Saturday, March 14, 2009

There's No Pill for This Kind of Depression

When you start a PhD program, the first thing you learn is that there is a world of difference between journalism and social science, and that difference begins with the way you write. Journalism is wet. The goal is to sell newspapers, to get to readers personally, to capture their interests, hearts, and emotions.

A lot like blogging for some of us.

And social science is dry. Research is dry. It is steeped in exacting, replicable findings, appeals to the side of the brain that demands significance, validation, logic. Science.

Some of us like both, and I happen to love Peggy Noonan, a political journalist for the Wall Street Journal. She is the Catholic sister I never had. I have Catholic sisters, Lutheran sisters, Episcopalian sisters, Muslim sisters, Korean sisters, Jewish sisters. We're all seriously middle-aged and own a perspective, a way of seeing we earned while toiling at books, people, and life. We've lived so we get to talk about it.

Generally Peggy spins a yarn as only she can (see last week's on the octuplets, just great) but today she dropped a stitch, providing me an opportunity to spleen about what to expect from medication and what not to expect. As a journalist I can't blame her for throwing her thoughts out there, for they're really easy going down, as always.

but they're wrong.

There's No Pill for This Kind of Depression
is the title of the essay, page 9, section A, Saturday-Sunday, March 14-15, 2009.

Her metaphor about the economic blows we're suffering are perfect to a fault.
The heart-pumping drama of last September is gone, replaced by the drip-drip-drip of pink slips, foreclosures and closed stores. . . .

People sense something slipping away, a world receding, not only an economic one, but a world of old structures, old ways and assumptions. People don't talk about this much because it's too big, but I suspect more than a few see themselves, deep-down, as "the designated mourner," from the title of the Wallace Shawn play.
Ms. Noonan asked a friend of hers, a psychiatrist, if he sensed pervasive anxiety, as if everyone is "on thin ice," and he answered in the affirmative. We've talked about that here.

She goes on to tell us that the sale of antidepressants and anti-anxiety drugs is widespread. (Big news, here). She feels that drug seeking behavior has become more common in New York since 9/11. Where she gets her statistics who knows. She doesn't need them, this is journalism, and opinion, no less. And you, the reader, should believe her, this goes without saying. You read it in the Wall Street Journal.

Fine, fine, fine. No harm done. But the following, Peggy, forgive me, begs an argument. As my sister, the one I can't wait to read on Saturday mornings, you should have called me, seriously, before writing this, referring to psychotropic medication as a cause of the crash.
We look for reasons for the crash and there are many, but I wonder if Xanax, Zoloft and Klonopin, when taken by investment bankers, lessened what might have been normal, prudent anxiety, or helped confuse prudent anxiety with baseless, free-floating fear. Maybe Wall Street was high as a kite and didn't notice. Maybe that would explain Bear Stearns, and Merrill, and Citi.
It would make a nice dissertation thesis, perhaps. But honestly, ill-conceived.

What would Ms. Noonan suggest? The half-glass of bourbon that Denny Crane and Alan Shore (the hot shot lawyers on Boston Legal) make look so psychologically appealing? America's favorite drug? Because that's so safe, after all.

Allow me this.

(1) Anti-depressants don't get you high. If you're lucky, when you take these medications properly, the weight sitting on top of your head disappears and you can get out of bed.

And suicidal people? They're less likely to shoot themselves in the head on anti-depressants, and less likely to take others down with them. Caveat here, of course, for some anti-depressants, taken by some people, can trigger manic episodes. But a real physician, one who performs an extensive evaluation before prescribing anything to anyone, knows this.

(2) Anti-anxiety medication that is taken as prescribed, does not interfere with reality testing. People who are on these medications as prescribed are still anxious, they still think about things that worry them. They still worry. But they can get to work. They learn, in therapy, not to obsess about what they cannot control, and we teach them how to do that. But prudent thought is not disabled with medication. And if you're on medications like these you are discussing what is prudent, what is not, with your therapist.

