Your Attitude About Anti-depressants is Killing People
I’ve suffered from depression starting in adolescence. I resisted medication for a long time. It meant I was weak, it would change my personality, it meant I was really “broken”. It was overprescribed, it wasn’t real happiness, it was fake, it was the wrong solution to the problem of our society not meeting people’s fundamental needs for connection and meaning…blah blah blah. Meanwhile, I was miserable.
I finally got to the point where I decided that whatever I thought it would be like, it couldn’t really be worse than my depression. I tried a few different kinds, and settled on Wellbutrin. I’ve been well-medicated for so long I sometimes forget how awful it was. If I’m really, really stressed out sometimes a hint of the symptoms will come back a little and I’ll remember.
Depression is like my brain is trying to eat me alive. Gnawing self-criticism. Life felt like grinding, pointless torture. Depression is different than grief — grief ends, or at least abates with time, and it’s about something specific. Depression is painful, broiling emotional turmoil that is about nothing at all. It’s a brain in distress trying to make meaning of that distress, and the meaning is always horrible. Life is pointless. I’m worthless. Nobody loves me. I’m not lovable. I’m a piece of shit and everyone knows it.
Having been on both sides of it, I understand why people don’t get it. There’s nothing really like it. It colors your entire world. Life itself feels and seems different. It affects your perception of meaning, purpose, good, bad, reality.
When I came out of it I was like wait…so life is just this easy?? The contrast of not having to spend all my energy fighting with myself to get through the day made me buoyant. Spontaneous feelings of joy which used to happen maybe once a year became a daily thing. And now, I take it for granted.
Back then, the news about Robin Williams would have put me in a tailspin for weeks. Any time I heard about a suicide it would affect me deeply, because I shared the feeling that enduring the pain of living is just not worth it. I never seriously considered it for myself (I’m too stubborn to give up, even when something seems unbearable), but I understood it. Every day, under the surface, I felt the same endless pain.
But today it doesn’t hit the same way. I felt sad, I feel the tragedy, and I cried when I found out—but it didn’t trigger the same feelings of hopelessness and worthlessness. It didn’t drop me into that inner desolate world of despair, because the door to that place is closed now.
Today I feel lucky that medication worked for me. I feel lucky that I have unipolar depression, because bipolar is trickier to treat. I feel grateful that it’s been so long that I have to really think to recall what it felt like. And I feel grateful that I have the privilege to be able to afford medication and therapy and time to devote to my mental health.
But I also feel angry. It took me years of excruciating emotional pain to get to the point where I would even try medication. It took people I respected telling me they took medication because it helped them. It took exhausting myself over and over trying to mentally get myself out of where I was at, before I “gave in” and tried it. And that resistance was in large part due to how anti-depressants are seen in our culture.
This isn’t about blame—I used to believe these things too. I’m only talking about it because they aren’t true, and I had to learn that the hard way.
I’m talking about beliefs like, “anti-depressants are overprescribed” or “doctors just hand out pills, and that doesn’t help anything” or “pills aren’t the answer”. Or my favorite, “What if Van Gogh had taken medication?” This seems logical on the surface, but think what this implies: people should live a tortured existence so that you can have pretty pictures to look at? Is that worth it? And who decides?
The truth is we all decide. As a culture we either support people to get well, or we shame them into not accepting help. Nobody gets out of depression by themselves. We need help, and we need the people around us to support us to get that help — and the most basic level of that support is to not stigmatize it.
I am not disagreeing completely with the ideas. The answer is not just about medication. And I’m sure there are people who are prescribed medication who don’t actually need it. But I also know that anyone who actually does need it, and gets it, and who it works for, has just had their life saved. They have a chance at what every one else in this world takes for granted. Not happiness even — just the luxury of your own brain not trying to kill you.
It’s not a magic solution or a guarantee. I did a whole lot of therapy too. I have a stack of self-help books. I worked through shame, fear, anger, and learned how to regulate my emotional life. I took relationship classes and learned about codependency. I did attachment therapy. Depression is a complex problem and often coexists with other problems that need to be addressed. But medication absolutely worked for me.
Medication made it even possible to gain benefits from all those other things I did. It gave me traction on working with my thought distortions. It gave me a tiny gap between an overwhelming or discouraging stimulus and my depressive response. In that gap, I could see an option other than falling into a mental pit. And I clawed like hell to take that option.
But without the medication, that option wasn’t there. I didn’t have that choice. I didn’t have a chance to interrupt that mental thought train because the reactions happened so fast.
Mental illness is when you try to change, but your brain resists. It keeps looping you back into the same circles, the same thoughts, the same painful perception of reality. That is why I finally took medication. Because I was fighting as hard as I could, and it was beyond me. I couldn’t think my way out of it, because my brain was fighting against me.
