Antidepressants in the SSRI family don’t appear to be any more effective than a placebo in treating any but the most severely depressed people. That’s the conclusion of a study published last week in the Public Library of Science Medicine. The study analyzed trial results, both published and unpublished, of six widely prescribed SSRIs. The researchers found that a placebo worked just as well as the SSRIs for people with mild or moderate depression.

I don’t find these conclusions particularly surprising. To my mind, there are very few situations in which someone with mild depression should be prescribed an antidepressant. Actually, I can’t think of even one, but bear in mind that I’m not a doctor. However, I think that most doctors would agree that other approaches are as effective, such as talk therapy and exercise. Whether or not moderate depression should be treated with antidepressants is a little more complicated. My take on it is that antidepressants shouldn’t necessarily be the first line of defense.
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I had my quarterly appointment with my psychiatrist the other day. As planned, I told him that I would like to switch to a new antidepressant. I felt that Wellbutrin, which I had been taking since 2000, was exacerbating my overall anxiety level. I showed him my nails, which were bitten down to the quick. Although I’ve been biting my nails since I was a child, normally I can stop for a year or so, but it’s been over seven years since I had long nails - since I started the Wellbutrin. And my husband made a point of agreeing when I told him that I thought I’d been more anxious overall since I started the Wellbutrin, so I knew that it had been (painfully) obvious to him also.

I detailed my past antidepressant history for my doctor, with the thought that this might help him choose a new medication for me. In addition to Wellbutrin I had also taken Norpramin for most of the first decade that I was on antidepressants. Norpramin is a tricylic antidepressant that had been very successful in banishing my depression, but it’s a decade-old medication with side effects including dry mouth and teeth decalcification. During one year of that decade I had taken Prozac, but went back to Norpramin since the Prozac made me feel flat emotionally (although it did help my obsessive compulsive disorder).

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I’ve never been officially diagnosed with Generalized Anxiety Disorder (GAD), partly, I believe, because there have been so many other disorders for my doctors and I to focus on (depression, Obsessive Compulsive Disorder and Attention Deficit Disorder, anyone?). Looking at the description of GAD, though, I am pretty sure that I have had at least mild anxiety disorder most of my life. I’m definitely a worrier, although I’ve learned to control it to some extent, and I have had tension knots on my neck since I was a teenager. And I’m really, really bad at relaxing. It’s almost impossible for me to relax unless I’m physically exhausted. I used to think that it had something to do with my ADHD, but I’m beginning to think that’s not the culprit.

Another tipoff is my nail biting. I’ve bitten my nails as long as I can remember, down to the quick. I’ve tried to stop many times, and have even succeeded, sometimes for a year or more, but the majority of my life has been spent with virtually no nails. It took me a long time to figure out why I could stop sometimes and why I couldn’t, but I think I’ve finally hit on it. I think that when I go through periods of heightened anxiety, I start biting my nails again. When I am going through those fairly rare periods of low anxiety, it’s a snap to stop.

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For many older adults, the “golden years” are indeed golden. My parents, who are both over the age of 65, are enjoying their retirement here in Northern California. My father is supervising the building of their new house and my mother runs a website she created for senior women. They go to baseball games and symphonies, among other activities, and spend a lot of time taking their grandchildren to museums of all kinds. I think they probably would be a good commercial for vitamins marketed to seniors.

Unfortunately, for some seniors, the golden years are more like leaden, especially if they’re living with depression. Not only can depression suck all the enjoyment out of life, as it can at any age, but depression can also be dangerous to an older adult’s physical health.

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You can stop feeling like it’s your fault that you haven’t found an antidepressant that works. Not that you should have ever felt that way anyway, but most depressed people blame themselves for everything that goes wrong in their lives.

But this one is definitely not your fault, and probably not your doctor’s either, for that matter. Last week a paper published in The New England Journal of Medicine showed that publication bias put antidepressants in a more positive light than was warranted by the evidence. To put that in plain English, when drug makers ask the FDA to approve a drug, they have to submit all studies that have been done for that drug, even the ones that show the drug to be less than successful. However, they are under no obligation to publish all the studies in medical journals. They can, and apparently did in this case, cherry-pick the studies and only submit the positive ones for publication. Not only that, some of the negative studies that were published were slanted to make them appear more positive.

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It’s 5:30am and it’s still dark. For some reason I’m actually awake. Granted, my usual waking time is only half an hour later, but to me, voluntarily getting up early is an idea that just doesn’t compute. However, I am deliberately giving up sleep for a good reason. I’m going to do some yoga to help wake myself up and, hopefully, become more flexible and strong. Since I have Multiple Sclerosis, that’s very important. I’ll also do some walking at lunchtime up a hill on the campus where I work.

If you’re suffering from depression, you’re probably thinking, “How nice for you.” After all, you can’t even contemplate exercising when you’re depressed. Just getting through the day is an accomplishment. Trust me, I do know how you feel. I went through twenty years of untreated depression. But I also know that some of my best periods during those two decades were the times when I was exercising regularly.

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Lawrence told me this morning about a nightmare he had last night about Transformers coming to his school and killing him and his friends. He paused and added, “But I’m trying to move past it.”

Before I was diagnosed with depression and realized that I suffered from a mental illness, in my mind the most vital issue in terms of health insurance was whether I had it or not. I think you’d find that’s the case for nearly everyone in America. If you have good health insurance, for the most part it’s not something you think about, and you’re pretty darn thankful that’s the case.

However, once I started treatment for depression I became aware of one of the ugly aspects of the health insurance coverage I had thought was so complete. Not only were there limits on my mental health care in terms of number of visits allowed, both annually and for my lifetime, but my co-pay was higher for mental health visits than for other types of care. And I’m not just referring to talk therapy, which is always a 50 minute long appointment. Even a 5 minute medication check with my psychiatrist cost me more than a 45 minute long appointment with my gynecologist.
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I’ve been taking Wellbutrin (generic name Bupropion) for about seven years, minus the time I was pregnant with my son. I would say that overall it’s been very successful, except during one period. All of a sudden, even though I was faithfully taking my medicine, it was as though I was taking sugar pills. I realized that the color and size of the pills in my most recent prescription refill were different from the ones that I had been taking.
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Are you a compulsive shopper? At this time of the year, when the gift buying starts to get out of control, you may begin to wonder. I personally am afraid to add up how much I’ve spent on Christmas presents. But when the holiday season is over, most of us will go back to a much more normal level of buying, especially after we get our credit card bills in January. Some people, however, will continue to shop, not because they need something or are buying gifts, but because they’re driven by an addiction.

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