That's all I want to say. Depression, anxiety-- crippling disorders. Medicine helps people function, helps them manage their emotions. Therapy can, too. Together it all goes a little faster, is all.

I will grant that it's possible that the dayans of Wall Street may have used amphetamines and crack to stay awake, to keep up the energy necessary to be a mover and a shaker, a Master of the Universe (Ms. Noonan refers to Tom Wolfe). This will mess with a person's judgment, cocaine and dex, derivatives of amphetamines, anything that increases mania and a sense of omnipotence.

And hey, that's interesting, too, and sells newspapers.

But it might not pull at you, might not reach as large an audience, pull at as many heart strings, as only Peggy can.

therapydoc

34 comments:

Rachelz said...

Great post. I agree.

I do think a lot of people are misusing drugs. I do think some doctors who have the power to are not prescribing these kind of drugs in the right way.

But when prescribed and used correctly, these medications can literally save peoples lives. Their physical lives and the quality of their lives.

There's a lot of stigma and mistaken notions out there about this stuff. Thank you for battling it.

cb said...

Interesting premise she has but as you rightly say, it is flawed in so many ways. It is an easy jump to make though and again, as mentioned above, does nothing except further marginalise those for whom the medication is not only vital but life-saving.

blognut said...

Awesome post - I'm grateful you're here to explain the stuff we read.

Have I mentioned that you rock? Probably not lately, but you do.

Glimmer said...

How do people know that doctors aren't prescribing drugs in the right way? I hear this frequently. Is it because people abuse drugs and get into trouble for it? Is that reason to withhold them from everyone, even the majority, the people who are using them as prescribed and therefore aren't getting into the news and-or jail?

As I said, something I wonder about. Because I hear this remark by people who aren't doctors and I am wondering where they are getting their information. Where these facts are coming from, their sources.

therapydoc said...

AND roll.

Penelope said...

Great post! I agree - if only my PhD work could be so easily slapped together - no stats, no citations, no research, just a bunch of opinions...I guess I could just blog...

Harriet said...

There was a news report on my local news last week about a man who was overworked (who isn't) so his doctor prescribed him Provigil to get through the day and get all of his work done. I guess he had a lot of pressure in these days of massive lay-offs and was worried that if he didn't get everything done he would be fired. Provigil to the rescue. The man said it is a wonder drug.

therapydoc said...

THERE we go, thank you Harriet. Let's not forget Provigil.

JJ said...

Sign me up for the new class of anti-depressants that WOULD function like Noonan postulates that the current ones do!! Valium, the next anti-depressant. (Just kidding, of course... I'll settle for a clear mind and a SSRI any day.)

porcini66 said...

I swore up and down, left, right and center that drugs were for the WEAK. That anyone who copped to seeking happiness in a little pill wasn't going about life the RIGHT way. Pills were for those who didn't have the courage and the strength to face life.

After 40+ years, I finally realize how much braver it is to seek help, to actually BATTLE the fears, the insecurities, the anxieties head on with EVERY resource at our disposal! Yep, I take an SSRI. And I have stopped using alcohol to run from feelings, I have started my master's degree, I don't hide within my job, I am more focused on my family, my girls have a (relatively) balanced mother and I no longer see every upset as a personal affront to my sanity.

If that makes me weak...so be it. I am glad to take that little white pill now and realize that my misconceptions were just that - MISconceptions. I am finally learning to be me. I am grateful every day for every step of my journey - if that means medication, it is worth it.

Thanks for writing! :)

therapydoc said...

I don't even like the word "weak." Sounds so mean, don't you think?

porcini66 said...

Exactly my point! It is NOT weak! But I used to be incredibly mean to myself, justifying it every step of the way with, "hafta be strong, hafta learn to cope, don't cry or I'll give you something to cry about, you are TOO sensitive!, you are such a BABY, etc, etc, etc".

