Monday, 6 February 2012

When the 'Happy Pills' work no longer

I have no opinion on anti depressants.  They have at different times been helpful to me, and to hundreds of thousands of other people.  But they are not right for everybody.  They don't represent the solution.  They aren't a quick fix.  First off, they tend to take several weeks to 'kick in' and even then, the kick may not resemble the Rooney-esque strike that is so desperately sought.  They lack precision and it's often trial and error to find the right one.  Research shows that, alone, they're not terribly effective.  There is definitely a significant placebo effect.  Nothing wrong with that.  You take something because you believe in it, and because you believe in it, you start to feel better.  Individuals notice shifts in their thinking patterns and their habitual moods within a short period of time taking a blank pill with little except sugar in it, so strong is the power of belief.

This time of year is a tough one for many.  The days are still too short to feel productive, or else they seem to stretch out uninvitingly, alarmingly, or overwhelmingly.  Punctuating our days is always important, and taking prescription medication fulfils this role, at least in part, for some people.  The routine they create can be tremendously helpful when life feels to be going painfully slowly, lacking in momentum or direction.  They can also represent self care, something which feels other worldly to anyone in the grips of a depressive episode.  Sometimes the mere act of making a commitment to observe a prescription can itself be nurturing, and carry with it associated benefits.

For some, anti depressants are the way forward.  Their benefits should not be underestimated, and they may continue to take them for considerable periods of time.  There is no shame in that.  They can, after all, be the supplements our neurochemistry need and deserve.  But for many, they are not the whole story.  There is work to be done.  The meds help, but they only scratch the surface.  They treat the symptoms, and not the causes.  In this scenario, therapy has proven benefits.  The talking cure is far from that - as a therapist, I don't seek to cure anyone, or anything.  The answers lie within, but anti depressants can often make these more accessible.  Meds can assist the process.  They can expedite the process, and enable people to function whilst addressing their difficulties, head on.  Some clients have described the changes they notice in themselves as having the lights put back on, or living in colour having existed in grayscale before commencing a medication.  For such presentations, it would be negligent not to take the medication alongside counselling or psychotherapy.  It would be tantamount to trying to find one's way relying on a GPS that lacks a power supply.  Therapy can provide a road map, but we need sufficient illumination to be able to discern the way.     

For others, anti depressants work for a while.  Until they don't.  The initial effects appear to wear off.  Or perhaps the effects were largely those of the hope aroused by reaching out, asking for help, and being given a prescription.  The power of a diagnosis can be nothing short of radically significant.  Walking into a GP's surgery, and having it confirmed that one's symptoms fit with criteria; being told that there are options available, and walking out with a green piece of paper ordering 28 pills with a household name can be tremendously reassuring.  This affirmation and assurance can lift spirits beyond measure, and get us through the next month, even adding a spring to our step.

But then comes a crash.  We wake up feeling as we did before.  Life has seemingly lost its appeal.  We lack a sense of purpose.  We find we are no longer interested in the things that amused us before...  Taking our meds feels pointless.  After all, what difference does it make?  Depression isn't a tap that gets switched on or off.  It trickles, and flows.  It responds to circumstances, as well as chemistry.  Its management requires patient persistence.  It's a delicate balance, and differs from individual to individual.  What works for one may not work for another.  What worked at one point, may not work this time.  Similarly, what didn't work previously, may work this time.  It demands exactly what is at a serious premium in the midst of low mood - open mindedness.

Psychiatry:  art or science?  Discuss.  It's a blog in itself...  But, to my mind, the body and mind cannot be separated.  I tend to approach the matter of mental health holistically, both my own and my clients'.  Taking medication of any sort might best be regarded as a supplement.  Supplementing everything else that needs to be happening in parallel.  Getting out and about (come rain, shine, or more recently, snow) is a must.  10 minutes in daylight gives the body something we most need, but tend to forget.  Sleep, diet and exercise are something of a holy trinity, and in a depression this can turn unholy very quickly.  The links between food and mood are well documented.  Just like cars, we need petrol and regular maintenance to run smoothly.  Seasonal adjustments are par for the course and can't be skipped just by treating the car to a wax and polish.  When did you last check the tyre pressures, or change the oil?          

Sometimes addressing the symptoms is sufficient remedy. Oftentimes, this will only make a superficial, and short lived difference. Any beginning is a good start. When you've broken down, you have two choices: to walk on and find alternative transport, or call for assistance. Breakdown recovery may tow you to a garage or perform basic repairs at the roadside, but more significant work will take time and expertise.   


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