change was "like night and day," she said. Yet she, too, had a tough time getting off the drug.

Olson said that patients who are aware of the risks of taking an antidepressant tend to stay on them longer; he advised an extensive conversation with a doctor about the pluses and minuses. He said the study made him think more about how patients are chosen; people who are less depressed may actually benefit less from meds than those who are severely afflicted. The interview wasn't groundbreaking, nor were the callers' comments, but it's interesting to hear media coverage of the issue now that I'm part of that 10%.

One in ten

My reaction to recent growth in antidepressant use differs from Philip Dawdy's. He declares: "Yes, America is one doped-up nation"; I think that's awfully glib. I actually found comfort in the news that slightly more than 10% of Americans are using some form of antidepressant, because while Lexapro has hardly been a panacea since I began taking it last October, it's certainly helped me battle a sense of hopelessness that was keeping me in bed, in the house, and unemployed for a bit too long. It's reassuring to me that an increasing number of people see medication as an option, even if it's a flawed one.

Dawdy points to a particular doctor as a voice of reason in the debate over antidepressants. Here's the excerpt from Reuters:

Dr. Eric Caine of the University of Rochester in New York said he was concerned by the findings. "Antidepressants are only moderately effective on population level," he said in a telephone interview.

Caine, who was not involved in the research, noted that several studies show therapy is as effective as, if not more effective than, drug use alone.

"There are no data to say that the population is healthier. Indeed, the suicide rate in the middle years of life has been climbing," he said.

Moderate effectiveness isn't the same as scant effectiveness or ineffectiveness, and it's well known that drug use alone isn't nearly as helpful as medication combined with therapy (which is what I'm doing). Finally, a lack of data doesn't prove or disprove the population's increased health, and who can say why more middle-aged people are committing suicide? Dawdy notes that it's nice to see his opinions echoed by a professional, but I find Dr. Caine's points pretty unconvincing.

This is not a long, reflective post

I haven't been writing those for a while. Variety of reasons. I do want to get back to them, but in the meantime I've tried to post little things I've found around the Internet. And I hope to feature more old poems -- the ones I'm willing to share.

I have a new writing goal: Send poems to trusted fellow writers, get feedback, and read at Coffeehouse in August. I've found myself writing new poems lately from a place of need, i.e. "I'm going slightly crazy and I need to get this out in a brief, relatively unstructured form that forgives vagueness, at least in the first draft." So I'll maybe start posting those. I read other people's blogs and see what personal stuff they reveal -- Sasha and Dane come immediately to mind -- and I'm inspired and a little ashamed that I don't do the same.

There's the 21st-century dilemma of how much to make public, since your boss or mother or friends or ex might be reading what you write, but other bloggers seem to find that fine line pretty consistently. I thought I was running a slight risk when I wrote about going, and staying, on Lexapro, but there's stuff that's a whole lot more personal than that. And maybe by posting poems I can bring some of it to light.

"Happy pills" in the (medical) news

Someone on Facebook posted a Medical News Today article on psychiatric meds. Amazingly, it's the first time I've ever seen the phrase "designer consciousness."

My chemical romance, part three

Some romances are destined to be short-lived. After less than two weeks on Celexa, I've decided to return to Lexapro. I could compensate for the price increase ($13 per month for Celexa, nearly $100 per month for Lexapro) by going to therapy biweekly rather than weekly, and as my money-management advisor, Moorea, wisely noted the other day, mental and physical health are things you can't put a price tag on, because everything else hinges on them. (Similarly, in tonight's Nextbook salon on Jews and the body, we discussed the idea that our corporeal selves are on loan to us from God, so we're obligated to treat them well; I think sticking with the medication that works absolutely qualifies.)

Anyway, I look forward to returning to Lexapro, since even my brief time off it has been marked by trouble concentrating and, amazingly, problems articulating my thoughts -- a situation I rarely find myself in. (Even if my thoughts are ridiculous, I can almost always spit them out coherently.) Here's hoping I don't have too much longer to wait until the contentment I've enjoyed since Thanksgiving comes back to me.

News feed

Since my last post, a bunch has happened. To wit:

• My boss pointed out author-provocateur (provocateuse?) Norah Vincent's newest outrageous, ethically questionable piece of muckraking;
• my former NWsource.com colleague Jon Palmer drew my attention to the Times' new blog, Coffee City;
• Facebook revealed plans for another big facelift;
• and former Seattle Weekly managing editor Chuck Taylor -- aka my former boss -- unveiled his new Seattle Post-Post-Intelligencer wiki, just one of many online responses to the probably imminent demise of the Seattle P-I. Chuck has been interested in the topic of technology and journalism for a long time, so it's good to see him stay ahead of the curve.

In more personal news, I:

• visited my half-sister Lore in Los Angeles and took a lot of pictures (the image above is of a public high school, believe it or not);
• watched The Class, the Heroes pilot, and Atonement, the last of which was better than I thought it would be (The Class and Heroes were, respectively, quite good and just fine);
• saw the Irish band Lunasa perform on a wonderfully warm night;
• read quite a bit of Curtis Sittenfeld's American Wife, which I'm really enjoying;
• began to realize that my 20 daily milligrams of Celexa aren't, thus far, measuring up to my previous prescription, 10 milligrams of Lexapro;
• visited L.A.'s Central Library;
• consumed various authentic Mexican delicacies, including candied lime skin stuffed with sugared coconut and watermelon, cantaloupe, and mango cut in pieces, tossed in a plastic bag, and seasoned with chili powder, salt, and lime juice;
• and got my beloved car, Gracie, back from the mechanic. She's doing fine.

It's been a busy time, and I'm working full days (8:30 a.m. to 5 p.m.) until St. Patrick's Day. I'm staying in Seattle this weekend rather than going to Vancouver, as I'd planned to do, because I'm in stop-the-world-I-wanna-get-off mode, and I'd like a few work-free days to cool back down.