Oh, yes, I learned to be incredibly mean to myself. It's nice to finally be learning the balance is all...

T. J. said...

I so needed to read this today. Thank you.

Anti-anxiety meds don't take away all of the anxiety. Anti-depressants don't take away the sadness and depression that is appropriate in our lives.

They give us another chance, another track, another path.

AND roll is right!
--Ms. T. J.

Lisa Marie said...

There's no doubt that there is a pervasive sense of worry in just about everyone of us that is aware of what is going on in the world. Even when things were "good" I was a worrier. But the difference between general worry and intense anxiety and depression is what you just described: the ability to go to work, or get out of bed.

And yet I still struggle with the fact that I need medication even though I recognize the huge difference between those two things.

Midwife with a Knife said...

Possibly inappropriate self disclosure ahead...

I've been on lexapro (SSRI) now for a few years for a couple of relatively minor (meaning that the diagnoses sound worse than I am? I'm not as symptomatic as one might imagine? Something like tha.. I'm aware that technically speaking, these are counted among the major mental illnesses) mental health problems (PTSD and depression). It's possible that lexapro saved my life. It's probable that lexapro saved my career.

When I'm depressed and anxious, I'm a terrible doctor. OK, well, during the episodes I've had, I haven't been negligent, but it feels (in retrospect, at the time, I just feel like nothing is good and it's all my fault) like my brain doesn't work right. My decision-making is affected when I'm depressed but not when I'm treated. And every time I try to stop the lexapro, it's been a bit of a minor disaster.

So... I agree. Treating mental illness doesn't impair people's decisionmaking.... at least not as much as the original mental illness does.

isabella mori said...

just ONCE i'd like to stop by here and yawn at a post of yours. just ONCE (just for the experience)

but no, you did it again, therapydoc. your mix of wit and common sense and knowledge is unsurpassed.

anyway ...

now i probably won't go down as the world's most enthusiastic supporter of big pharma - but as you say, medication has its place, and for most people it has a good place.

it's amazing how ill-informed people are. even if it IS journalism - you still gotta check your facts.

what you portray here reminds me of the people who are afraid of giving morphine to people in pain with terminal cancer because it might addict them. a lack of understanding of the basics of psychopharmacy. (which is ok, many people don't need that understanding - but then they don't write about this in a major newspaper, either)

oh well, i guess we're all entitled to make mistakes. have you pointed this out to her? is she retracting some of what she's saying?

ilanadavita said...

Thanks for straightening thinhs up. Great post.

Anonymous said...

Israeli Gal

what about Ritalin as The missunderstood drug that helps those with ADD &ADHD?

Miriam L said...

Peggy Noonan's "high as a kite" comment does seem like a bizarre leap of non-logic. As you said, antidepressants don't make you high. The more accurate description -- what people usually say when a family member starts taking one -- is "he's back to being himself."

You can take any two phenomena that occurred together and try to link them, but that doesn't make it reasonable. Did global warming cause the financial meltdown? Did the increased use of SSRI's lead to the decrease in crime over the past decade? (Well, you never do know, right?)

therapydoc said...
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therapydoc said...

So many great comments, where to begin. Forgive me if I don't address it all.

a) I love that Miriam made the spurious connection point. Just because it seems that people eat more ice cream in the summer doesn't mean the hot weather causes them to do so. I know, you're thinking, Why not? We think maybe conditioning, or the fact that it's cheaper, or that ice cream stores aren't open in the winter.

(b) the ADD drugs are misunderstood and for some people, life savers on their jobs or at school. Are they over-prescribed? Could be. This one we'll have to discuss more, for sure.

(c) About wet writing and Isabelle's comment: the way I figure is that if I would be bored, you would be bored.

(d)Midwife, thanks for this disclosure (this is why we're anonymous). Professionals tend not to talk about their meds, obviously concerned about stigma. But as a therapist, all I can say is that, as you imply, there's a world of difference between functioning and not. And when people are counting on you, not is not an option.

