From the book
Noonday Demon: An Atlas of Depression
by Andrew Solomon
Since I am writing a book about depression, I am often asked in social situations to describe my own experiences, and I usually end by saying that I am on medication. “Still?” people ask. “But you seem fine!” To which I invariably reply that I seem fine because I am fine, and that I am fine in part because of medication.
“So how long do you expect to go on taking this stuff?” people ask. When I say that I will be on medication indefinitely, people who have dealt calmly and sympathetically with the news of suicide attempts, catatonia, missed years of work, significant loss of body weight, and so on stare at me with alarm.
“But it’s really bad to be on medicine that way,” they say. “Surely now you are strong enough to be able to phase out some of these drugs!” If you say to them that this is like phasing the carburetor out of your car or the buttresses out of Notre Dame, they laugh.
“So maybe you’ll stay on a really low maintenance dose?” they ask. You explain that the level of medication you take was chosen because it normalizes the systems that can go haywire, and that a low dose of medication would be like removing half of your carburetor. You add that you have experienced almost no side effects from the medication you are taking, and that there is no evidence of negative effects of long-term medication. You say that you really don’t want to get sick again.
But wellness is still, in this area, associated not with achieving control of your problem, but with discontinuation of medication. “Well, I sure hope you get off sometime soon,” they say.
“I may not know the exact effects of long-term medication,” says John Greden. [Director of the Mental Health Institute at the University of Michigan.] “No one has yet taken Prozac for eighty years. But I certainly know the effects of nonmedication, or of trying to reduce appropriate doses to inappropriate levels – and those effects are brain damage.
Editor’s Note: strongly disagree with this: You start to have consequences from chronicity. You have recurrences of increasing severity, levels of distress there is no reason for you ever to experience. We would never treat diabetes or hypertension in this on-again, off-again way; why do we do it with depression? Where has this weird social pressure come from? This illness has an eighty percent relapse rate within a year without medication, and an eight percent wellness rate with medication.”
Robert Post, of the NIMH, concurs: “People worry about side effects from staying on medication for a lifetime, but the side effects of doing that appear to be insubstantial, very insubstantial compared to the lethality of undertreated depression. If you have a relative or a patient on digitalis, what would you think of suggesting he go off it, see if he has another bout of congestive heart failure, and have his heart get so flabby that it can never get back into shape again? It’s not one iota different.”
The side effects of these drugs are for most people much healthier than the illness they address.