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.

Stay

I love the poet and essayist Jennifer Michael Hecht, and I appreciate her bossy tone in her recent post about suicide. Particularly this:

Don’t kill yourself. Life has always been almost too hard to bear, for a lot of the people, a lot of the time. It’s awful. But it isn’t too hard to bear, it’s only almost too hard to bear.

Abnormal psychology

I've written here about my struggles with depression and disordered eating, but not so much about my obsessive-compulsive tendencies. They've died down a bit since I went on Lexapro more than a year ago, but I still find myself battling irrational cause-effect relationships in my mind. It's not "If I lend this camera to my friend for the night, he'll break it," but instead: "If I lend this camera to my friend for the night, I'll be unable to stop worrying about whether he'll break it and thus my work will suffer." It's a step removed from actually not trusting the friend.

It's not (usually) that I'm an ungenerous person, it's that I let my neurosis hijack my behavior and prevent me from being as giving as I want to be. (And yes, I'm the one letting this happen. I'm getting better at fighting what I call "pre-worry" or "meta-worry" -- worrying compulsively that I'll worry -- but I still have a ways to go.) Sometimes it's hard for me to separate my mind's obsessive-compulsive "reasoning" from valid logic or meaningful emotion. It's the same problem I've long had with ambient noise, a big pet peeve of mine.

Sometimes I have reason to complain about noise (i.e., a "normal" person would), while at other times I'm unusually sensitive to unwanted sounds (a "normal" person wouldn't be upset, but I am). Figuring out the boundary between reasonable and unreasonable discomfort remains tricky for me, though again, I'm improving. Using earplugs, which I began doing when I moved to the Kibbutz in August of 2008, has been a minor revelation. How did I survive without them all those years? How much tension could they have relieved when I was in high school and college?

I don't have a lot more to say about this at the moment, except that I've gotten better at making decisions, and not whipping myself into a total neurotic lather in the process, since starting therapy in late 2005. I'm grateful to have somewhere to go each week -- or every couple weeks, now that I'm in a money crunch -- where I can decompress, talk through my issues du jour, and realize how much stress I carry around. I still prescribe exercise and meditation for my problems, but I'm having a devil of a time getting myself to fill the prescription.

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%.

Windows on the world

Yesterday, my first full day wearing my new glasses, was a little odd. After all, I've had the previous frames for so long that I don't remember when I got them. The new pair has virtually the same prescription, but the frame is quite different, and I think there's no question that it both fits my face better and is more stylish. Considering that the new glasses have a different "face feel" and different dimensions than the old ones (which means it's a little harder to ignore the frames, which still appear in my peripheral vision), I'm doing pretty well. I was able to power through my usual OCD-ish tendencies ("These feel weird; I don't like them; I can't go through an entire day wearing them") and have started to really get used to my new specs.

When I first picked them up, I thought maybe they had been a waste of money, a silly luxury. But glasses are one of the first things people notice about you when they meet you, and it's nice to be more confident about how mine look. It's true, too, that when you have a pair for as long as I've had the previous one, they come to represent your idea of vision -- they really are like little windows on the world, and if you don't change them up, say, once a decade, a new pair can seem like an intruder. I look forward to the day when I don't think about my new glasses at all, and I think it's coming soon.

Frere-Jones on Gaga; Talbot on "neuroenhancers"

The artist I first encountered on C89.5 gets the New Yorker profile treatment this week. (I've had "Poker Face" stuck in my head, off and on, for longer than I care to admit.) Also worth reading: Margaret Talbot's piece on the off-label use of Adderall and other "neuroenhancers." Particularly interesting is the following passage, which echoes the dilemma I faced before going on Lexapro:

Chatterjee told me that many people who come to his clinic are cognitively preoccupied versions of what doctors call the “worried well.” The day I visited his office, he had just seen a middle-aged woman, a successful Philadelphia lawyer, who mentioned having to struggle a bit to come up with certain names. “Here’s an example of someone who by most measures is doing perfectly fine,” Chatterjee said. “She’s not having any trouble at work. But she notices she’s having some problems, and it’s very hard to know how much of that is just getting older.” Of course, people in her position could strive to get regular exercise and plenty of intellectual stimulation, both of which have been shown to help maintain cognitive function. But maybe they’re already doing so and want a bigger mental rev-up, or maybe they want something easier than sweaty workouts and Russian novels: a pill.

My conundrum, like that of the woman Chatterjee cites, was of the chicken-and-egg variety. Maybe regular exercise, a better diet, and, say, a healthy dose of Landmark Education would have done the trick -- or maybe I needed a chemical boost before I could even muster the energy to try any of those strategies. I had to decide, before using medication, whether I was a member of the "worried well" or genuinely unwell and in need of pharmaceutical intervention. The result has been a mixed bag -- Lexapro is hardly a cure-all -- but I don't think I'll ever regret giving it a try.

Meds for anorexia?

Damn, things have changed since I was a teenager.

"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.

One more argument for the elimination of television

I kid, of course. But I couldn't help but be both intrigued and amused by today's Herald Tribune article on yet another of TV's many (alleged) side effects. It's the new smoking, people. I expect that in the next several years, scientists will link excessive Family Matters viewing to blood clots, too much Full House to severe schizophrenia, and any contact whatsoever with America's Funniest People to massive stroke.

Good news for people who love bad news

Thanks to Kelly for the tip-off on this Times piece. I'll let you decide whether it's good news or bad.