(e) LisaMarie, the only thing I regret about the post is saying, "getting up and going to work." This line might have worked when the economy did.

Thanks everyone, your comments always make me think. Gotta' run for now.

Anonymous said...

I heartily agree with the premise that we (journalists, scientists, doctors, the general public, etc) need to do more to remove the stigma around the use of psych meds.

That said, could you have written this post without insulting Peggy Noonan and her profession? Without setting yourself up as the expert research scientist and consummate professional, in contrast to her base goal of "selling papers"? To draw a line in the sand between "real research" and journalism creates a polar binary that is simply not true -- especially in places like the WSJ, where "fact checkers" are responsible for catching blatant falsehoods. In fact, many MANY people rely on these sources for their "science", since most scientific research is written in such a way that ACTIVELY excludes the general public from participating in any kind of dialogue. As your post suggests... the doctor knows best...

So, where does she get her statistics? Try the CDC, which conducted a study that shows that antidepressants have become the most commonly prescribed drugs in the United States, with an increase of nearly 50% from 1995-2002. Then look at the stats from the National Institute on Drug Abuse (one of the National Institutes of Health), which cites the Drug Abuse Warning Network findings that one of the two of the most frequently reported prescription medications in drug abuse-related cases are benzodiazepines (e.g., diazepam, alprazolam, clonazepam, and lorazepam) In 2002, benzodiazepines accounted for 100,784 mentions that were classified as drug abuse cases.

Of course there's no causal relationship between the two. It's the source of debate and discussion among docs. Some docs claim that the increase in prescriptions reflects an increase in the identification (and treatment) of depression. Other docs worry that the increase is, in fact, a sign of abuse of this class of drugs. Gee... maybe more research is needed?

I got these stats from a 2 minute google search. I assume (perhaps a big leap?) that Noonan did more. That she talked to a few high-placed professionals. That her goal was not (simply?) to sell papers but was to educate, enlighten, and spread the news. Your post suggests that you assumed otherwise...

therapydoc said...
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therapydoc said...

I should hope Ms. Noonan didn't feel insulted, think she's made of tougher stuff, and am a big fan, and that's implied in the post. She's the first voice I read on Saturday, I love her essays, consider her a soulmate.

And I love the Wall Street Journal.

If you follow this blog regularly you know that I love WSJ, and it's not because it is The National Enquirer.

As for journalism and science, yes, WSJ uses fact finders and usually gets it right. But if you read the letters to the editor you'll find discrepancies. I think we have one here, implying Wall Street bankers were high on psychotropic medication. If they took medication it would not make them high or impair their reality testing.

And I wanted to remind those who are working in the social sciences to check facts, not to glean them from the newspaper because, (I still believe this) the goal of printing newspapers is to sell newspapers. Return readers know this is one of my themes, fact- checking (you're obviously on the same page).

And anyone, as I've suggested on other posts, can Google facts and find summaries and abstracts of research like you did. You have to pay to read the articles, and you're right, they're not always accessible.

How you got that I set myself up as an expert, I'm not sure. Listing my degrees only tells readers that I once had an education.

A letter like yours humbles me, makes me self-reflect. It is silly to assume people have read old posts. Readers will misconstrue my meanings at times and I have to watch that.

I like it a lot, the scrutiny, and a well-written comment like yours is a gift. Thanks for writing and keeping me on the ball, if that's at all possble.

Mark said...

Thanks for bringing some clarity to this article and what by many is a generalization of people who are taking prescribed drugs to take the edge off. I am sure you are correct, I am also sure that there are many who are mixing prescribed drugs with un-prescribed drugs who are too soft around the edges who may not have the ability to care enough to make the best decisions.

Syd said...

Good post TD. I wonder more about people who over do their medication. I have a staff person here who decides to double the dosage if he feels bad. The yo-yoing of medication isn't good. I think that there is a tendency to self-medicate with many prescription drugs, especially anti-anxiety and anti-depressants.