But I tried. I tried so, so hard. It’s not weakness that I couldn’t change my brain. It’s a disease. A diabetic can’t will her pancreas to produce insulin. An amputee can’t will their arm to grow back. Some things aren’t changeable by thinking about it. Some things require biological, chemical, physical solutions. Depression is like that for a lot of people. But they don’t necessarily get the help they need, because of the huge stigma attached not just to depression itself, but to the very thing that could help.
So let’s talk about anti-depressants differently.
Let’s talk about how we’re damn lucky to have discovered them, and the lives that they’ve saved. Depression makes life unlivable, even if you never think of killing yourself. It fuels addictive behavior — if not drugs, then overeating and overworking. The human cost is not just in the deaths by suicide, it’s in the un-lived lives of those who who spend all their energy trying to get through the day and appear “normal”.
Let’s talk about how, even if were true that people on medication are less tortured and therefore make less art (which is an assumption I don’t really buy, because I’m far more productive when I can actually get out of bed)—who cares? There is so much art in this world. Don’t make people suffer for it by implying it’s a more noble choice. Make your own damn art. It’s not your life. It’s not your brain. You aren’t suffering for it. So stop setting up a value hierarchy that includes noble suffering. Suffering when you don’t have to isn’t noble, it’s stupid.
Let’s talk about mothers and fathers who need to be there for their kids and can’t because they are depressed. Let’s remember that anti-depressants might help generations to come.
Let’s talk about how hard people who are depressed work to just stay alive. Let’s stop implying that people are weak for wanting to be happy. You want to be happy. You just don’t have to work so hard for it. Consider yourself lucky.
There are two final things I want you to understand about anti-depressants that may change how you talk about them.
First, anti-depressants don’t make you happy. They make it possible to become happy. They are a prerequisite, not a guarantee. The metaphor I like the best is this: think of your level of happiness like a bathtub full of water. It goes up and down from day to day, but generally it stays pretty full because there is a stopper in the bottom of the tub.
With depression, that stopper is gone. Any happiness you manage to acquire lasts a day, an hour, a minute…and then it drains away. You can’t hold on to it. You can’t build it up.
Part of the reason for this is that memory and mood are related. When you are happy, it’s easier to remember happy things. When you are sad, you remember sad things. When you are depressed, you can’t remember anything good ever happened to you, that anyone ever liked you, or that you ever contributed anything of value to anyone. All those good feelings and positive events that should be filling your mental-emotional bathtub of worth and value and connection are just…gone. The only thing you have is this pit of despair, a void of meaninglessness. And the more you hang out in these brain states and memories, the easier and more automatic they are to access.
The right medication, for some reason, can interrupt this pattern. When I started taking it, the constant litany of just-below-the-surface self-criticism I had always had just disappeared. Silenced. No more critical self-talk meant no more arguing with myself about whether it was true. I could just…live my life.
Here’s my second take-home message: when a depressed person hears something like “anti-depressants are over-prescribed”, they don’t take it in as an interesting opinion. They hear, “You’re already a worthless piece of shit, and taking anti-depressants would make you an even more worthless piece of shit.”
The stigma attached to anti-depressants puts you in a bind. Your self-worth is already teetering on empty, and you are considering doing something that will be perceived as weak, “admitting you are broken”, and joining the ranks of “those people”.
So I’m asking you, Dear Reader, if this applies to you, please don’t say anti-depressants are bad, or useless, or overused, make you weak, fake, “doped up”, or are not the right solution to the “real” problem. And if someone expresses these attitudes to you, speak up about it. Don’t participate in the stigma.
Most people who have depression don’t talk about it. You don’t know when you’re talking to someone what they have struggled with in their life. You don’t know how hard they might work to be the person who “seems OK”. They might just be someone who would really benefit from taking anti-depressants. They might need to hear that it’s OK, that there’s nothing wrong with not wanting to suffer anymore. They might need to hear that you don’t think there should be a stigma about it. They might need to hear that they are good however they choose to approach their mental health. They might need to hear that no matter how long it takes to figure out what works, it’s worth it, because everyone deserves to be happy and well.
And if you take medication yourself, consider being more open about it. Coming out is the quickest way for people to replace unquestioned beliefs with reality.
When we use the phrase “mentally ill”, we think “crazy person”. But that’s untreated mental illness. The truth is, I’m still “mentally ill”. I will have the capacity for depression for the rest of my life. If I stop taking my medication, it comes back, regardless of all the other work I’ve done. The work I’ve done in therapy has given me new options. It’s given me new habits of thinking and feeling and action. It’s given me the tools to be happy and well. But the pit of despair is still there somewhere in my brain. It’s just closed for business at the moment.
So when people talk about “the mentally ill”, I sometimes remind them that I’m mentally ill too. It’s one of the worst things you can claim to be. I cringe a little inside still. But somehow this stigma has to change. We have to change the way we think about “craziness” if we want people to stop killing themselves. Think about that the next time you want to call someone “cray-cray”. What are you saying about mental illness? And what do you want to say?