Anonymous said...

Thanks for the thanks, TD :-) My comment was not intended as "scrutiny" -- merely as part of the dialogue.

You asked where do you set yourself up as the expert: 1) where you say "...you [Noonan] should have called me, seriously, before writing this"; 2) where you compare a long and distinguished professional career in journalism to blogging; 3)when you provide the "correct" information, without any of the stats or scientific data that you noted were lacking in her article, including alternative interpretations ("..it's possible that the dayans of Wall Street may have used amphetamines and crack..")

Perhaps you're right that I'm reading out of context and it won't make sense unless I slog through the archive of your blog -- from this post alone, it looks to me that this whole hubub is about one phrase.. "MAYBE WALL ST WAS HIGH AS A KITE..." Probably a bad turn of phrase, not even close to accurate, a misrepresentation of what psych meds do, a copy editor asleep at the wheel. On the other hand, it was the opening that you were looking for: "she dropped a stitch, providing me (TD) an opportunity to spleen" and to bring in a little sarcasm of your own ("What would Ms. Noonan suggest?... America's favorite drug?")

You do good work here, TD. Just not sure why you had to set up Noonan as the bad guy to get your message across. (And if you doubt my take on Noonan as the bad guy, please re-read some of the earlier comments where people jump on the Noonan-was-wrong bandwagon.)

Anonymous said...

I'm just jealous people can take a pill and feel better. I think I've tried em all..and all I get is wt gain and dry mouth. Sigh.

therapydoc said...

Right, which is why I try to avoid recommending a med evaluation if I can. Side affects, however, beat wanting to die.

barfly said...

I like reading this blog because you have your own way of thinking, TD, as a person who has lived. I think you have the right with all of your training and time working to your opinions. I think most of us like to hear them and take whatever we want out of them.

the psycho therapist said...

Your Noonan excerpt was just plain funny...to me. So ridiculous, it's impossible to take her words as anything either than tongue-in-cheek or seriously misinformed, which is the part you find bothersome onna counna her being perceived of as a voice of authority, n'all. I get that.

I appreciate the smile that appeared while reading your small "rant", though, so many thanks for that.

nashbabe said...

Hubs has been depressed for three years plus. I finally persuaded him to go to a psych, and that psych stubbornly tried only one med and wouldn't try anything else. Let's just say that eventually he lost his job and I was a very depressed caregiver who ended up going to a psych too. Hubs was so depressed he wouldn't consider a second opinion.

If I had not had meds, I doubt seriously that I would have hung on at all. The weight was too great. But meds got me to the point where I was willing to do the other things that would also make a big difference (therapy, exercise, taking better care of myself).

If I hadn't gained some strength, I wouldn't have been able to continue essentially harrassing hub's shrink until he finally tried a different med on him. Three weeks after I finally got my husband on a different med, he improved dramatically, and in a week will be gainfully employed in a job he looks forward to doing.

The meds made the difference. He had been in therapy, but was too depressed and unwilling to even consider that he should try some of the things mentioned in therapy.

The meds basically jumpstarted him, and I am seeing my husband return to me (emotionally) each day.

Widespread media comments such as Peggy Noonan's are especially poorly timed at this juncture in our country's history, where many folks may need them to be willing to even face what they need to do in order to keep it together.

therapydoc said...

Ya' know, NASHBABE, that's what I thought, ill-timed.

phd in yogurtry said...

Thanks for calling Noonan to the therapist's carpet.

How convenient to blame the little white (green, pink, yellow) pills instead of free-wheeling investment brokers, unchecked greed, and the incredibly shrinking SEC regs of the past decade.

I tell people that antidepressants tend to give people more clarity, not less. Medications often allow them to focus more on the concerns that really matter, letting go of the more irrational fears and worries. So IF these Wall Street brokers WERE taking antidepressants, they should have been MORE on their ballgame, not less.